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Want to hear something I got in the mail from my insurance company

Buzzard's picture
Buzzard
Posts: 3073
Joined: Aug 2008

I received Saturday a letter that read pretty bluntly that the use of avastin in my treatment was accepted by the nurses and Drs on the insurance bd only to go ahead in the use but not sure at this time whether or not they were going to pay for it..If they don't then I won't...I have to assure my family will get by if I am not around... Also, that my copay because of my illness and eligibility may be increasing because of my change in status....I remained on the same insurance (not Cobra) and am now paying being retired the full amount of 1076 per month out of pocket plus 2500 copay for myself...Ya know, you use to be able to shake a mans hand and it stood for something, you use to ask a favor and expect nothing in return, you use to try and do the right thing and hold your head up, and no one ever tried to screw ya, cause everyone was in the same shape. America use to be one Nation, Under God, Indivisible, with Liberty and Justice for all.......

where did we go wrong...........................Bless our Caregivers and children......

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

You obviously never had to deal with insurance companies. Crooks and liars for their entire history.

tootsie1's picture
tootsie1
Posts: 5056
Joined: Feb 2008

Oh, Clift.

I'm sorry about all this. It's not fair!

*hugs*
Gail

Brenda Bricco
Posts: 579
Joined: Aug 2011

having cancer wasn't bad enough. I still can't believe how many people are willing to make a buck on someone's illness. Insurance companies can be some of the slimiest snakes. ugh

taraHK
Posts: 1961
Joined: Aug 2003

Grr!

If you want to see a good -- and very funny - movie about 'getting back at' insurance companies (with apologies to those on this board who may be working in that profession....), check out "The Man Who Sued God" (starring Billy Connelly). Warning about some foul language.....I just watched it last night and I laughed -- and cried a little too.

So sorry about this latest. I'm having insurance nightmares myself -- and also worried about not bankrupting my family.....

Love,
Tara

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

...personal rights, consumer orientation, and free marketplace competition.

We have far too many agencies telling us, or our medical providers, what to do. The prices aren't competitive with the global competition for medicine here that may not work as well as in some 3rd world country.

Our US medical industrial complex serves various special, corporate and government interests, not ours. Good medicine should both work well, and be affordable, at cash prices. I am not making idle wishes, we already try to achieve superior results with diet, generic drugs and supplements with only out of pocket expenses.

buckeye2
Posts: 428
Joined: Jul 2011

Sometimes I think the insurance companies implement practices with the hope that the insurer will get tired of fighting with them and will accept less rather than jumping through all the hoops. One thing I have done is demand one caseworker and all communique be done via email to insure accurate records of communication. It's a chess game. You have to get them in a corner with their own policies as ammunition rather than anger. Know that policy better than the claims manager. Lisa

PhillieG's picture
PhillieG
Posts: 4907
Joined: May 2005

but we've seemed to perfected it. Everything from the Enron Math (2-2=$5 in our pockets) to US Companies setting up Foreign Headquarters by just renting an office in Switzerland and keeping the CEO, Staff, and all employees in the US just to avoid paying their fair share of taxes. Believe me, I LOVE America and what we stand for, but too often we don't practice what we preach. That's something I do NOT like about us. I know we're not unique, but that don't make it right...

This is disturbing Buzz, on the one hand they say "that the use of avastin in my treatment was accepted by the nurses and Drs on the insurance bd (board?) only to go ahead in the use but not sure at this time whether or not they were going to pay for it.". It's accepted as a viable treatment yet they aren't sure they'll pay for it???

This is another situation where having my brother as my Medical Advocate (more like Pit Bull) came in handy. I'm pretty sure it was for Avastin (could have been Erbitux) and my insurance company wasn't sure if they'd pay due to the cost involved. He got on the phone with them and explained the situation which was it's Avastin or I die. They paid for it. I'm quite sure he did it without yelling but he kept having them transfer him to people up the "chain of command" and didn't waste too much time dealing with the phone reps who are often trained to say no.

You have the letter that says that use of avastin in my treatment was accepted by the nurses and Drs. Have you tried getting YOUR Oncologist on board to try to intervene on your behalf and express the URGENCY that you need Avastin to stay alive? You certainly have enough going on without having to deal with BS. You pay your insurance so THEY can pay to help you.

Integrity is something that does seem to be lost. If a person does not have "their word" as something of value, then what does a person truly have? NOTHING as far as I'm concerned.
Didn't the govt declare that "Corporations ARE People"? I guess they declared them people who often happen to be jerks.

You've fought cancer for a long time Buzz and are beating this. Don't give up the fight now. Pull out all the stops and lay it on the line. Talk to your Onc and explain what's going on. See if they have your back(side) then approach the insurance and use their words against them. "use of avastin in my treatment was accepted by the nurses and Drs".
If it was accepted then what's the conflict?
Hugs
-phil

Buzzard's picture
Buzzard
Posts: 3073
Joined: Aug 2008

and one thing I promise....its far from over....they will be getting their eyes dotted and T's crossed before I am finished...and I will not allow them (whomever "them" turn out to be) to herd my family into bankruptcy, nor will I play martyr either...I will speak with both Oncologists today and get this ironed out. What have I got to lose.....my life ?.....I will keep all in touch as it plays out...I have through this journey learned to sometimes be a horses azz, or sometimes if need be a gentle horses azz, whatever the situation dictates...........buzz

PhillieG's picture
PhillieG
Posts: 4907
Joined: May 2005

you always have your health
;-)
I figured you've been paying attention all along and I KNOW you're not a quitter.
If nothing else, dealing with cancer tests one's patience and also helps teach us how to navigate "with those people".
Thanks for keeping us posted and best of luck to you.
-p

laurettas
Posts: 372
Joined: May 2011

Isn't this just so aggravating? As much as I have had to fight with insurance companies over the years, I have to say they are not the only ones I am distressed with. The fact that a pharma company can charge $40,000 a month for a drug is totally over the top in my book. Not to mention the amount that hospitals and doctors charge. Why should some become wealthy from other's illnesses? Makes no sense to me at all. I think pretty much everyone in the medical profession needs to undergo a profound examination of their conscience. Just my opinion.

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

Hi Clift,

I think Phil gave you some good advice, and I know that you're a fighter. Doctor documentation and persistence and speaking to the right higher up people in the chain of command within the insurance company are key, as I think you know.
I know when I was fighting to get my Gemzar approved, it took two denials before I went to the Dept of Managed Care at the state level. That got their attention- within a week they had reversed their decision and provided coverage. I accompanied that request with a letter from me (along with the documentation and dr letters) making myself a real person to them- making sure they knew I had young children, that I was otherwise healthy and functional (not someone about to die "anyhow"), and were they going to be the ones to cause my death by not allowing a drug that was vital to my survival?! I would put it to them that way & in addition to calling, I would definitely put something in writing to them. I know it's a hassle and we shouldn't have to do things like this, but this is our reality- you gotta do what you gotta do.

Keep hanging onto that rope, Buzz-

Hugs,
Lisa

ketziah35
Posts: 1154
Joined: Jun 2010

I am becoming very irritated at the state of our healthcare system. It is very disappointing to see people in need being jerked around.

jjaj133's picture
jjaj133
Posts: 869
Joined: Mar 2011

Oh buzz, i can't say what my first thoughts were. Is there help like there is for zeloda?
I will pray that they do the right thing. I can hope.Lova ya, Judy

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

buzz, its not just the good old usa, its the whole planet.
not that thats any real help.

well if its any consellation chinese herbs are cheap.
see my i love henry post.

also maybe checkout the life extension foundation stuff.
they got some cheaper options, maybe juicing.

carrots and celery are cheaper than steak.

hugs,
pete

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