Insurance Drops MD Anderson

NewHere
NewHere Member Posts: 1,428 Member
in Colorectal Cancer #1

For some reason I thought I saw this posted here, but looking at the date did not see the topic.  Apologies in advance.  And blame chemo brain Sealed

 

http://www.houstonchronicle.com/business/medical/article/Loss-of-insurance-plans-could-devastate-cancer-6603232.php

Comments

  • tanstaafl
    tanstaafl Member Posts: 1,313 Member
    #2
    breaking the bank, salvation thru cheap generics and CAM

    From above, rationing started with a bait and switch, from PPO to HMO.  PPO insurance in Houston was a victim of the total system cost of high tech/high cost treatments.  In essence so many going locally to MD Anderson (or other super specialists) broke the PPO insurance coverage around Houston:

    BCBS of Tx,...decision to drop PPOs... was not made lightly....the company paid out $400 million more in claims than it collected in premiums...."Since the Affordable Care Act began, the market has changed. We found the individual PPO plan was no longer sustainable at the cost it was being offered," 

    ..."Being in Houston is good and bad. We have all of these wonderful medical facilities. People come from all over the world to be treated in Houston. But that kind of care comes with a very high price," 

    My wife's only salvation, both technically and financially, has been through cheaper treatments based on generic drugs, experimental and alternative medicine, while not counting on insurance to pay it.   Much of her generic based treatment is not US available because of bad FDA rules.  

    The FDA and state license monopolies are where much of the US medical and insurance crisis originates due to high prices and the unavailability of cheaper, superior competitors.    Basically, conventional US medicine couldn't touch my wife for survival or quality of life or cost.  They might put you or your doctor in jail, if you tried too hard.

    -------

    Btw, for those that think "single payer"is some magic answer, under medicine in the US controlled as rigidly as the Canadian system, we would just die.

  • Hugmoe
    Hugmoe Member Posts: 9
    #3
    tanstaafl said:

    breaking the bank, salvation thru cheap generics and CAM

    From above, rationing started with a bait and switch, from PPO to HMO.  PPO insurance in Houston was a victim of the total system cost of high tech/high cost treatments.  In essence so many going locally to MD Anderson (or other super specialists) broke the PPO insurance coverage around Houston:

    BCBS of Tx,...decision to drop PPOs... was not made lightly....the company paid out $400 million more in claims than it collected in premiums...."Since the Affordable Care Act began, the market has changed. We found the individual PPO plan was no longer sustainable at the cost it was being offered," 

    ..."Being in Houston is good and bad. We have all of these wonderful medical facilities. People come from all over the world to be treated in Houston. But that kind of care comes with a very high price," 

    My wife's only salvation, both technically and financially, has been through cheaper treatments based on generic drugs, experimental and alternative medicine, while not counting on insurance to pay it.   Much of her generic based treatment is not US available because of bad FDA rules.  

    The FDA and state license monopolies are where much of the US medical and insurance crisis originates due to high prices and the unavailability of cheaper, superior competitors.    Basically, conventional US medicine couldn't touch my wife for survival or quality of life or cost.  They might put you or your doctor in jail, if you tried too hard.

    -------

    Btw, for those that think "single payer"is some magic answer, under medicine in the US controlled as rigidly as the Canadian system, we would just die.

    Try this

    Try the link on this page called community resources. All they can tell you is no. If they can't help you maybe able to get you in contact with somebody that can. The main thing is DON'T give up by the word no. Hope it helps.

  • NewHere
    NewHere Member Posts: 1,428 Member
    #4
    Hugmoe said:

    Try this

    Try the link on this page called community resources. All they can tell you is no. If they can't help you maybe able to get you in contact with somebody that can. The main thing is DON'T give up by the word no. Hope it helps.

    I Am At Sloan Kettering

    Just know of MD Anderson's rep.  And I am guessing there will be more stories like this.  Just found out my insurance is terminating the end of this month and hoping a new one can be put in place without breaking the bank.  Too much.

  • NewHere
    NewHere Member Posts: 1,428 Member
    #5
    NewHere said:

    I Am At Sloan Kettering

    Just know of MD Anderson's rep.  And I am guessing there will be more stories like this.  Just found out my insurance is terminating the end of this month and hoping a new one can be put in place without breaking the bank.  Too much.

    And The Insurance Shoe Drops On Me

    I am $%^&#*((0%@$%#.  Cry

  • Trubrit
    Trubrit Member Posts: 5,804 Member
    #6
    NewHere said:

    And The Insurance Shoe Drops On Me

    I am $%^&#*((0%@$%#.  Cry

    I am so sorry to hear this

    I know the gut wrenching feeling where lack of financial help is concerned. I pray something comes up soon, that helps your situation. 

    I hope all of your treatments have been covered and that other than the regular tests, you see NED for ever and ever. 

    Sue - Trubrit

  • Daisy13
    Daisy13 Member Posts: 43 Member
    #7
    NewHere said:

    And The Insurance Shoe Drops On Me

    I am $%^&#*((0%@$%#.  Cry

    I know you are troubled ...

    are there treatments or procedures that you need that only M.D. Anderson provides? 

  • NewHere
    NewHere Member Posts: 1,428 Member
    #8
    Trubrit said:

    I am so sorry to hear this

    I know the gut wrenching feeling where lack of financial help is concerned. I pray something comes up soon, that helps your situation. 

    I hope all of your treatments have been covered and that other than the regular tests, you see NED for ever and ever. 

    Sue - Trubrit

    Thanks Sue

    My health insurance went up a ton, just found out.  And other issues where it looks like I may not be covered.  Long story. 

    Thankfully surgery and chemo is complete.  So it is scans and monitoring that is the issue. I will figure out a way as it comes up.  It just got dropped in my lap and after being a bit bummed and ticked, starting to plan.  As long as NED, everything else is relatively minor in the grand scheme of things.  

  • NewHere
    NewHere Member Posts: 1,428 Member
    #9
    Daisy13 said:

    I know you are troubled ...

    are there treatments or procedures that you need that only M.D. Anderson provides? 

    I Am At Memorial Sloan Kettering

    I saw the article about MD Anderson before I just the news yesterday.   As to treatments/procedures, when I got the initial diagnosis I immediately though "MSK" since I am right there.  But I did meet with other doctors before my MSK appointment.  Was not impressed, and there seemed to be some guessing and not really "being on top of it."  My surgery turned out to be more complicated compared to what the scans and colonoscopy showed.  I really believe that if I had gone with some of the other doctors I would not be in the shape I am in now.  

    At this point I am hoping it is just scans and monitoring, will figure out a way.  If there is future surgery or chemo or the rest, that will be a big issue.

  • lizard44
    lizard44 Member Posts: 409 Member
    #10
    NewHere said:

    And The Insurance Shoe Drops On Me

    I am $%^&#*((0%@$%#.  Cry

    Oh, No

    That is  infuriating- and wrong. Meanwhile, a lot of  insurance  companies are pleading poverty and losses and  dropping  customers or  increasing their premiums while paying their executives  exorbitant salaries and bonuses.

    Before retirement, we were self-employed and had  issues with insurance companies for years.  Sometimes it seemed we needed a letter from God before they would cover  some medically necessary procedures. It seemed like we were paying very high premiums for  very little coverage.  I am thankful I have Medicare with a  supplemental  policy now.  We switched private insurers last year, dropping the  major insurer in our state and going with  a company  affiliated with the  major medical research university  here. It was a good move.  We have  a high annual out-of-pocket expense of   just over $6700-- not exactly   an easy amount to cover  on a  very limited income  consisting mostly of  Social Security, but  since the insurance company has already been billed over $100,00 this year, I can't really complain too much, and they have not balked at covering any tests or treatments my doctors have requested coverage for.

    I hope you can find another policy that is affordable. Does MSK  have a department that  helps patients with  insurance and financial issues?

    Hang in there.

    Grace

     

  • Trubrit
    Trubrit Member Posts: 5,804 Member
    #11
    NewHere said:

    Thanks Sue

    My health insurance went up a ton, just found out.  And other issues where it looks like I may not be covered.  Long story. 

    Thankfully surgery and chemo is complete.  So it is scans and monitoring that is the issue. I will figure out a way as it comes up.  It just got dropped in my lap and after being a bit bummed and ticked, starting to plan.  As long as NED, everything else is relatively minor in the grand scheme of things.  

    Same here

    My deductable is $3,500 (Husbands is the same) which just kills us, as we're not rolling in the moola. 

    Something will work out, my friend. Hang tight!

    Sue - Trubrit

  • NewHere
    NewHere Member Posts: 1,428 Member
    #12
    lizard44 said:

    Oh, No

    That is  infuriating- and wrong. Meanwhile, a lot of  insurance  companies are pleading poverty and losses and  dropping  customers or  increasing their premiums while paying their executives  exorbitant salaries and bonuses.

    Before retirement, we were self-employed and had  issues with insurance companies for years.  Sometimes it seemed we needed a letter from God before they would cover  some medically necessary procedures. It seemed like we were paying very high premiums for  very little coverage.  I am thankful I have Medicare with a  supplemental  policy now.  We switched private insurers last year, dropping the  major insurer in our state and going with  a company  affiliated with the  major medical research university  here. It was a good move.  We have  a high annual out-of-pocket expense of   just over $6700-- not exactly   an easy amount to cover  on a  very limited income  consisting mostly of  Social Security, but  since the insurance company has already been billed over $100,00 this year, I can't really complain too much, and they have not balked at covering any tests or treatments my doctors have requested coverage for.

    I hope you can find another policy that is affordable. Does MSK  have a department that  helps patients with  insurance and financial issues?

    Hang in there.

    Grace

     

    Yup On This

    , We were self-employed 

    That is my issue.  And in the last three years it has become remarkably difficult and expensive.  It is exteremly difficult to find insurance now and the exchange plans in my State have some serious weaknesses.  The one I just discovered - though the insurance companies do cover MSK, and MSK accepts, their various plans, including their HMOs - the insurance companies do not cover MSK if purchased on the exchange.  If I worked for someone and got the same plan through a company, then it is covered.  

  • abrub
    abrub Member Posts: 2,174 Member
    #13
    NewHere said:

    Yup On This

    , We were self-employed 

    That is my issue.  And in the last three years it has become remarkably difficult and expensive.  It is exteremly difficult to find insurance now and the exchange plans in my State have some serious weaknesses.  The one I just discovered - though the insurance companies do cover MSK, and MSK accepts, their various plans, including their HMOs - the insurance companies do not cover MSK if purchased on the exchange.  If I worked for someone and got the same plan through a company, then it is covered.  

    As far as I know, the ONLY Individual plan that includes MSK

    for residents of NY are the off-exchange Oxford plans, which starting in 2016 will still cover MSK, but not include NYU.

    Send me a PM if you need more information, and I can help you.  I'm a broker, with strong ties to MSK (I go there for my cancer care) and am very attuned to the issues of the Individual plans.

    Alice

  • NewHere
    NewHere Member Posts: 1,428 Member
    #14
    abrub said:

    As far as I know, the ONLY Individual plan that includes MSK

    for residents of NY are the off-exchange Oxford plans, which starting in 2016 will still cover MSK, but not include NYU.

    Send me a PM if you need more information, and I can help you.  I'm a broker, with strong ties to MSK (I go there for my cancer care) and am very attuned to the issues of the Individual plans.

    Alice

    Thanks

    Appreciate the information.  That is even worse than I thought in terms of Individual Plan.  Been looking all weekend trying to find my doctors in the off-exhange plans.  Now I know why it was so problematic. Cry  I may be stuck paying the outrageous premium if the plan still covers MSK.  (Just looked at the Oxford Rateson their site.  Premiums  a ton less a month than my new bill.  Just concerned about switching due to the wonderful C word.)    

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