The @#$%! insurance company

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faith_trust_and_a_little_bit_of_chemotherapy
faith_trust_and_a_little_bit_of_chemotherapy Member Posts: 319 Member
edited March 2014 in Breast Cancer #1
So, two weeks after completing radiation I receive a thick envelope in the mail from the @#$%! insurance company indicating that they are declining the radiation treatments. So, I have to give them back? Maybe wash dishes in the hospital kitchen? Sell a couple of non-essential internal organs?

No one dared make a move without verifying benefits for every procedure along the way. MRI, CT, surgery, chemotherapy....EVERYTHING!
If I see one more commercial for a 'caring nurse'...forget that mine forgot about me...I will scream. Now a doctor, that probably hasn't touched a patient in 20 years, has decided that the team, tumor board and all recommended IMRT is investigational and not medically necessary for my condition. These are the same folks that wouldn't foot the bill for OT, but only PT.... just try to find a PT that is trained in lymphedema therapy. Wait, their cheerful caring nurse portrayed in the commercials was going to do that and forgot, but I digress.

I photocopied, even though the packet indicated a cc was sent to my treatment facility, and ran a copy over to the center ASAP. This stuff irks the living crap out of me. My threshold for bureaucratic nonsense has never been high...but being on the hook for $50+K after the fact makes my bald little head want to explode.

I will give them credit for including a lovely explanation of the appeal process, although the language is rather pessimistic. Nothing like working your entire life, tolerating crap from bosses and co-workers for a plan that use to be described as the Cadillac of PPOs to find this out...the lousy @#$%!.
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  • carkris
    carkris Member Posts: 4,553 Member
    #2
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    Actually a friend of mine is
    Actually a friend of mine is in one of those commercials, but we dont do the billing etc...I am hoping that the appeals process works, I thought rads was pretty standard.
  • John_32
    John_32 Member Posts: 71
    #3
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    What an outrage! $50,000?!!
    What an outrage! $50,000?!! My wife got radiation in Canada. Cost of radiation: $0. Knowing that we didn't have to deal with blood-sucking insurance companies: Priceless.
  • Dawne.Hope
    Dawne.Hope Member Posts: 823
    #4
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    @#*&%
    Grrrrrr!!!!!!!!! I am so sorry.

    One of the hardest things to deal with and one of the most frustrating on top of EVERYTHING else we're dealing with ... is dealing with bureacrats who really have no idea of the protocal, do not know and/or do not care about the pecularities of our own case. Not fair. Disgusting. Disheartning. Cold. Cruel. Mean.

    And then you've got to sort through and try to figure out the legaleeze of the documents ... again, the last thing we need to deal with. Difficult to deal with on our best days. Disgusted. I'm so sorry. I have no tolerance for cr@p like this. Makes me so angry!!!

    I was dropped by my insurance on Oct. 1. Heard repeatedly, "They can't do that." Well, they have. Can appeal. But time, energy, patience are scarce these days. So incredibly sorry faith_trust_and... You're story has struck a nerve with me ... makes me fighting mad!!
  • shy violet
    shy violet Member Posts: 167
    #5
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    Well was in hospital for
    Well was in hospital for four days, bill 16000...looking at bill almost 1000 for rad svcs and supplies...umm not...turns out for the iv team to use that dinky portable not so new ultrasound machine to grab a quick pic for a blood draw uh yeah 1000...go fisshhhh!
  • meena1
    meena1 Member Posts: 1,003
    #6
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    shy violet said:

    Well was in hospital for
    Well was in hospital for four days, bill 16000...looking at bill almost 1000 for rad svcs and supplies...umm not...turns out for the iv team to use that dinky portable not so new ultrasound machine to grab a quick pic for a blood draw uh yeah 1000...go fisshhhh!

    First of all, why are they
    First of all, why are they denying the claim? I am assuming due to "not medially necessary or investigational". If that is the case then your doctor can send over the information to appeal the denial. I do not see how they can deny radiation, so i would calm down. Also, is the hospital where the rads were done a participating hospital? If so then you should not be responsible for this, they should have had an auth for this. I do not believe you will be on the hook for all this money. So take some deep breaths!
  • Heatherbelle
    Heatherbelle Member Posts: 1,226 Member
    #7
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    ugh - this really p*sses me
    ugh - this really p*sses me off. Really, I dont know where there insurance companies get off...and going back even further - $50,000 for life saving treatments -why does the number even have to be that high? I am SO SORRY you have to deal with this crap -feel our strength with you as you fight this bureaucratic BS. I really hope they straighten this out and don't continue to charge you for this. In the meantime, deep breaths, deep breaths...
    *hugs*
    Heather
  • Marcia527
    Marcia527 Member Posts: 2,729
    #8
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    You should talk to the
    You should talk to the insurance company and see why it was denied. It could be the billing department made an error. All it takes is a coding mistake. usually everything is ok'd in advance so it sounds like someone made an error.
  • aisling8
    aisling8 Member Posts: 1,627 Member
    #9
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    Marcia527 said:

    You should talk to the
    You should talk to the insurance company and see why it was denied. It could be the billing department made an error. All it takes is a coding mistake. usually everything is ok'd in advance so it sounds like someone made an error.

    Grrrrrrrr
    As if you don't have enough on your plate without having to make a zillion phone calls to bored, curt, snippy people who seem to enjoy saying "Well, ma'am, that's our policy" over and over then when you finally suppress the curse words and sigh and get ready to hang up, they say "Is there anything else I can help you with?" Grrrrrrrrrrrrrrrrrrrrrrrrrrr.

    Good luck. Patience and peace be with you.

    xo
    Victoria
  • mwallace1325
    mwallace1325 Member Posts: 806
    #10
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    Since I'm still paying my deductible
    and co-insurance and whatever else they call it, I'm always afraid they're going to bring my tumor back, kind of like repossessing a car, only in reverse.

    Sorry my sick sense of humor is working overtime.

    marge
  • cahjah75
    cahjah75 Member Posts: 2,631
    #11
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    John_32 said:

    What an outrage! $50,000?!!
    What an outrage! $50,000?!! My wife got radiation in Canada. Cost of radiation: $0. Knowing that we didn't have to deal with blood-sucking insurance companies: Priceless.

    John
    have you been able to make contact with your wife???
    Char
  • cahjah75
    cahjah75 Member Posts: 2,631
    #12
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    I agree with
    Meena and Marcia that all treatments are pre verified before they are done and that all it takes is a coding mistake to throw it all back. Take a deep breath and I'm hoping it all takes care of itself.
    {{hugs}} Char
  • roseyposey333
    roseyposey333 Member Posts: 68
    #13
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    cahjah75 said:

    I agree with
    Meena and Marcia that all treatments are pre verified before they are done and that all it takes is a coding mistake to throw it all back. Take a deep breath and I'm hoping it all takes care of itself.
    {{hugs}} Char

    I can relate
    Just got a bill today stating that my treatment was "out of network", uuuggghh, I know the hospital checked it all out before my treatment.

    Also, found out that my insurance company will not pay for my Arimidex. $250 a month for 5 years, well isn't that great.

    On a job search now to make some $$ for all the bills. The party is over,if you can call breast cancer/treatment a party. had to leave my job because I moved to a different town and haven't been strong enough to start a new job but time is up, reality bites. R
  • shy violet
    shy violet Member Posts: 167
    #14
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    roseyposey333 said:

    I can relate
    Just got a bill today stating that my treatment was "out of network", uuuggghh, I know the hospital checked it all out before my treatment.

    Also, found out that my insurance company will not pay for my Arimidex. $250 a month for 5 years, well isn't that great.

    On a job search now to make some $$ for all the bills. The party is over,if you can call breast cancer/treatment a party. had to leave my job because I moved to a different town and haven't been strong enough to start a new job but time is up, reality bites. R

    rosey, any chance you can
    rosey, any chance you can get month supply of arimedex samples and then contact the pharmaceutical company to see if they can help especially since you are not working?
  • Marcia527
    Marcia527 Member Posts: 2,729
    #15
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    shy violet said:

    rosey, any chance you can
    rosey, any chance you can get month supply of arimedex samples and then contact the pharmaceutical company to see if they can help especially since you are not working?

    Rosey
    Which one was just made generic? Was it arimidex? If so the generic will be cheap. I just did a search and one online company is advertising 30 pills for $25. check with your onc.
  • Lighthouse_7
    Lighthouse_7 Member Posts: 1,566 Member
    #16
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    Marcia527 said:

    Rosey
    Which one was just made generic? Was it arimidex? If so the generic will be cheap. I just did a search and one online company is advertising 30 pills for $25. check with your onc.

    OK here goes...I'm at risk
    OK here goes...I'm at risk of most of you hating me but I'll have to live with it. For reasons that I experienced first hand,
    I wish this country had socialized medicine. I am tired of the huge bills I've received since my dx and they are just MY portion and now (with relatively good insurance) I am told it's gonna cost me 279.00 a month for the new aromatase inhibitor I'm supposed to start.
    Aromisin. Well, I can't take it until I can come up with the money and that ladies, breaks my heart.
    Sorry, had to rant.
    I hate insurance companies!
  • Marcia527
    Marcia527 Member Posts: 2,729
    #17
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    Lighthouse_7 said:

    OK here goes...I'm at risk
    OK here goes...I'm at risk of most of you hating me but I'll have to live with it. For reasons that I experienced first hand,
    I wish this country had socialized medicine. I am tired of the huge bills I've received since my dx and they are just MY portion and now (with relatively good insurance) I am told it's gonna cost me 279.00 a month for the new aromatase inhibitor I'm supposed to start.
    Aromisin. Well, I can't take it until I can come up with the money and that ladies, breaks my heart.
    Sorry, had to rant.
    I hate insurance companies!

    The way I understand it,
    The way I understand it, Aromisin and Arimidex are the same so you might as your onc about starting on the generic instead. I stopped taking it because of the cost but that was 2 1/2 years ago. They made Arimidex generic not too long ago.
  • John_32
    John_32 Member Posts: 71
    #18
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    cahjah75 said:

    John
    have you been able to make contact with your wife???
    Char

    No. Yesterday was our second wedding anniversary, and I called her father's cell phone to try and reach her and say happy anniversary but he hung up on me before I could get more than three words out. Ontario mailed out a copy of the wedding certificate finally, so I should have it any day now, and then I will immediately go up to Canada and visit her in the hospital without obstruction. Her parents actually had her name removed from the hospital registry, so i have no way of knowing if she is still there, but I have to try.
  • Bella Luna
    Bella Luna Member Posts: 1,578 Member
    #19
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    This is outrageous! This is
    This is outrageous! This is the last thing you need after going through so much. I don't see how these insurance company nitwits can look themselves in the mirror, much less get a good nights sleep. I will say some prayers for you.
    BL
  • cindycflynn
    cindycflynn Member Posts: 1,132 Member
    #20
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    That SUX!
    So sorry you have to deal with this, but it may be resolved more easily than it appears right now. I received a similar letter from my insurance company about the cost of my Oncotype DX test (not nearly as expensive as your radiation, but still). When I contacted the company who submitted the bill to make sure they had the proper coding, etc., they were already submitting the appeal for me. I didn't have to do anything, and the insurance company did pay for it.

    There are many reasons, some of which are not even the insurance company's fault, that this might be happening. I'd try calling them first to find out more specifics about why it's being denied, and then call the hospital/facility to see if they're already working on resubmitting it (usually the denial is sent to the medical provider the same time it's sent to you).

    I deal with helping employees through this process as part of my job. If you'd like more direct help with this, just send me a PM and I'll be happy to help in any way I can.

    Rosey - Marcia is correct about Arimidex being generic now. Hopefully you can find a lower cost option for that.

    (((HUGS)))
    Cindy
  • KayNYC
    KayNYC Member Posts: 495 Member
    #21
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    roseyposey333 said:

    I can relate
    Just got a bill today stating that my treatment was "out of network", uuuggghh, I know the hospital checked it all out before my treatment.

    Also, found out that my insurance company will not pay for my Arimidex. $250 a month for 5 years, well isn't that great.

    On a job search now to make some $$ for all the bills. The party is over,if you can call breast cancer/treatment a party. had to leave my job because I moved to a different town and haven't been strong enough to start a new job but time is up, reality bites. R

    Radiation is precertified...
    Oh boy, can I relate. I got precertification for radiation as required but somehow they put down the wrong doc's name on the form submitted to the insurance company.The doc they named was not a network provider (I had checked all this out before making my appt for the consultation). So it took a few phone calls to the hospital and the insurance company. Did a three way call that settled the matter, or so I thought. I was double billed for my copay and I called the department and the insurance company. They told me all was settled, no worries. This weekend I got a letter from a collections company. I was taken to collections for a 30 dollar copay that I paid the day the service was rendered. Go figure...Now back to square one, writing to the insurance company, hospital and collection agency to resolve this. Have to check my credit rating too to find out if it has been put on my report. This is really the pits...
    K

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