Pay up front?

I was due for radiation and chemo tomorrow 1/15/2013. The chemo people called to say they will require $1700 prepay up front for first week and $290 per week after that for Erbitux (about 7 visits). Up to that point I have had 6 operations and 11 teeth extracted along with many visits to various doctors at $40 per visit prepay. If we were given some warning regarding cost and having to pay up front things would have been ok, or at least give us some sort of payment plan. At least the radiation people said they would give us some sort of payment plan, lets hope it is reasonable. I will be seeing a social worker soon to discuss finances and disability of some sort which will help no doubt.

I just thought it was a little rich being told at the last minute to come up with $1700 etc. as if everyone has a spare few thousand lying around.

Any thoughts?

Michael

«1

Comments

  • phrannie51
    phrannie51 Member Posts: 4,716
    Are you in Austrailia?

    ...for some reason I thought that is where you live.  This is the first time I've heard anybody having to come up with "front money" when they have insurance.  I know that somebody here will have some ideas....I didn't have to face anything like that.....just paid my co-pay and the rest they billed out.....kind of a "built in" payment plan....the kind where I send as much as I can....and they just kept billing till it was paid off.

    p

  • Billie67
    Billie67 Member Posts: 898

    Are you in Austrailia?

    ...for some reason I thought that is where you live.  This is the first time I've heard anybody having to come up with "front money" when they have insurance.  I know that somebody here will have some ideas....I didn't have to face anything like that.....just paid my co-pay and the rest they billed out.....kind of a "built in" payment plan....the kind where I send as much as I can....and they just kept billing till it was paid off.

    p

    Hmmm...
    I didn't have to do more than just pay a copay each time. I think it's a little harsh to ask for that up front. I think in our state they can't ask for more than your copay. Do you have HMO or PPO?
    My question to them would be, "what if I don't have it?"
    There are other facilities to go to I'm sure??
    Good idea on the social worker. Keep us posted.
    Billie
  • Ladylacy
    Ladylacy Member Posts: 773 Member
    Co-pays

    My husband never had to pay anything up front.  We were billed after insurance paid.  This was for both radiation treatments (2 different times) and all of his chemo treatments.  The only upfront we had to pay (co-pays) were for the doctor visits.

  • Ingrid K
    Ingrid K Member Posts: 813
    Ladylacy said:

    Co-pays

    My husband never had to pay anything up front.  We were billed after insurance paid.  This was for both radiation treatments (2 different times) and all of his chemo treatments.  The only upfront we had to pay (co-pays) were for the doctor visits.

    Michael
    You look too young to

    Michael

    You look too young to be on Medicare, so I'm sure you mean private insurance.  WOW, it sucks to find this issue out just the day before.  They couldn't get the OK before now ?  I was not on Medicare either, but the hospital checked right away about insurance coverage for me and luckily I had just retired from a major telecom company so I had terrific insurance and all was covered.

    Definitely get to see the social worker.....they usually know all the little tricks/tips needed to help in your situation.  Perhaps the treatments weren't coded correctly and therefore denied by insurance ?  sometimes it could be a miscommunication issue and easy to resolved.

    Hope you get this taken care of and you can start on the road to complete recovery.

  • VivianLee5689
    VivianLee5689 Member Posts: 546
    Ingrid K said:

    Michael
    You look too young to

    Michael

    You look too young to be on Medicare, so I'm sure you mean private insurance.  WOW, it sucks to find this issue out just the day before.  They couldn't get the OK before now ?  I was not on Medicare either, but the hospital checked right away about insurance coverage for me and luckily I had just retired from a major telecom company so I had terrific insurance and all was covered.

    Definitely get to see the social worker.....they usually know all the little tricks/tips needed to help in your situation.  Perhaps the treatments weren't coded correctly and therefore denied by insurance ?  sometimes it could be a miscommunication issue and easy to resolved.

    Hope you get this taken care of and you can start on the road to complete recovery.

    My guess its the yearly deductible

    We have to pay 15% of expenses for health care up to 2700 to meet our deductible, then insurance really kicks in.  This means right after Christmas if you have procedures you have to find money somewhere.  David has a bone marrow biopsy on the 22 so I am sure we have a big deductible to pay then.  I don't know if this is your situation or not.

  • katenorwood
    katenorwood Member Posts: 1,912
    Insurance issues

    Michael,

    I had to make a rushed descission back in '11....due to my insurance deductable coming back around in less than a month.  Would have had to come up with the first $6000 up front.  So yeah this is probably an insurance blurp.  I would hope that this social worker will have fantastic resources for you when you meet with them.  Like you needed this on top of just getting better.  Let us know if things work out....otherwise we'll dig for more resources o.k. ?    Katie

  • wolfen
    wolfen Member Posts: 1,324 Member

    Insurance issues

    Michael,

    I had to make a rushed descission back in '11....due to my insurance deductable coming back around in less than a month.  Would have had to come up with the first $6000 up front.  So yeah this is probably an insurance blurp.  I would hope that this social worker will have fantastic resources for you when you meet with them.  Like you needed this on top of just getting better.  Let us know if things work out....otherwise we'll dig for more resources o.k. ?    Katie

    Wondering How Some Stuff Works Also

    I try to stay pretty much on top of what bills to be expecting, so I'm frequently checking Medicare and our secondary to see what portion has been paid by each. For the most part, we're not asked to pay the co-pay upfront. But the hospital bill for hubby's recent stay has me stumped. The amount billed to Medicare was approx. $75,000 and all of it was Medicare approved. But the amount paid by Medicare was only $11,500. So, I'm lost on this one. Waiting now to see what UHC is going to pay. Surely this can't be right. All the many doctors involved seemed to get paid the correct amount.  Will probably end up owing about $1,000 to them. All this before his cancer treatment has even started. Haven't even see the first bill from MDA yet.

    If the hospital is seriously expecting the balance of $75,000, you guys can come visit me in debtor's prison.

    Luv,

    Wolfen 

  • ausrebel53
    ausrebel53 Member Posts: 74
    Thank you

    Thank you for your concerns. I live in Florida Phrannie (Panama City Beach) and have private insurance through my wifes work, she is an RN at the local hospital where I have been going. I would have thought her insurance would be pretty good, (has been up to now) we pay over $500 per month for family insurance. I'm still a little unsure how the deductable works as we haven't had to see a doctor very much at all. Australia has public health insurance which sucks, it pays for everything but you can literally die waiting and the quality can be questionable for anything serious.

    I originally came from Australia Phrannie but married my beautiful Southern Belle, Kelly....I am a permanent resident (legal)and have lived in the USA for nearly 14 years and have worked most of that time. I just turned 60 in case you were wondering.....my wife keeps me young heh heh, I do love it here especially the South.

    I will definatelly keep you posted Billie, again thank you for your responses, it didn't sound right to me.

  • ausrebel53
    ausrebel53 Member Posts: 74

    Insurance issues

    Michael,

    I had to make a rushed descission back in '11....due to my insurance deductable coming back around in less than a month.  Would have had to come up with the first $6000 up front.  So yeah this is probably an insurance blurp.  I would hope that this social worker will have fantastic resources for you when you meet with them.  Like you needed this on top of just getting better.  Let us know if things work out....otherwise we'll dig for more resources o.k. ?    Katie

    Insurance blurp

    Thank you Katie, would really appreciate any help, it may just be the deductable coming back around to bight us.

  • ausrebel53
    ausrebel53 Member Posts: 74
    wolfen said:

    Wondering How Some Stuff Works Also

    I try to stay pretty much on top of what bills to be expecting, so I'm frequently checking Medicare and our secondary to see what portion has been paid by each. For the most part, we're not asked to pay the co-pay upfront. But the hospital bill for hubby's recent stay has me stumped. The amount billed to Medicare was approx. $75,000 and all of it was Medicare approved. But the amount paid by Medicare was only $11,500. So, I'm lost on this one. Waiting now to see what UHC is going to pay. Surely this can't be right. All the many doctors involved seemed to get paid the correct amount.  Will probably end up owing about $1,000 to them. All this before his cancer treatment has even started. Haven't even see the first bill from MDA yet.

    If the hospital is seriously expecting the balance of $75,000, you guys can come visit me in debtor's prison.

    Luv,

    Wolfen 

    Debtors prison

    I hear what you are saying Wolfen, fortunately there is no more debtors prisons. My only fear is losing our house which we own outright.

    regards Michael

  • ausrebel53
    ausrebel53 Member Posts: 74

    My guess its the yearly deductible

    We have to pay 15% of expenses for health care up to 2700 to meet our deductible, then insurance really kicks in.  This means right after Christmas if you have procedures you have to find money somewhere.  David has a bone marrow biopsy on the 22 so I am sure we have a big deductible to pay then.  I don't know if this is your situation or not.

    Hope Davids biopsy goes ok

    Hope Davids biopsy goes ok Vivian. Hope you feel better lately, we were worried about you as you seemed upset recently.

    Please take care

    regards Michael

  • phrannie51
    phrannie51 Member Posts: 4,716

    Hope Davids biopsy goes ok

    Hope Davids biopsy goes ok Vivian. Hope you feel better lately, we were worried about you as you seemed upset recently.

    Please take care

    regards Michael

    Individual Dr.'s wouldn't know how much of your

    deductable you've already paid when you're seeing 3 or 4 doctors, and they all have separate charges, and separate lab tests etc....I wonder if the Rad place called your insurance company and asked how much they would NOT pay and they said $1700.....which considering that rads are pretty expensive, isn't that bad a deal....I think mine ran close to $85,000 by the end of the 7 weeks.  It's just  too much to come up with at one time. 

    p

  • George_Baltimore
    George_Baltimore Member Posts: 303

    Thank you

    Thank you for your concerns. I live in Florida Phrannie (Panama City Beach) and have private insurance through my wifes work, she is an RN at the local hospital where I have been going. I would have thought her insurance would be pretty good, (has been up to now) we pay over $500 per month for family insurance. I'm still a little unsure how the deductable works as we haven't had to see a doctor very much at all. Australia has public health insurance which sucks, it pays for everything but you can literally die waiting and the quality can be questionable for anything serious.

    I originally came from Australia Phrannie but married my beautiful Southern Belle, Kelly....I am a permanent resident (legal)and have lived in the USA for nearly 14 years and have worked most of that time. I just turned 60 in case you were wondering.....my wife keeps me young heh heh, I do love it here especially the South.

    I will definatelly keep you posted Billie, again thank you for your responses, it didn't sound right to me.

    Wolfen

    relax!!!  Medicare reduces the amount billed by doctors, hospitals,etc.  You shouldn't have to pay what Medicare and your Medi-gap insurer don't pay.  Medicare enters into agreements with health providers.  In most cases, they agree to accept whatever Medicare pays.  Since it's January, any services you incur this month will probably have a yearly deductible of $155 (off the top of my head) attached to it that you would have to pay.  This is a one time deductible.

    OOOPPPS, I just reread your post.  For inpatients in a hospital the deductible is somewhere around $1100 but that is nowhere near $75000.  Sometimes a hospital will waive the deductible if it would cause a financial hardship.  They would give you forms to fill out and you would have to send them back to the hospital along with copies of your last two bank statements, proof of income, etc.

    As far as insurance coverage for treatments, when I received treatment back in 2004, I was not on Medicare or Disability.  I had BCBS.  They footed my bills to the tune of over $156,000.  Neither my chemo or radiation facilities ever asked for any pre-payment.  They billed BCBS and whatever small amount wasn't covered, I paid.  BCBS is not cheap, but if you have a big illness, they are definitely worth it.

    If you live in the states, I would definitely apply for SS Disability.  For certain type cancers, they will approve you without you having to fight with them.  Once you are approved for disability, you can then apply for Medicare and your bills will be pretty much be paid.

  • ausrebel53
    ausrebel53 Member Posts: 74

    Wolfen

    relax!!!  Medicare reduces the amount billed by doctors, hospitals,etc.  You shouldn't have to pay what Medicare and your Medi-gap insurer don't pay.  Medicare enters into agreements with health providers.  In most cases, they agree to accept whatever Medicare pays.  Since it's January, any services you incur this month will probably have a yearly deductible of $155 (off the top of my head) attached to it that you would have to pay.  This is a one time deductible.

    OOOPPPS, I just reread your post.  For inpatients in a hospital the deductible is somewhere around $1100 but that is nowhere near $75000.  Sometimes a hospital will waive the deductible if it would cause a financial hardship.  They would give you forms to fill out and you would have to send them back to the hospital along with copies of your last two bank statements, proof of income, etc.

    As far as insurance coverage for treatments, when I received treatment back in 2004, I was not on Medicare or Disability.  I had BCBS.  They footed my bills to the tune of over $156,000.  Neither my chemo or radiation facilities ever asked for any pre-payment.  They billed BCBS and whatever small amount wasn't covered, I paid.  BCBS is not cheap, but if you have a big illness, they are definitely worth it.

    If you live in the states, I would definitely apply for SS Disability.  For certain type cancers, they will approve you without you having to fight with them.  Once you are approved for disability, you can then apply for Medicare and your bills will be pretty much be paid.

    Have relaxed, thanx to you guys

    This is certainly wierd, had my first radiation treatment today and was told insurance covered 100%, didn't have to pay a dime (whew). The rad doc said he was concerned but gave me an alternative chemo doc if we can't sort out insurance issues with the (yes I'm going to use the word) idiots at the first chemo doc. Love being in a position of strength when bargaining, I feel it's one point for our side especially since we are so vulnerable in many ways. The first chemo doc will lose a crap load of money if I choose number 2 which I am more than willing to do at the drop of a hat (greedy bast***s).

    Regarding hospital care Wolfen, I used the same hospital where my wife works as an RN and only had to pay a surgeons co pay, we didn't have to pay any hospital fees of any kind. We do have good insurance but they seem to try to bluff us at times, they initially tried the pre existing number on us which seems to have been resolved.

    Will keep you blokes and shielas (guys and gals) informed on the outcome of the chemo fight.

    Thank you for your input

    Regards Michael

  • phrannie51
    phrannie51 Member Posts: 4,716

    Have relaxed, thanx to you guys

    This is certainly wierd, had my first radiation treatment today and was told insurance covered 100%, didn't have to pay a dime (whew). The rad doc said he was concerned but gave me an alternative chemo doc if we can't sort out insurance issues with the (yes I'm going to use the word) idiots at the first chemo doc. Love being in a position of strength when bargaining, I feel it's one point for our side especially since we are so vulnerable in many ways. The first chemo doc will lose a crap load of money if I choose number 2 which I am more than willing to do at the drop of a hat (greedy bast***s).

    Regarding hospital care Wolfen, I used the same hospital where my wife works as an RN and only had to pay a surgeons co pay, we didn't have to pay any hospital fees of any kind. We do have good insurance but they seem to try to bluff us at times, they initially tried the pre existing number on us which seems to have been resolved.

    Will keep you blokes and shielas (guys and gals) informed on the outcome of the chemo fight.

    Thank you for your input

    Regards Michael

    YEAH...you have begun the journey!!

    and you didn't have to cough up $1700....phew!  Anyway, you are on the road, and that's a good feeling after having to wait and wait...getting everybodies poop in a group, while you're thinking the C is wrecking havoc in your body.  Glad everything worked out.

    p

  • Ingrid K
    Ingrid K Member Posts: 813

    YEAH...you have begun the journey!!

    and you didn't have to cough up $1700....phew!  Anyway, you are on the road, and that's a good feeling after having to wait and wait...getting everybodies poop in a group, while you're thinking the C is wrecking havoc in your body.  Glad everything worked out.

    p

    good news

    Glad you are able to get the treatment started, Michael.

    As P51 says, that's a huge first step towards your ultimate recovery.

    BEST OF LUCK TO YOU.

  • donfoo
    donfoo Member Posts: 1,771 Member

    Have relaxed, thanx to you guys

    This is certainly wierd, had my first radiation treatment today and was told insurance covered 100%, didn't have to pay a dime (whew). The rad doc said he was concerned but gave me an alternative chemo doc if we can't sort out insurance issues with the (yes I'm going to use the word) idiots at the first chemo doc. Love being in a position of strength when bargaining, I feel it's one point for our side especially since we are so vulnerable in many ways. The first chemo doc will lose a crap load of money if I choose number 2 which I am more than willing to do at the drop of a hat (greedy bast***s).

    Regarding hospital care Wolfen, I used the same hospital where my wife works as an RN and only had to pay a surgeons co pay, we didn't have to pay any hospital fees of any kind. We do have good insurance but they seem to try to bluff us at times, they initially tried the pre existing number on us which seems to have been resolved.

    Will keep you blokes and shielas (guys and gals) informed on the outcome of the chemo fight.

    Thank you for your input

    Regards Michael

    Happy for you

    Glad it worked out Michael. Dealing with the direct medical issues is enough, adding a financial track of issues just adds more to the plate.

    Don

  • ausrebel53
    ausrebel53 Member Posts: 74
    Good wishes

    Thank you for your good wishes, the original reason for the insurance glich was the chemo doc wanted to use Erbitux as he felt this the best way to go. The insurance company came back and said this would have to be pre approved which would take 30 to 90 days (they kidding?). The chemo doc explained to them this proceedure had to be in conjunction with radiation therapy for it to be fully effective and that I had already started radiation. Unfortunately Kelly's work (hospital) recently changed hands and consequently changed insurance, the old insurance always approved these proceedures without any preapproval requirements.....not the new ones.

    The chemo doc came up with a new plan, they would use cheaper meds and be able to charge less: $600 up front, the second visit $250 then $150 per visit after that. Due to the fact that I have already started radiation thus leaving us no time to explore alternatives (insurance has timed it perfectly) my wife, Kelly has really insisted on taking the recent offer. If the pre approval goes through, this "prepay" would be returned to us. "IF" I'm taking the offer because I am too frigging tired to fight and I don't wish to stress out my wife too much.

    I hope you are all confused coz this is sure confusing the crap out of me. As I have previously said, where I come from, Australia has public insurance (like Obama care) and bean counters and beaurocrats DICTATE (and I emphasize that word) what medications or treatments are used, NOT DOCTORS. My dear mother spent her last years in New Zealand that also has public medical insurance. She contracted lung cancer and 2(Ibelieve) years after that metastisised (however you spell it) to the liver. I was able to spend the last couple of days with her in hospital in Aukland thankfully. What really shocked me was the day before mum died the nurse came in and wished I meet with her doc, what those (insert adjectives here) did was suggest I move mum to a private hospital, sadly mum passed away the next day. I told them they would move my mother over my cold dead body, let her go in peace I said. The point I make here is you will not be saved if over a certain age or at a certain level of sickness with public insurance....too expensive. I have grown to love this country the more I see of it, we Australians are fiercely independant and individualistic beneath that carefree exterior, and we strongly identify with the USA....we've been mates for ages. I guess it just saddens me to see some freedoms seemingly erroded and I pray you keep this country in the hands of the people coz i've seen what happens when a country leaves the hands of the people. I'm happy to work and pay my way, sometimes one just needs a little help not a last minute landslide

    Guess I better step down from my soap box, this episode has brought back some bad memories and made me a little paranoid. I thank you for your time

  • ausrebel53
    ausrebel53 Member Posts: 74

    YEAH...you have begun the journey!!

    and you didn't have to cough up $1700....phew!  Anyway, you are on the road, and that's a good feeling after having to wait and wait...getting everybodies poop in a group, while you're thinking the C is wrecking havoc in your body.  Glad everything worked out.

    p

    Getting started

    Yes Phrannie, it is good to finally get started....like trying to lay a square egg. Thank you

  • ausrebel53
    ausrebel53 Member Posts: 74
    Social worker

    I will still see the social worker, just haven't had time yet.