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My Wonderful Husband

Sandi1's picture
Sandi1
Posts: 278
Joined: Aug 2008

My husband has stage 4 colon cancer that spread to his liver and lungs. He has had his surgery about 3 years ago and has been on chemo ever since. The Onc wants to keep him on chemo, because she is afraid that the cancer will come back. He is currently cancer free. But something has been bothering me for awhile now, and yesterday it finally made itself known. I always kept thinking as long as our health insurance is good, we will be fine. Well yesterday, my husband was informed by his companies HR that they will changing the health insurance this year. While he will still be covered (thank god), they have indicated that we will now have to pay for 10% of all procedures - so now i'm panicking. I know how much these chemo treatments are, there is no way we will be able to afford 10% of every chemo. I'm afraid that he will stop chemo because he doesn't want to leave me with nothing when he finally does go. I just don't know what to do. Thanks for letting me vent.
Sandi

Buckwirth's picture
Buckwirth
Posts: 1272
Joined: Jun 2010

My company changed to a plan with a 10% copay this year. Along with that is a $5k maximum out of pocket that INCLUDES the amount spent on the deductible (in our case $2.5k).

Once we hit the max out of pocket spend (which happened in a hurry), our copays went to zero for everything, including prescription drugs.

Check on what the max out of pocket is, and look at that like a deductible, it may make the plan seem a bit more palatable.

Blake

pepebcn's picture
pepebcn
Posts: 6352
Joined: Aug 2010

original contract unilaterally ? Don't understand!

Buckwirth's picture
Buckwirth
Posts: 1272
Joined: Jun 2010

Under our employer based system, we re-up annually. Sometimes there is no change, but if our Human Resources department finds a plan that is "better", either for the employees, or for the portion paid by the employer, they can move at that point to a different provider, or to a different plan under the same provider.

Sé que això és difícil per a un socialista com a tu mateix com d'entendre, però nosaltres, els americans capitalistes encanta aquest sistema.

Keeps us on our toes every single year.

:smile:

pepebcn's picture
pepebcn
Posts: 6352
Joined: Aug 2010

But even not been socialista can not understand you Buck! hahaha!.
A reveure!

abrub's picture
abrub
Posts: 2098
Joined: Mar 2010

First, a quick note: Blake is right - check to see what your maximum out of pocket is. The 10% copayment is often limited to "10% of the first $10-20,000 in costs" which would total $1,000-$2,000 on top of your deductible.

Regarding unilateral changes in plans:

In some cases, the Insurance Companies make the changes, which are applied across the board. (Last year, the Emergency Room and hospital copays went up dramatically in all of our plans. This was an Insurance Company decision, not ours.) In others, HR or Benefits Administrators make changes to make the plans economically better for the company and/or the clients.

I am a Benefits Administrator/Broker for a group of plans, and know that I will be changing the plans for the January, 2012 renewal. I'm doing so to try to keep the premium increases as low as possible (the Insurance companies tell us what the renewed plans will cost.) This can involve changing deductibles or copays. My goal is to get our clients the best coverage for the least money, but that will involve compromise. Is saving $50/month worth paying a little more for your prescriptions? Is eliminating an out-of-network option worth it to save money on a plan which already has a very high out-of-network deductible, and very high hospitalization costs? By requiring participants to use in-network drs for this plan, I can cut their office visit copays from $75 to $50 per visit, and lower their hospital costs from $3750/year to $1500/year, while cutting their monthly premium costs. We offer 5 different plans, and they'll span a wide variety of options, but virtually all of the plans will see changes so that we don't get caught by huge increases in cost required by the insurance company.

Our clients may change among our plans as of January 1, so if they are not happy with what is happening to their current plan, they may opt for another. Unfortunately, in the standard business environment, employees are not usually given the choice of plans. It is usually what the company offers or nothing. We are fortunate in that we are able to offer a variety of plans. However, another significant difference is that our clients pay the entire cost of their plans, whereas companies usually pay a portion or all of their employees' plans.

Just a quick summary of what goes on in American insurance.

Annabelle41415's picture
Annabelle41415
Posts: 6244
Joined: Feb 2009

Yes check for your deductible as plans are different. We pay for the first $7,000 and then 20% and this is GM insurance. You might have the 10%, but you might only have to pay the first $3,000 or whatever of it.

Kim

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

We found that shopping overseas for oral chemo was a great way to beat deductibles and insurance headaches - their chemo was simply much, much cheaper than the US mafia's chemo.

In my wife's case, using *daily* UFT ($5)- leucovorin($1-5) to continuously mop up residual microscopic disease, appears even better to us because of UFT's HIF-1 inhibitor (a big deal), "no gaps 5FU coverage", and the low(est) 5FU toxicity. We also use supplements (e.g. PSK, coQ10, vitamins C + K2, D3) and off label generics (e.g. cimetidine) with known molecular targets and immunological properties that have been published in major medical journals to add breadth and strength to the "regular chemo". Capecitabine (generic versions of Xeloda) should be available now in many places (primary patents expired).

Resolving any insurance reimbursement and logistics issues, would be a time investment. The need in some countries may be getting scripts that work for US and "locally", in 90 day quantities (US Customs package limit; in some countries distributors won't care about local prescriptions or quantity bought). I suspect a cutting question is which Carribean or Latin American country has the best arrangements and airplane fares. The question whether the employer is willing to help you with any insurance policy issues may be eased if they can recognize a major cost savings opportunity (there are solvable tax issues) more broadly.

Immigrants to the US may help with country insights and comparisons.

smokeyjoe
Posts: 1428
Joined: Feb 2011

tanstaafl, how do you have these shipped, don't you have any issues importing them into the U.S.?? Do you need a prescription for these drugs, how do you do that, who accepts and approves your prescriptions overseas?? Just curious.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

don't you have any issues importing them
Not really, but things change. Less commonly, theoretically, patents might be a problem, not for most CRC generics, or something highly proscribed for idiot reasons. A prescription, a note, and my phone number was pretty much all I needed last time I shipped something into the US, but now I'm shipping out. The internet indicates that there is a degree of arbitrary flexibility with Customs and the phone (or email?) contact can be important, for irregular items. I shipped in a year's worth of something before (larger bottle), wrote Customs a polite note avoiding any direct mention of quantity issues, and they didn't hassle me, but I wouldn't count on it (The total shipped cost of a year's supply of an item, still in ounces, had cost $20 more than a month's supply in a smaller bottle...).

how do you have these shipped
In fall-winter, regular mail may be okay if freezing temp is ok. Summer, choose an express shipper that isn't thermally abused, if you didn't stockpile earlier. Hand carry is good for 90 days worth of the (maximum) prescribed amount.

Do you need a prescription for these drugs
Of course, US Customs if no one else.

who accepts and approves your prescriptions overseas
It varies, that's the homework part, starting with timing and quantity. Some countries, with a foreign(US) prescription, you may have to buy them within 24 hours before your plane leaves. Other countries, some prescription orders can be prearranged with little fuss and delivered to your door (very convenient in a strange megalopolis). Carrying power of attorney and a stage IV folder is probably a good idea for back up. Again, preparation.

Sandi1's picture
Sandi1
Posts: 278
Joined: Aug 2008

Thank you for your great insight. Our problem is coming up with that 10% - we just don't have it. We are just now getting back on our feet from when he was diagnosed 3 years ago. I really don't want to have to borrow money from his mother again, even though she won't mind and always asks us if we need help. it's not fair to her, she is 76 looking after her 96 year old mother.

But thanks for your help, we will look into things a little bit more.
Sandi

Buckwirth's picture
Buckwirth
Posts: 1272
Joined: Jun 2010

There are programs from the drug manufacturers to help with the 10%.

What treatment is he on? If you send me note I would be happy to take the time to try and find links to co-pay assistance for you.

Blake

Buckwirth's picture
Buckwirth
Posts: 1272
Joined: Jun 2010

If he moves into Long Term Disability (assuming his employer offers it) it opens up a couple of other options for funds. One of them could be any life insurance plans he may have, including, but not limited to, anything he gets from his employer. Most of these plans have an option for early payout IF you face a potentially fatal disease. mCRC is an automatic qualifier for Social Security Disability, so qualifying for the LTD would not be an issue.

Another thing that the LTD does is free up any funds he may have in 401k/IRA plans. These can now be withdrawn without penalty, paying only the income taxes that would be due that year.

The problem would be that he would have to move into a COBRA health plan, and that could come as an even greater sticker shock. That said, it may be inevitable anyway, so it is a good idea to look into all of these options, if only to know what lies ahead.

Sandi1's picture
Sandi1
Posts: 278
Joined: Aug 2008

Well, we have looked into the disability route - problem is, one of his friends is an investigator for the disbility act, they go around watching people that claim to be to sick to work and go on disability (sad that people have done this so much that they need investigators to make sure you are telling the truth about your health) - his friend told him, that if they even just seem him on his motorcycle to go to the store - the disability goes away. He is not sick enough to give up his motorcycle, it is his only source of enjoyment from this awful disease. We have already exhausted our 401K to get back on our feet. But we will figure something out, we always do.

Thanks for your thoughts and ideas.

Sandi

Buckwirth's picture
Buckwirth
Posts: 1272
Joined: Jun 2010

Disability from a cancer diagnoses is COMPLETELY different from say, a back injury.

SSDI is a get out of jail free card for those with LTD insurance, and the diagnoses of metastatic disease for CRC is an AUTOMATIC qualifier. In fact, if you put cancer down as the reason, someone from SSDI is likely to call you to help you rush through all the paperwork.

For the record, I am speaking from experience, as I just got my approvals for both SSDI and LTD in the last two weeks. Not surprisingly, though both organizations got the medical records on the same day, SSDI came through with an approval about a week before the private insurance (so much for private enterprise being more efficient).

He could ride his bike back and forth to chemo and no one could take away the fact that he has a legitimate disability.

My offer of research stands btw, happy to help any way I can.

laurettas
Posts: 372
Joined: May 2011

You know, when I read that about disability, it didn't seem to make sense when talking about cancer. Glad you cleared that up, Blake, because I was worried for a little. Jake does go out and drive our tractor around the farm!

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