Insurance / financial concerns!!!

[tjrasMOM]

My mom and I went to her "chemo teaching" appointment today. While we were in there another new patient told her that the nausea drug can cost up to $4500 per dose. Is this true? My mom started crying right there. She turned to me and said, "with all these bills I feel like not even doing treatment and just giving up." Her bronchoscopy cost $11,000. Blue Cross only covered $6000. Mom is responsible for $5000. Now we're up to around $15,000 that SHE is responsible for paying!!!! And she hasn't even started treatment!! It's only been diagnostic. Has anyone ever received financial aid or are there any programs out there that can kick in & cover major medical? She pays her own insurance....and she stopped working when all these symptoms took over. These bills are causing so much stress that I honestly believe she'll lose the will to fight if we don't find a way to find financial help. Also, she's already selling her house and not buying another one simply to have some money put aside. But I swear, if the bills keep adding up....all her money will be GONE in less than a year. HELP!!

[Laura Ann]

Check and see if your mother's insurance has an annual "maximum out of pocket expense", most insurance policies do. After that amount has been reached, usually insurance pays 100%.

Hope this helps.

Laura

[Nick C]

My mom's cap was $7,500, then the insurance kicked in. Also, if the "price tag is $11,000 for something and insurance pays $6,000, often the patient responsibility is NOT the remainder, but some lesser number.

Also, I am not sure, but with disability comes certain additional medical correct? I don't know what stage your mom is, but certain stages automatically qualify for disability...and I am not sure, but I would think then benefits...so please tell mom not to give up because of $$$, there are a lot of options out there.

[missyk]

As Nick brought up...get ahold of the Social Security Administration and get the paperwork going for disability. It takes up to 6 months to start receiving benefits, I believe (someone will come around who knows better than I do) but it'll take some of the strain off knowing it's coming!!

All the other's have had great advice, too! Please take it and remind Mom that right now it's not about the money...it's about the fight. I know that was something my Mom worried about often, too...and we reassured her often that it just didn't matter...SHE mattered.

I had to come back and add...you might also want to have her check with her local department of human services on a "medically needy" service. I'm not sure what it all entails but they should be able to tell her if there's a program available. If she's paying her own insurance and they DO have a program, alot of times it will also pay HER premium, too!!!

Sending many prayers for you all...

[tjrasMOM]

See, I'm confused because I understand the deductable part...her cap is $2500. And the way I understand this stuff is that you pay your percentage until the deductable is met....For example, you're expected to pay say 40% of all visits, etc. UNTIL the deductable is met ($2500) - and after that, then it kicks in 100%. But why is she getting billed for everything? I have seen this personally with my own insurance, where the first bill shows one payment from the insurance, you start a payment plan with the doctor's office and then they (insurance payments) kick in again later on. This happened with my husband last year when he had his gallbladder removed. We were getting bills and then suddenly all the balances were really low. I just don't understand why she's expected to pay this high amount. She has Blue Cross PPO with a $2500 max deductable. She's responsible to pay 40% of most things. I'll need to read her policy I guess. But the disability thing is something we need to look in to. THANK YOU! I'm still checking this post if anyone has any other suggestions. =)

[Liz13]

I have BCBS. If the doctor or hospital is a prefered provider, then they agreed to a price with BCBS before hand. Some try to get the patient to pay the difference, but you only owe what BCBS says you owe, not the doctor. I can't tell you how many time they have tried this on me. Let the bills go for a month or two, then make a call. Keep your papers in order. I have a big folder and just match up bills to payments, etc. BCBS also has a web site that you can check status of you bills. I'm lucky. My out of pocket is 1,250. Last years they billed my insurance over 200,000. My part was 1,250. I don't know nor do I care what the insurance paid. But it's some where around 20%. The mark up is terrible. So, wait and don't sweat it. It's harder to get your money back, if you pay too soon. Hugs, Liz

[Shelley (MLC)]

Hi, I agree with Liz about waiting a couple months before sending in payment. I used to send payment in immediately for dental services for the kids, only to find out a month later that the insurance had also paid the Dentist. It was easier at the time to leave the money "on the books", but now I wait a bit to see what's really going on. See if you can get a REAL person on the phone with the insurance company to go over the policy with you. Write down their name and start a file for your mom. I made the mistake of telling my mom what they charge for neulasta and i don't think she slept at all that night, worried about having to pay for it. (Her insurance covered it) Good luck, dealing with the insurance companies can be time consuming and frustrating. Shelley

[Nick C]

I have seen this too...they may send you the bill, but you don't owe that...you only owe what the insurance statemetn you will receive says you owe.

The ins company sent me about 7 pages of items their portion and what I owed.

Every doc bill that came in, I matched up and refused to pay any thing above. After I sent the insurance report with those bills which said what was the patient responsibility...the bill went away.

It sucks to see these large numbers...feels like it almost can make you sicker...don't worry...I think you won't end up owing the numbers you are seeing right now.

[Don M]

I have bcbs. Just make sure that you don't confuse meeting your deductible with catastrophic cap. I think the way it works is that you first have to meet your deductible. Then your insurance will pay the agreed upon amounts. It often is 80%. for my insurance, they pay 70% of the allowed amount for chemo. After I reach $5000 out of pocket costs, they pay 100% of everything.

I have put off switching to an insurance with a lower catastrophic cap because I did not want to plan for having more chemo, hoping that I would not have to do it again, but I think next year I will switch to a lower cap in case I have to do tarceva or taxotere. I will have to pay more deductible and my premiums will be higher, but I will be out $3500 at the end of the year instead of $5000.

Don M

[fillise]

You've gotten some very good advice here. If your mom's insurance is PPO, then the physicians have agreed beforehad to accept "reasonable and customary" costs. I was on a BCBS policy one time where the 'reasonable and customary" part was left off the contract so the doctors and hospitals (doctors office often contract out billing services so they just send whatever the computer generates) billed me for the amount above. I found that if I called the doctor or hospital and asked if they would accept the same payment they do with other BCBS patients (the reasonable and customary charge) 9 out of 10 would. I switched away from the 10th doctor who wouldn't.

That said, do wait. It often takes 2-3 months for everything to sake out.

Susan

[Nova]

I would call the 800 number for the Social Security office. Your Mom may be eligible for SSI payments, which money-wise, is not enough to live on, but it makes you automatically eligible for a Medicaid card.

Harry has one, but we've never had to use it, because his employer is still paying for his health Insurance - (bless thier hearts!), with United Health Care.

I don't know if California is different or not, but you really should call the SS office and talk to them.

Harry was declared eligible the same month he applied for Disability, (in February), but we have to wait until August to get a check.....(They make everyone wait, and you don't get "back pay", unless it takes them longer then 5 months to decide if you are eligible).

Good luck to you,

Nova

PS

If your Mom has a "lot" of savings, you may need to shuffle some of it around, if you know what I mean.....You can PM me if need be.

[tjrasMOM]

Since I've read Lance Armstrong's book, "It's Not About the Bike" I decided to research his foundation. I contacted them asking for help and support for many things....mentioning financial assistance. I was contacted through email immediately by a representative. It wasn't an automated email -- it was an in depth email about our situtation and she explained that she was passing on my information to a social worker through their foundation. Then I received another email today from that social worker asking when she could call me & we could meet. They provide financial and legal help. It's a non-profit. YEAH!! Thank you God! Also, I forgot to mention that I did know about the OUT OF POCKET. I explained all that to Mom today. Man, she was SOOO relieved! Thank you everyone...I printed some responses for her to read herself. Now she can sleep & prepare for chemo tomorrow. =)

[recce101]

What a diff’rence a day makes,

Twenty-four little hours...

My head is still spinning after reading through all this. Amazing! So happy for your mom -- and you!

Aloha,

Ned

[VegasMomOf3]

Hi there,

For example, if your Mom has an in-network co-insurance of 10% and she is seeing a participating provider (in-network physician/lab/hospital, etc) then the negotiated rate is applied toward deductible. For example: your Mom has a test that costs $150, the participating provider & the carrier (BCBS) have already negotiated a set rate for this test, which we will just use an example of $100. Because your Mom's deductible has not yet been met she will owe that $100 to the provider of this test. The balance of $50 is then written off by the provider.

If your Mom has this same test with a non-participating provider(out of network) they can bill what is referred to as "Usual & Customary" charges which can in many cases be higher. Plus, that non-participating provider can balance bill your Mom for the amount that is still unpaid after BCBS & your Mom pay their portions. For example: your Mom has a test with the non-par provider and their usual & customary charge for this test is $400. Your Mom's percentage owed lets say is 25% which is $100. That non-par provider then bills BCBS for $300. Remember my first example where BCBS paid $100 for this test with the participating provider?? Same thing happens here - BCBS will only pay that $100 which leaves a balance owing of $200. That non-par provider can and in most cases will bill your Mom for that $200. Using in-network providers is IMPERATIVE in order to keep your Mom's out of pocket costs down....always ask the provider if they are an "in-network" provider for BCBS prior to utilizing any medical service. In my Mom's case I have alerted everyone in her Pulmonologists office that they MUST use only in-network if referring her out. Even after doing this, I still call the provider my Mom is being referred to AND go online (most insurance carriers have their provider networks online)to double check that the oncologist is indeed an in-network doc AND I call my contact at her insurance carrier to triple check. You MUST take the reigns on this and check, double check and triple check because if for example there is a new employee at the doc's office who tells you "oh sure that lab is in-network" and it ends up not being the case, our Mom's will pay the price.....not that new employee who just made a mistake.

Once your Mom has met her deductible this is how it works: If Mom goes in to see her in-network physician for a follow-up appointment and the cost of this is $75. If her in-network co-insurance is 10%, she would pay the physician $7.50. This $7.50 is the amount that will be applied towards her out-of-pocket maximum. Once the annual out-of-pocket maximum has been met, the carrier (BCBS) will pay 100%.

Your Mom will receive bills and EOB's in the mail. EOB = explanation of benefits come from the carrier (BCBS)and it serves to explain how a service was paid. EOB's will normally state "this is not a bill" on the top......but not always so you will need to be able to recognize a bill from an EOB. Your Mom needs to start a folder that will contain receipts from every service (including prescriptions) she has. Once an EOB comes in, match it up to the proper receipt AND review to verify that it was paid correctly by BCBS - because yes, insurance carriers make mistakes. I know, hard to believe...LOL. They actually make alot of mistakes so it is imperative that you do the checking.

I hope I helped some. Please feel free to contact me with any further questions or issues and I will try my best to help.

That goes for EVERYONE!!!

Be Blessed,

Donna

[yirol]

I hope this is not too off post, but I wanted to add to all of the great and useful posts above. If you have a Gilda's Club in your area, you and your Mom can join for free; and I believe that all or many clubs have pro bono legal and financial advisors tailored to people dealing with cancer and covering insurance issues, etc. Gilda's Club offers other kinds of support as well, including stress-reduction techniques and positive comraderie that every family needs. Success to your Mom and family. DON'T GIVE UP!