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I need a shoulder to cry on...

Kamushka
Posts: 22
Joined: Feb 2017

I am feeling down and need to vent .. i finished my last chemo session and had a severe allergic reaction to the carboplatin. The nurses maxed me out on steroids, benadryl and something else to try to get the swelling down so I could breathe. They neglected to stop the carboplatin until the doctor suggested it ( and it was almost empty) and the swelling stopped but it was scary. My immune system was so low that I also developed an allergic reaction to the anti-nauseous patch, something that never happened before. It looked like an iron had burned my back and after three weeks I finally got all the blisters to heal. The next step is six weeks of daily radiation so I went to the hospital and did the consultation with the radiologist and then went back for the mapping and tattoos and to get the leg stabilizer made. I prepared myself to start this week; however, last Thursday I got a letter from my insurance Federal Blue Cross Blue Shield saying they were denying the radiation. The letter said, according to their policy,they do not have any statistics showing radiation prolongs life. I called the radiologist's office and the billing department said they had already requested an appeal to the insurance company and requested a radiologist review the appeal and radiation plan. Apparently, an internist originally reviewed it and denied the plan. My radiologist's billing department said not to count on the denial being overturned because they are rare. She did say that they would come up with a payment plan for me to pay it on my own. Does anyone know what six weeks of daily radiation could cost? I am so depressed over this whole thing and scared that after the four horrible months of chemo I had that by delaying or not having the radiation, the aggressive cancer will rear it's ugly head again! 

arunirma
Posts: 7
Joined: Feb 2017

So sorry that you had to go through these. Hopefully, your oncologist can resend a request to your insurance company. Did you also touch base with social- worker in the hospital who could look up some resources for you. I once enquired about loans for cancer treatment, CTCA has some resources where they could provide some loans based on your life insurance coverage or something. I am so sorry I couldn't recall the specifics. 

Will be praying for you, Good luck !

Soup52's picture
Soup52
Posts: 906
Joined: Jan 2016

While my insurance did cover all my cancer treatments, I first had to meet 3,500 deductible and yes I made it up to my 5,500 out of pocket. Fortunately my friend who also sells insurance said to make a payment plan with the hospital and with no fees. That is what I did. Now my husband is going through treatment and we are doing the same thing. They may tell us do you know you owe ___ amount and we say yes. Many people think that then means you must pay today, but that isn't the case. They just want their money eventually. Also, you may also qualify for some financial help. We don't as we make too much money. No, we aren't rich just middle class. It's always worth it to give it a try. I pray you get it approved anyway, but let us know how it goes.

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

Insurance companies interfering with your doctor's clinical decisions for you and high deductibles and high maximum out of pockets. I had a $4500 deductible last year and $7500 max OOP and met them both plus $10,000 in expenses that were not reimbursable. That's what our politicians should be talking about. 

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

i had about $11,000 total out of pocket costs. Not additional $10,000. Plus 1200 miles on my car at 0.19/ mile. Can you tell I'm doing my taxes?  I would push your doctor hard to appeal this decision. 

Editgrl's picture
Editgrl
Posts: 903
Joined: Jun 2015

This kind of thing makes me furious! I am so sorry you have to deal with this. Soup is right, though. I have known several people who managed to diminish their costs that way. Sucks to have to go through machinations like this when all you should be focused on is healing.

Kvdyson's picture
Kvdyson
Posts: 789
Joined: Jan 2016

I agree with the others to ask your gyn-oncologist or medical oncologist to also contact the insurance company to appeal their decision. For your own research, you may want to check the most recent NCCN Treatment Guidelines for Uterine Neoplasms for the current standard treatment for your type, stage and grade.

My EOBs from United Healthcare show each week of external radiation averaging around $2,000 (before discounts). The discounts were about half that cost so if you do end up having to pay it yourself, you should ask for those same discounts. There is no reason that they should demand a higher rate for that services just because you're paying personally. 

Good luck to you and don't let them bully you. If they give you any grief, tell them you are going straight to your State Assemblyman or Senator. Once they get a call from that person's office, they tend to become more understanding.

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

Go to your State Department of Insurance and register a complaint. Insurance companies also hate that. You can either call or also probably do it online. 

MoeKay
Posts: 356
Joined: Feb 2004

If I were you, I would first take a look at your 2017 Coverage Brochure and see what it states as far as coverage for radiation for cancer.  That will tell you what has to be shown for the radiation to be a covered service.  This information should be provided to your rad-onc who will need to establish how your radiation treatment meets the coverage criteria. 

Several years after I finished treatment for endometrial cancer, my insurance company notified me that they would not provide coverage for my CA-125 blood test because it was only used to monitor ovarian cancer.   I contacted my radiation oncologist, who had ordered the test for which the insurer had denied payment.  My rad-onc wrote an appeal letter to the insurer and provided supporting documentation.  The appeal letter stated as follows:

"I received a letter from one of my patients indicating that you will not provide coverage for her to receive a CA-125 blood test, a tumor marker that is being followed for her diagnosis of endometrial adenocarcinoma.  My patient was diagnosed with endometrial adenocarcinoma, Stage II.  She had tumor invading 80% of the myometrium, extensive lymphovascular invasion, lower uterine segment involvement, and she underwent radiation treatment in our department.  CA-125's are used to screen ovarian cancer as well as endometrial cancer for ruling out recurrence.  The patient had a risk for having a recurrence of her tumor and therefore we are using every screening modality possible to be able to detect this if it should occur.  She does have her physical exams and the screening CA-125 is used as a marker because if it becomes elevated then it means we would need to look for recurrence and this would lead to earlier pick-up of recurrence than with physical exam or CT scans. 

Even though it is not specific for endometrial cancer, it does become elevated in some cases.  As seen in the refresher course from the American Society of Therapeutic Radiation Oncology (attached), CA-125 is also considered as part of the work-up and diagnosis.  Usually these markers are used afterwards for following patients, ruling out tumor regrowth.  As you can see also from the attached Follow-up of Cancer Handbook for Physicians, Fourth Edition, when following patients with endometrial cancer, CA-125 is also used as indicated.  Therefore, this patient's CA-125 should not be denied for payment.  I hope you will provide payment for this tumor marker which could potentially save my patient's life." 

After my insurer received my rad-onc's appeal letter and supporting documentation, they reversed their denial and paid for all my subsequent CA-125s.  Good luck in getting your rad-onc to provide the necessary information to your insurer to get your denial reversed!!

Nellasing
Posts: 529
Joined: Oct 2016

I don't have anything to add to what the other ladies have already said- such good information!  I do want you to know that I am praying for you and hoping for the very best for your ongoing treatment options.   (((HUGS)))

Kamushka
Posts: 22
Joined: Feb 2017

Just hearing from all of you lifted my spirits! We, too, are not rich but not poor enough either....nor would I want to be! I shall re-read everyone's comments again and again now that I am better informed! Thank you .....thank you ....a thousand times thank you!

CheeseQueen57's picture
CheeseQueen57
Posts: 936
Joined: Feb 2016

Again, this is why it's important that you carefully choose where to get your treatment. Some docs and facilities will go all out to fight for you and others not so much. I'm convinced that it was the expertise of my team at Fox Chase that expertly completed my Social Security Disabilty paperwork that resulted in me getting approved in a mere month. In an unrelated example, my husband once had some dental work by an endodontist that the insurance refused to pay. He had no interest in substantiating his recommendations although they were sound. Just couldn't be bothered. 

janaes
Posts: 800
Joined: May 2016

Hi, I wish you the best with getting the appeal.  I dont know completely how you feel, but i almost lost my insurance right before my radiation treatments started. I was on state insurance and it looked like I was going to loose my insurance.  It was so stressful.  I hated it.  Worrying about money is the last thing a cancer patient wants.  Im glad you are feeling better after comming to this forum.  Thats What helped me too.

Lots of love Janae

Big Sister 5
Posts: 18
Joined: Feb 2017

I am so sorry that you have to deal with all of this on top of everything else. I can't add anything more to the comments. These ladies know so much more than I do. I can however pray for you and your situation. God Bless.

Lynn

SandyD's picture
SandyD
Posts: 130
Joined: Oct 2015

You should not have to be put in the position of worrying about money when your focus should be on fighting the beast and doing what you need to do for yourself. We have a lousy system in the US compared to other developed countries! Bugs the hell out of me! Feel free to cry on my shoulder any time! Hope you've been able to get some resolution and things are going better for you ((HUGS)).

MaryVig
Posts: 37
Joined: Feb 2017

If your doctor asks for it, you need him to be your advocate. I have not nneded to focus that with my cancer treatment yet but I did with knee replacement. When I maxed out my physical therapy, the therapist and Dr said I needed 2 more months. They argued with the insurance and I got it Reversed so I could continue. Let the advocate but ask to be on the line so you can follow and prod ur Dr if need be. Good luck. It sux.

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