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idlehunters's picture
idlehunters
Posts: 1792
Joined: Apr 2009

Oh Boy....... Wow, I didn't even think this was going to be an issue. I have Aetna insurance thru my husbands work. Just found out that Cancer Treatment Centers of America do not take it as it is a HMO and they would be out of network which would not cover them. I have been on this computer doing research until my tummy is sore from being in one position. Not quite healed yet I guess. Anyway, Aetna don't seem to have ANY cancer centers on its plan that cover me. What have you all done to cover this vast expense?

Jennie

mom_2_3
Posts: 965
Joined: Nov 2008

Our insurance is Aetna but it's the PPO. I did check my oncologist on the Aetna page and found her through a search for providers for the HMO. When I clicked on her name it says that she accepts the following:

Aetna Choice® POS (Open Access)
Aetna Choice® POS II (Aetna HealthFund®)
Aetna Choice® POS II (Open Access)
Aetna Health Network Only(SM)
Aetna Health Network Option(SM)
Aetna Open Access® Elect Choice® EPO (Aetna HealthFund®)
Aetna Open Access® Managed Choice® POS (Aetna HealthFund®)
Aetna Select(SM)
Aetna Select(SM) (Open Access)
Behavioral Healthcare Program
Elect Choice® EPO
Elect Choice® EPO (Open Access)
HMO (Open Access)
HMO**
Healthy New York HMO
Managed Choice® POS
Managed Choice® POS (Open Access)
NYC Community Plan(SM)
National Advantage™ Program
Open Access Aetna Select(SM) (Aetna HealthFund®)
Open Choice® PPO
Open Choice® PPO (Aetna HealthFund®)
QPOS®

Not sure if your plan is above but you may want to investigate it further. Did you speak with a representative from Aetna?

idlehunters's picture
idlehunters
Posts: 1792
Joined: Apr 2009

I only asked them if they covered second opinions. It did not even enter my mind that it would be a out of network second opinion. I will speak with them more on Tuesday but according to my insurance booklet my resources are limited because that is the type of coverage employer imposed. Thanks so much for checking into it for me

Jennie

I have Aetna Open Access

scouty's picture
scouty
Posts: 1976
Joined: Apr 2004

You'll need to find a public (state supported) comprehensive cancer center, the Cancer Treatment Centers of America are private as are many of the centers on the list. There are some public ones though. Here in North Carolina we have 3 comprehensive cancer centers out of the 120 plus in the US, Wake Forest and Duke are private but the University of North Carolina at Chapel Hill is public and would accept your insurance.

Google comprehensive cancer centers and check out the list for ones close to you and then you should be able to see which ones might accept your insurance.

Lisa P.

Nana b's picture
Nana b
Posts: 3045
Joined: May 2009

I use UHC, it's a PPO but with an in network side which works like an HMO. My last surgery cost close to $150,000 but my surgeon in network contract cost was $29,000. So definitley check what you have, who/where you can go to. Had I gone to the first surgeon my oncologist sent me to, without checking, I would have be responsible for the difference. WOW!

kimby's picture
kimby
Posts: 804
Joined: Oct 2007

Your best bet is to call your insurance company directly and determine what is in network. They will have some to choose from. Here is the link to the NCI Comprehensive canzer Center list by state.

http://cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html

Check out the list so you can compare with your insurance company. You might just ask them directly about a specific center - that's what I did. I chose where I wanted to go for a second opinion, went to my insurers website and looked up coverage for that center.

Good Luck,

Kimby

usakat's picture
usakat
Posts: 625
Joined: Jul 2006

....to get what you want and what you need.

One of the things I've learned during my cancer experience and the during the following years is that you can work the system (insurance) or let the system work you.

I had an HMO when I was first diagnosed and now I'm in the military health care system, which is similar to an HMO (it's mostly single provider/single payer - it's not great), but I decided that I would ask for what I want, rather than take what they give me.

For instance, when I was first diagnosed I wanted to go to a specific cancer center that had a great reputation and group of very competent doctors. It was also recommended by my surgeon, but it was not listed on my HMO's provider directory. So I called the cancer center directly and spoke with their patient coordinator. After a little paperwork and some back and forth between the cancer center and my insurance company, the cancer center worked with my HMO to accept the insurance. I was treated at the cancer center of my choice and I received exceptional care.

I've done similar things with my current insurance/health care system to get the best care possible and see the doctors of my choice - both my oncologists are not listed as provider doctors, but I worked it out to see them and be fully covered by my insurance. It takes a little effort, but it's well worth it!

You will often read on this board that you are your own best advocate. And remember, only accept a "no" from someone who has the authority/power to give you a "yes".

This may not work with Cancer Treatment Centers of America because they are somewhat different than other hospitals, but there are many great cancer centers out there who accept most insurance plans. And there are many oncologists out there who are not necessarily affiliated with a major cancer center, but are quite good all the same. You might ask your primary care doctor or surgeon if they can recommend someone.

I hope this helps....

idlehunters's picture
idlehunters
Posts: 1792
Joined: Apr 2009

usakat..... thank you for infor.... since cancer treatment centers of america is a private facility there is no way insurance will cover it. BUT..... thanks to Kimby...many thanks to you Kimby... I have looked into the Chicago Cancer Centers you suggested and 1 is ranked 7th in US. Sounds great to me. That is the only one around me that has any kind of ranking...and i want one of the best. It is a 5 hour drive one way but i will have to figure that out. Right now I am going to tell my insurance company that is where i want to go.... contact the center and ask them to work with my insurance company to help me get there. Tomorrow should be an interesting day

Jennie

kimby's picture
kimby
Posts: 804
Joined: Oct 2007

My thoughts will be with you tomorrow. Good Luck! You are on a whole new journey that you never thought you'd need. You can do this!

Kimby

Madre's picture
Madre
Posts: 124
Joined: Apr 2008

Try a state university hospital. They are a teaching hospital, usually and because it is state funded they usually take people regardless of ability to pay. It's worth a shot. This is how it is in NY.

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Hi Jennie,

I also have Aetna HMO for my insurance. They won't let me go to the oncologist I want to go at UCSD/Moores Cancer Center in San Diego. They DID let me go there, thankfully, for my liver surgery and they let me go to the oncologist there for a consultation/2nd opinion. After the 2nd opinion when I decided I wanted to change oncologists to go to him where I'd have a "team" for my care instead of just an unaffiliated oncologist who isn't good at communicating with my specialists, my insurance told me "you can't change doctors while you're still in treatment". I told them "I'm a stage IV cancer patient- I may always be in treatment. Does that mean I can never change doctors?!" Their reply was "Yes, that's our policy". Since the other oncologist has been gracious enough to still consult w/ me over the telephone on occasion when I've had questions or concerns w/ my current onc, I haven't pursued trying to fight them (yet, anyhow). Aetna has been good, however, in covering most of my tests. They usually deny the PETs, but allow it when the onc. writes back a more specific reason for it. Aetna won't let my oncology office access my port to do my bloodwork for some stupid reason. They make me go into the lab (Labcorp) each time the day before my chemo to have the bloodwork taken out of my arm in the regular way. Seems so stupid and unneccessary!

Anyhow- all in all, I can't complain too much- I didn't pay even one cent when I had my liver resection done at Moores/UCSD/Thornton Hospital & I was very happy they let me go there.

That's too bad you can't go to the Cancer Center of America, though.

Lisa

serrana
Posts: 163
Joined: Apr 2009

Hi Lisa, Serrana here......I still urge you ( and everyone else w/ constipated insurance companies) to challenge Aetna on their rigid policy. These challenges have been won. All contracts have appeal clauses.
Contact the Calif State Dept of Insurance managed care division, you can probably fill out a form on line. At the same time make a phone call to Aetna, tell them you are recording it, go right up the feeding chain, don't talk to Buffy and Muffy who answer the phone, ask for the "highest level" manager, find out his/her name and ask what the procedure for appeal is. Have them FAX you the paperwork. When you don't get what you want right away then go back and make noises about lawsuits.(There is a terrific attorney in Orange County that won the million dollar judgement last year for denial of coverage. His name is Shernoff . ) Talking about lawsuits will get their attention. HMOs are in the business of NOT providing coverage...it is how they make money.....they pay your doc a set fee per year per patient no matter what services the practice does for you so it is to the doctors benefit to deny alot of services. If you want me to help you on this, email me.
Serrana

idlehunters's picture
idlehunters
Posts: 1792
Joined: Apr 2009

I did call Aetna and challanged them about my insurance. I was surprised as heck to find out I had a PPO... not a HMO.... even tho all my basic payments are made just like an HMO with doctor/specialist/hosp deductables and thats all you pay. I had just changed to this insurance in January and had no idea that how my husbands work wanted it classified. Now I have been approved to go to MD Anderson Cancer Center in Texas (who is in my Aetna network) and receive my second opinion and/or treatment..... even tho I live in Illinois. So yeah... it definately helps to stay on them. Also, another thing I found out. Every institution invoices under a certain name. That is how Aetna knows if they are contracted with them... unless you have their federal ID number...

Good Luck

Jennie

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Hi Serrana,

Guess what? After talking with the nurse practitioner last Tuesday when I was getting my Avastin infusion at my oncology office, the discussion came up of all my problems in the past of the onc not k-ras testing me, etc. I said to her "They ARE testing everyone for that now after all my problems with it and finding out I had the kras mutation and the Eributx never even helped me, right??" He looked around and shook his head "no". After the doctor walked through, he said he went to a conference just last month on it and another onc from the office was with him. This onc said to the nurse "we really need to start doing this, I guess". The nurse said he said to the doctor "WHY haven't we been doing this when it's now considered standard practice to k-ras test colorectal patients?" The doctor didn't really answer, just said again "I guess we need to start doing it". This is a full eight months after they found out they had put me on the Erbitux for nothing and that I was postive for k-ras! The very fact that they're still not doing what they're supposed to be doing, really upset me and makes me VERY hesitant to trust my oncologist with the future of my care.

SO... I spent the day yesterday on the phone pouring my story out to someone at Aetna and to see what I can do to get around their "rule" of "not being able to change oncologists while I'm still undergoing treatment". I finally was told that I could probably get around it by changing my primary care Dr. (internist) to a doctor within the UCSD medical group, that way all the UCSD oncologists would be within network. I told them I was told that before also BUT that I was also told that I wasn't allowed to change primary care Dr while still in treatment- period. NOW I was told while that IS their official rule, it's actually up to the new medical group (UCSD in this case) whether to accept me or not as a new patient. I wish I had known that before! I'm pretty sure they would accept me since I've seen specialists there before and had consulted with the oncologist before already. With living fairly far away from UCSD, I'm not real excited to give up my internist, but I'm definitely willing to do it if it will allow me to change! I'm going to do it! I have an appt. w/ Dr. Fanta for June 17- currently set up as a "cash" appt, but hopefully the insurance will cover it by then as a 2nd opinion appt on referral from my current doctor.
So before changing, I'm going to my scheduled appt w/ my current onc this Monday to see what his angle is. Also, I have a referral in from my internist to see a rheumatologist in a couple of weeks & it will mess it up in the computer if I go and change doctors and medical groups before that appointment. It all gets so complicated!
Anyhow, wish me luck (or better yet- keep it in prayer for me) so everything will end up working out!
Thanks for the encouragement!!
Lisa

serrana
Posts: 163
Joined: Apr 2009

Lisa call me at home THis is a major issue I will be at the movies tonite until about 9, call me after that or any time tommorrow. You need to dump that oncologist
Serrana

CherylHutch's picture
CherylHutch
Posts: 1399
Joined: Apr 2007

I am reading all your stories here in this thread and it just makes my blood boil!! Some of you know that I have been on a rant about the insanity of the state of health insurance in other threads and through that I have actually learned a lot about the Canadian insurance system that I did not know before. For instance, I did not realize that Canadian insurance varies from province to province, even though it all falls under the same umbrella that every Canadian citizen is entitled to affordable healthcare, no matter what their walk of life.

Having said that... how can people who work for insurance companies sleep at night, knowing they are working in an industry that is built for profit at the expense of the most vulnerable and sick? I realize that everyone needs a job and the insurance industry obviously hires a lot of people from the clerical help up to the specialists and their own doctors, so a wide range of experience and intelligence... and yet, how, in good conscience, can anyone work for a health insurance company knowing that people are dying because the industry is more greedy than helpful?

I know we are forever telling newbies, "Don't go by the survival statistics, they are only numbers and they are usually 5 years or more out of date." That is true and the statistics are scary but I really have to wonder if one of the reasons there are so many deaths from Stage IV cancer is solely because of insurance? If it's because there are so many out there who can't afford insurance so don't go to doctors because they know they can't afford any visits, let alone treatment, or because those WITH insurance are given the run around and who knows if they ever did get the best care when they feel they could have gotten better elsewhere but their insurance company wouldn't let them?

It just boggles my mind the amount of running around, filling out forms, hours spent on the phone and everywhere you turn you are turned down. Then there's the process where you have to go through all this hassle with your insurance company, knowing you are going to be turned down, before you can go to the next step... and must go through that before you can file with another agency... and then go through that, repeat the process and then, MAYBE then you can get your treatment or change your doctor... then again, you might go through all of that and you are denied! Meanwhile, weeks, maybe months have gone by and you are getting more and more stressed out over the process and we all know that cancer THRIVES on stress!! In some cases, it is stress that caused the cancer. The insurance companies know this, and yet they purposely put people in situations that surround them in stress... why don't these same insurance companies just give sick people a gun?? It's obvious that as long as you are young, healthy and in top shape, these are the people insurance companies will bend over backwards to offer great coverage... knowing full well, the odds are it will be years before said young, healthy person is ever going to need insurance... meanwhile the company gets to rub their hands together in glee as they watch all these young healthy payments come in every month. But, along comes someone who has been diagnosed with a serious illness and the insurance companies want to turn up their noses at them. They are no longer useful and aren't the cash cow they have been for years and years. Oh sure, they are still paying the high premiums but now that they are in need of insurance for the medical nightmare they have to go through, they are spending more money than they contribute to the plan (who cares about the money they were contributing for years and not making any claims!). Now, all of a sudden the words "patient service" mean nothing. The company changes gears and treats the claimee to the run around. The front end staff who talk to the patients first, are trained to give them the run around (hence why you have to cut through all the BS and ask to speak higher up the ladder). When they turn down a claim "no, that med is not on our list of covered meds" they don't tell the patient the reason it isn't covered (if it's an employer benefit plan then the employer has negotiated with the insurance company as to what are the common meds that most people would need and make up a list of the covered meds) and that the patient must talk to their employer so the employer can call the insurance plan and have that med covered for you. Noooo... they just tell you it's not covered so that most patients will accept that that is that and either pay for it themselves or go without the med because they can't afford it... and meanwhile the insurance company has saved themselves the cost of that expensive med/procedure.

I wonder if any stats have been done to show where patients (of any serious illness) have died because they didn't get proper treatment because the insurance company interferred and wouldn't pay for certain items, or, like in Lisa's case where the patient is just not 100% trusting of the doctor she has and she can not change to another one because the insurance company won't allow it. And for this you are paying over $1300/month???

How many have died because they have just been too sick, physically and/or emotionally and don't have the energy to wade through all the paperwork and phone calls it takes to be sick?

No, I certainly don't meant to gloat or be smug (I am too angry at the system who puts patients in danger), but I have to wonder if one of the reasons I'm doing so well (at the moment) is because I've been pampered by the BC system. The only paperwork I've ever had to do is fill out the waivers that state I understand the surgery, it has been explained to me, and that I give permission to go ahead with X surgical procedure. I happen to have lucked out and gotten the best oncologist in the world but if I were having doubts, or questions or felt that I would get better treatment elsewhere, I could just up and change doctors (assuming he/she was taking on new patients) without having to give any reason... and it would be up to my current doctors to transfer all my files to the new doctor once they had been requested. In other words, the onus is not on the patient to work things out, pick up their med records from everywhere and bring to the new doctor. The onus is on the doctors to communicate and arrange for said documents to be sent over.

Having compared the two systems, I would LOVE to know what the survival rate percentages would be if EVERYONE had that kind of coverage/treatment and did not have to deal with the stress of wondering if they could afford insurance/treatment, let alone how they were treated. I bet we'd see a whole different set of figures and the survival rate would take a huge jump up.

I feel for all of you :/

Cheryl

menright's picture
menright
Posts: 258
Joined: Oct 2008

I have Aetna as well and thank God I do. I recently received notice that over $200K has been wired to the cancer center on my behalf.

My plan is titled Aetna Select (EPO) and covers 100% once I pay $1000 for a given year. I pay $500 a month for my family coverage, but now I really do not mind. I would be in the streets without insurance.

Best of luck. It does feel good to me to get something from Insurance after 20 years of paying with no health issues. It is a small positive I think about as I deal with the BEAST.

Mike

VickiCO's picture
VickiCO
Posts: 934
Joined: Oct 2008

I have CIGNA through my husband's work and they cover everything. I have a $30 co-pay on chemo or doctor days...big deal. We recently reviewed my paperwork and realized my bills over the past 8 months have totaled nearly $200K...our portion (including my $1000 annual deductible) so far has been around $2000. I'll take it. And we have the 'preferred' plan, so I can chose whatever doctors or treatment centers I want. I used to gripe at hubby when he upgraded the insurance, (it costs us about $250 a month for the both of us, his company pays the rest) but he would just say "you never know at our age." He was SO right!

I am blessed....Vicki

Hatshepsut's picture
Hatshepsut
Posts: 340
Joined: Nov 2006

My husband has Anthem/Blue Cross and is a retired university professor. For the two of us, we pay approximately $600 per month for his coverage.

Although his cancer was staged at stage IV, Anthem/Blue Cross (for many months) refused to pay for his Avastin chemotherapy. Our bills were allowed to accumulate into the $100,000 range. I spent many hours on the phone and writing letters to challenge Anthem/Blue Cross' decision and ultimately prevailed--not through Anthem but through an appeal to the retirement system through which we purchase my husband's insurance. This all came at a time when I was devastated by my husband's diagnosis and overwhelmed with the many responsibilities that came my way.

I remember when my husband was first diagnosed and I was asked if we had good insurance. I answered that we did. I was pretty naive then.

I am delighted for those of you whose insurance has met your needs. Our experience with our insurance has been hellish and I suspect there are a lot of others out there whose insurance experience has been similarly difficult. What happened to us should not happen to any cancer sufferer.

Hatshepsut

lizzydavis's picture
lizzydavis
Posts: 893
Joined: May 2009

I have Anthem Blue Cross and will be seeing the Oncologist for the first time on Tuesday. Your post really scares me but I am glad to know what can happen to me.

VickiCO's picture
VickiCO
Posts: 934
Joined: Oct 2008

I should have added that my case is not the norm and what is happening in this country regarding insurance is a travesty. My intent was to say that I realize how blessed I am and I do NOT take it for granted. My own daughter and SIL are in an insurance nightmare with their youngest, who is only 1 year old. He was born with a muscle condition, and the insurance company refuses to pay for therapy, calling it a "pre-exisiting condition." Hello...he was BORN with it! He should be automatically covered.

My apologies for appearing smug. I was merely trying to say I am grateful that I have good insurance, otherwise my house would be gone now.

Vicki

Hatshepsut's picture
Hatshepsut
Posts: 340
Joined: Nov 2006

Thanks, Vicki, for your note.

My post was not aimed at you. I'm happy for you that your insurance coverage has served you well.

I am exasperated that our country has allowed this awful, too often greed-driven, insurance system to victimize so many people at precisely the moment when they are most vulnerable.

In my husband's case, many roadblocks were thrown at us and every contractual loophole was exploited. I think most people, thankfully, don't have a major illness. Because they don't, they don't realize how really sick people are abused. In my husband's case, the insurance company's "games" made me so mad that I stayed on top of them (not always in my best emotional interests, by the way). I am sure that there are a lot of people out there who get overwhelmed and give up, shouldering sometimes overwhelming financial burdens or skipping critical treatments.

Hatshepsut

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Hi Mike,

I have Aetna HMO, which covers 100% other than my copays. You said you pay $500 a month for your family. Is that the total cost, or is your employer (or someone) kicking in some of the cost? I'm current paying $1375 a month for mine for my family of five! I'm paying my former employer on a COBRA plan. It actually includes vision and dental, so I think my actual Aetna cost is around $1250 a month. Outrageous, isn't it? But, on the other hand, my paid amount now is probably around $300K.

menright's picture
menright
Posts: 258
Joined: Oct 2008

Lisa:

This is my share. I am not sure of the total cost but my employer covers the balance.

Best of luck.

Mike

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

OK- over the last couple of days due to some more issues w/ my current onc, I have firmly decided that I have to find a way to change oncologists and I know the one I want to go to at UCSD/Moores Cancer Center. My insurance had told me in the past I "can't change doctors while you're already under someone else's care during treatment". I hadn't pursued it or tried to fight it at all until the past couple of days. I was thinking I was making headway because the sympathetic rep I spoke to at Aetna told me although that's their "official rule", it's actually up to the new medical group that I'm trying to become part of to decide to accept me or not. I was even willing to change my internists (primary care physician) within the new network so that all the doctors would be within the same network and referrals shouldn't be a problem. So, I pursued that (spent a lot of time on the phone yesterday and today) and got my answer just a little while ago- still NO! The new medical group rep said Aetna HMO "doesn't allow" them to ever accept new patients and that they "never" accept new Aetna HMO patients who are already under active care of another doctor outside of their group & that I need to continue care with my current oncologist. I was saddened and maddened at the same time!- and also surprised- I really thought they'd make an exception since I've already since specialists within their group and even had my liver surgery at their hospital! They wouldn't even let me tell my specific link with them that I already have. They said they weren't allowed to decide based on my circumstances, they just had to follow the insurance rules. So... the sympathetic Aetna rep helped me start the paperwork going on an appeal process. She said the state of California is really sticky with requiring the patients to appeal first to their insurance company before they can go on and appeal with the California State Medical Insurance Board. She told me that although it usually goes faster, but Aetna will have up to 30 days to give me an answer to my appeal. She said they may even still decide to make an exception and let me see this doctor since it doesn't seem that my current medical group even has an oncologist who actually has a specialty in my kind of cancer (isn't that maddening?!) If they still end up denying it, then I would then go on to appeal to the state medical insurance board. In the meantime, I don't think I'll let on to my current onc what I'm trying to do. I have an appt w/ him Monday to discuss my rising CEA numbers, which is happening while on my "maintenance" treatment schedule.
I don't know how anyone can work with cancer- not just because of the physical aspect, but because I seem to spend a LOT of time at appointments and ON THE PHONE with my insurance company- it's been that way off and on the whole time!
I'm trusting in God that this is going to work out. I've been praying a lot about it and I'm certainly trying to be as proactive in it all as I can be!
Anyone have any experience in filing appeals re. insurance decisions, especially in the state of California??

serrana
Posts: 163
Joined: Apr 2009

The State of CA Dept of Insurance will HELP you file your complaint
THey are on a warpath against those companies especially the HMOs
Get on the web and download the stuff from ca.gov dept of ins managed care
In the last resort you could file a lawsuit
When we talk I will give you the ref on the attorney who won't charge you but will take a cut of whatever settlement you get from them for putting your life in danger
I am sure you won't have to go that far.
Talk to you tonite.
PS I have news about UCSD to share
Serrana

Hatshepsut's picture
Hatshepsut
Posts: 340
Joined: Nov 2006

Lisa:

Here is a link that should be helpful to you:

http://www.insurance.ca.gov/0100-consumers/0070-health-issues/complaints-or-questions.cfm

The link explains the jurisdictional authority of the two main state agencies that handle insurance complaints in California.

My experience was that I did indeed have to file a complaint with our insurer (Blue Cross/Anthem) and they took a long time to conduct their review and answer my complaint. Because my husband's coverage was purchased through the Public Employees Retirement System (which is self-insured) I was required to file my second complaint through PERS. They were very helpful and my husband's denial of chemotherapy coverage for Avastin was overturned by PERS. As the appeals process was going on, PERS did contact my husband's oncologist and made sure that he would not be denied treatment. I was told my next step would have been an appeal to the California Department of Managed Health Care. Their contact information is listed in the link above.

As you work through the maze of insurance coverage, be sure you keep a diary of who you talk to and dates and times.

Hatshepsut

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Thanks Serrana and Hatshepsut for your info and links!
I will definitely follow through-definitely a pain, but I am determined this time. I dropped it once before a few months back, but I am not ready to drop it this time!
Cheryl, I appreciate your sentiments! If no one gets riled up about all this, then nothing will ever change. I know the big argument in the U.S. now is HOW to go about about those changes. It will interesting and scary to see what is going to happen in this country with it all.
I've got an appt w/ my current onc Monday afternoon. I'm not going to mention anything to him about wanting to see the other onc, filing an appeal, or anything like that. I want to first discuss his angle on my rising CEA, what he thinks, etc. Then, I definitely AM going to bring up this time my frustration with several things that should have been done differently in the past for me, and how I will expect him to be "up" on the "latest" in colorectal cancer treatments. I will have to still get my treatment from him in the meantime while I'm working on this appeal process. He'll probably find out soon enough, but I don't want to "burn my bridge" (too much anyhow) in the interim while he's still my onc.

Well, I'll report back to you all if I have any more news on all this later in the week.

I'm taking deep breaths now- I don't want to let myself get too stressed out over it, because I do believe that stress does feed cancer.

Blessings to you all & enjoy the rest of your weekends!
Lisa

serrana
Posts: 163
Joined: Apr 2009

Thanks to Cheryl for her post, it is SO TRUE in my opinion in every respect.
HMO subscribers think they have good coverage and low premiums, well you get what you pay for. HMOs are fine when you are well, not fine when you have cancer.

The important thing in the US is to know that HMOs give the same amount of money to the doctor regardless of what services/labs/tests he performs therefore it is to the practice's advantage to limit the services in order to make money. On the other hand the PPOs get paid for what they bill for so they can order what they think is in the patient's best interest.

If anyone is listening out there my opinion is that HMO's should be abolished. Certainly no one should sign up for one. Once you are sick you can't switch.

It is true that folks give up on their cancer because of financial issues that will put their families underwater forever. Organizations in the US should be addressing this with the Obama Healthcare folks before we have more of the same. United Health Care just announced a way to save money" is to limit hospitalizations etc. What!!!!! Lets get behind this issue. Our lives depend upon it.
Serrana

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

I actually posted another thread on this issue "I may actually get to change oncologists", but thought I'd comment here since this is where the whole insurance discussion started.
I got a telephone call this morning from someone identifying herself as my case manager from my medical group. (the medical group isn't the same as the insurance- the medical group is the network of doctors and specialists they use). Anyhow, I don't know why, but I had never thought of talking to/appealing to the actual medical group- I had just talked at length with someone actually from Aetna (a few times) and then also someone from the Dr's office of where I'm wanting to go. Well, this dear angel of a woman was so sweet and said to me, "I noticed your internist had put in for a referral to Dr. Fanta (the onc I want to see), but it's been denied." "I also see that you saw him already in November, so I'm wondering if perhaps you're wanting to change over to him." I said, "What?! That's what I've been trying to do! Aetna kept telling me "no patient is allowed to change doctors while still in treatment." She agreed with me that that's an insane answer or rule, considering as a stage IV patient still on treatment that I might technically not ever be done with treatment, and that would then preclude me from ever being able to change doctors. She said she's never heard that rule before (that's VERY interesting as how she would never have heard that rule but the Aetna reps I spoke to spout that "rule" off as if it's carved in granite.) She then informed me that Dr. Fanta IS within the network of our medical group, as well as the fact that he's also contracted with Aetna, and that I could have picked him as my oncologist right from the start if I had wanted (of course, I didn't know about him back then, though). So, this case manager is checking into it more for me. Nothing's solved yet, but I definitely have hope here that things will turn out well for me!!! In the meantime, I had already gotten the ball rolling for filing an appeal against Aetna. The case manager said don't stop that process in the meantime, but she's hopeful that I won't need to do that.
As before, I'll let you know when I find out more info. It may take a while.

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