› Forums › General Melanoma Community › Insurance Snags???
- This topic has 24 replies, 5 voices, and was last updated 8 years, 7 months ago by
ET-SF.
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- September 12, 2015 at 4:25 am
Hi everyone,
ET and I have been discussing the future treatments she may need to undergo, now that she has been formally staged at IIIb. We understand she is at about a 50% risk of recurrence, and we know that systemic treatments can be insanely expensive. Our discussion quickly turned to our inate distrust of insurance companies, with memories of how they have screwed us in the past. Of course that was then, and this is now. I believe the Affordable Care Act gives us a lot of protections we didn't have.
My question to all of you is this: What sorts of insurance snags might we expect when the insurance company receives a six-figure bill for some treatment? (I bet someone has written a cancer patients' guide to dealing with insurance.) Do insurance companies dictate which treatments you may and may not receive (or at least get reimbursed for)? Do they have policies we should look out for, such as the maximum number of rounds of some immunotherapy you can take (or be reimbursed for)? Or are they truly on the hook to pay for whatever we need, over and above our maximum out-of-pocket expense?
And what happens when an insurance company breaks the law to avoid paying? (We've experienced this with life insurance: Someone dies, and they're supposed to pay… but they refuse… for no reason they can cite…. so we have to take legal action to collect.)
Thanks!
ET and SF
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- September 12, 2015 at 2:27 pm
Let me start by saying that my experience may not be typical. I'm a retired state of Delaware employee, and I have top notch insurance. My insurance covers chemo (including immmunotherapy) at 100%.
I was nervous when my doctor started me on Keytruda after doing ipi. Blue Cross has ipi as an approved treatment for melanoma, but I couldn't find anything in their medical policies about Keytruda, probably because it was new and they hadn't added it to their website. They never batted an eye when they were billed something like $150,000 for my four ipi treatments.
Just yesterday I got a bill for my copay for a couple of doctor visits at the cancer center, and included on that bill was an itemized list of supplies and such for my first two infusions of Keytruda, as well as a line showing where my insurance had paid for it. So I have no worries. I'm also hearing that some doctors are skipping ipi and going right to one of the PD1's even though the FDA hasn't approved them as a first line treatment, and those doctors are getting very little pushback from the insurers.
I can't say whether that experience is typical, but I suspect that most people who have decent insurance will say that their insurance hasn't given them any trouble about paying for expensive treatments. The only thing my doctors may have gotten pushback on is doing a PET vs. a CT scan. One of them told me that most insurance won't pay for more than two PETs a year.
Given that the Affordable Care Act has reined in or eliminated some insurance company practices, such as lifetime caps on benefits, and the medical loss ratio provision requires them to spend more of the money they take in on care, I imagine getting insurance companies to pay for expensive treatments is easier than it was a few years ago.
Best of luck to you.
-Bill
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- September 16, 2015 at 2:57 am
Thanks, Bill! I'm surprised not an eye was batted at the $150k bill, but that's very encouraging. I think by the time we will have the high dollar medical bills, we will also have the best insurance we can buy. We've been chatting with other people about this very issue, and we have found that office nurses are a fountain of information. They see both sides of medical issues — both the treatment and the insurance. We have a few recommendations now as to what companies to use and which to avoid. Hopefully ours will be as good as yours.
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- September 16, 2015 at 2:57 am
Thanks, Bill! I'm surprised not an eye was batted at the $150k bill, but that's very encouraging. I think by the time we will have the high dollar medical bills, we will also have the best insurance we can buy. We've been chatting with other people about this very issue, and we have found that office nurses are a fountain of information. They see both sides of medical issues — both the treatment and the insurance. We have a few recommendations now as to what companies to use and which to avoid. Hopefully ours will be as good as yours.
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- September 16, 2015 at 2:57 am
Thanks, Bill! I'm surprised not an eye was batted at the $150k bill, but that's very encouraging. I think by the time we will have the high dollar medical bills, we will also have the best insurance we can buy. We've been chatting with other people about this very issue, and we have found that office nurses are a fountain of information. They see both sides of medical issues — both the treatment and the insurance. We have a few recommendations now as to what companies to use and which to avoid. Hopefully ours will be as good as yours.
-
- September 12, 2015 at 2:27 pm
Let me start by saying that my experience may not be typical. I'm a retired state of Delaware employee, and I have top notch insurance. My insurance covers chemo (including immmunotherapy) at 100%.
I was nervous when my doctor started me on Keytruda after doing ipi. Blue Cross has ipi as an approved treatment for melanoma, but I couldn't find anything in their medical policies about Keytruda, probably because it was new and they hadn't added it to their website. They never batted an eye when they were billed something like $150,000 for my four ipi treatments.
Just yesterday I got a bill for my copay for a couple of doctor visits at the cancer center, and included on that bill was an itemized list of supplies and such for my first two infusions of Keytruda, as well as a line showing where my insurance had paid for it. So I have no worries. I'm also hearing that some doctors are skipping ipi and going right to one of the PD1's even though the FDA hasn't approved them as a first line treatment, and those doctors are getting very little pushback from the insurers.
I can't say whether that experience is typical, but I suspect that most people who have decent insurance will say that their insurance hasn't given them any trouble about paying for expensive treatments. The only thing my doctors may have gotten pushback on is doing a PET vs. a CT scan. One of them told me that most insurance won't pay for more than two PETs a year.
Given that the Affordable Care Act has reined in or eliminated some insurance company practices, such as lifetime caps on benefits, and the medical loss ratio provision requires them to spend more of the money they take in on care, I imagine getting insurance companies to pay for expensive treatments is easier than it was a few years ago.
Best of luck to you.
-Bill
-
- September 12, 2015 at 2:27 pm
Let me start by saying that my experience may not be typical. I'm a retired state of Delaware employee, and I have top notch insurance. My insurance covers chemo (including immmunotherapy) at 100%.
I was nervous when my doctor started me on Keytruda after doing ipi. Blue Cross has ipi as an approved treatment for melanoma, but I couldn't find anything in their medical policies about Keytruda, probably because it was new and they hadn't added it to their website. They never batted an eye when they were billed something like $150,000 for my four ipi treatments.
Just yesterday I got a bill for my copay for a couple of doctor visits at the cancer center, and included on that bill was an itemized list of supplies and such for my first two infusions of Keytruda, as well as a line showing where my insurance had paid for it. So I have no worries. I'm also hearing that some doctors are skipping ipi and going right to one of the PD1's even though the FDA hasn't approved them as a first line treatment, and those doctors are getting very little pushback from the insurers.
I can't say whether that experience is typical, but I suspect that most people who have decent insurance will say that their insurance hasn't given them any trouble about paying for expensive treatments. The only thing my doctors may have gotten pushback on is doing a PET vs. a CT scan. One of them told me that most insurance won't pay for more than two PETs a year.
Given that the Affordable Care Act has reined in or eliminated some insurance company practices, such as lifetime caps on benefits, and the medical loss ratio provision requires them to spend more of the money they take in on care, I imagine getting insurance companies to pay for expensive treatments is easier than it was a few years ago.
Best of luck to you.
-Bill
-
- September 12, 2015 at 2:27 pm
Let me start by saying that my experience may not be typical. I'm a retired state of Delaware employee, and I have top notch insurance. My insurance covers chemo (including immmunotherapy) at 100%.
I was nervous when my doctor started me on Keytruda after doing ipi. Blue Cross has ipi as an approved treatment for melanoma, but I couldn't find anything in their medical policies about Keytruda, probably because it was new and they hadn't added it to their website. They never batted an eye when they were billed something like $150,000 for my four ipi treatments.
Just yesterday I got a bill for my copay for a couple of doctor visits at the cancer center, and included on that bill was an itemized list of supplies and such for my first two infusions of Keytruda, as well as a line showing where my insurance had paid for it. So I have no worries. I'm also hearing that some doctors are skipping ipi and going right to one of the PD1's even though the FDA hasn't approved them as a first line treatment, and those doctors are getting very little pushback from the insurers.
I can't say whether that experience is typical, but I suspect that most people who have decent insurance will say that their insurance hasn't given them any trouble about paying for expensive treatments. The only thing my doctors may have gotten pushback on is doing a PET vs. a CT scan. One of them told me that most insurance won't pay for more than two PETs a year.
Given that the Affordable Care Act has reined in or eliminated some insurance company practices, such as lifetime caps on benefits, and the medical loss ratio provision requires them to spend more of the money they take in on care, I imagine getting insurance companies to pay for expensive treatments is easier than it was a few years ago.
Best of luck to you.
-Bill
-
- September 12, 2015 at 2:27 pm
Let me start by saying that my experience may not be typical. I'm a retired state of Delaware employee, and I have top notch insurance. My insurance covers chemo (including immmunotherapy) at 100%.
I was nervous when my doctor started me on Keytruda after doing ipi. Blue Cross has ipi as an approved treatment for melanoma, but I couldn't find anything in their medical policies about Keytruda, probably because it was new and they hadn't added it to their website. They never batted an eye when they were billed something like $150,000 for my four ipi treatments.
Just yesterday I got a bill for my copay for a couple of doctor visits at the cancer center, and included on that bill was an itemized list of supplies and such for my first two infusions of Keytruda, as well as a line showing where my insurance had paid for it. So I have no worries. I'm also hearing that some doctors are skipping ipi and going right to one of the PD1's even though the FDA hasn't approved them as a first line treatment, and those doctors are getting very little pushback from the insurers.
I can't say whether that experience is typical, but I suspect that most people who have decent insurance will say that their insurance hasn't given them any trouble about paying for expensive treatments. The only thing my doctors may have gotten pushback on is doing a PET vs. a CT scan. One of them told me that most insurance won't pay for more than two PETs a year.
Given that the Affordable Care Act has reined in or eliminated some insurance company practices, such as lifetime caps on benefits, and the medical loss ratio provision requires them to spend more of the money they take in on care, I imagine getting insurance companies to pay for expensive treatments is easier than it was a few years ago.
Best of luck to you.
-Bill
-
- September 12, 2015 at 2:27 pm
Let me start by saying that my experience may not be typical. I'm a retired state of Delaware employee, and I have top notch insurance. My insurance covers chemo (including immmunotherapy) at 100%.
I was nervous when my doctor started me on Keytruda after doing ipi. Blue Cross has ipi as an approved treatment for melanoma, but I couldn't find anything in their medical policies about Keytruda, probably because it was new and they hadn't added it to their website. They never batted an eye when they were billed something like $150,000 for my four ipi treatments.
Just yesterday I got a bill for my copay for a couple of doctor visits at the cancer center, and included on that bill was an itemized list of supplies and such for my first two infusions of Keytruda, as well as a line showing where my insurance had paid for it. So I have no worries. I'm also hearing that some doctors are skipping ipi and going right to one of the PD1's even though the FDA hasn't approved them as a first line treatment, and those doctors are getting very little pushback from the insurers.
I can't say whether that experience is typical, but I suspect that most people who have decent insurance will say that their insurance hasn't given them any trouble about paying for expensive treatments. The only thing my doctors may have gotten pushback on is doing a PET vs. a CT scan. One of them told me that most insurance won't pay for more than two PETs a year.
Given that the Affordable Care Act has reined in or eliminated some insurance company practices, such as lifetime caps on benefits, and the medical loss ratio provision requires them to spend more of the money they take in on care, I imagine getting insurance companies to pay for expensive treatments is easier than it was a few years ago.
Best of luck to you.
-Bill
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- September 12, 2015 at 8:49 pm
Your Dr.'s office can and should contact the insurance company and get pre-authorization for treatment. Almost all HMO's require this anyway.
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- September 15, 2015 at 1:00 pm
I make sure I've received authorization from my insurance company prior to my MRI's, CT Scans, surgery, infusions, and so on. I check the authorizations carefully to make sure they are covering what was requested. I take the hard copy(ies) with me to the appointments just in case. For Keytruda, I was authorized for a year at time of treatments. I also take a copy of my list of medications, doctors, and surgeries to all my appointments. It makes filling out the paperwork much easier because I just write "see attached" where they ask to list medications, etc. I keep all my info in binders.
Best wishes!
Terrie
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- September 16, 2015 at 3:08 am
Wow, you're organized! We haven't been getting everything preauthorized, but we'll start doing that. So far we haven't hit any snags. Surgery was $20k, and we were billed for $200 of it, which we expected. Office visits have been $15. Our biggest fear is that some new administration tears the Affordable Care Act apart, such that we are subject to pre-Obamacare insurance practices. That would really hurt right now!
Like you, we carry our records with us. We have about an inch of paperwork so far that we haul around with us, and I've bought a little tablet w/ keyboard just for insecure networks (e.g. in hospitals) I have a huge thumb drive that I can plug in (secure connection) or unplug (insecure) that has all of ET's info on it. Ask me for any document, and I can fax you a pdf in a couple of minutes with a few clicks. I imagine our typical day would take a week if I didn't have our information organized this way!
I like your "see attached" approach. We'll have to do that!
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- September 16, 2015 at 3:08 am
Wow, you're organized! We haven't been getting everything preauthorized, but we'll start doing that. So far we haven't hit any snags. Surgery was $20k, and we were billed for $200 of it, which we expected. Office visits have been $15. Our biggest fear is that some new administration tears the Affordable Care Act apart, such that we are subject to pre-Obamacare insurance practices. That would really hurt right now!
Like you, we carry our records with us. We have about an inch of paperwork so far that we haul around with us, and I've bought a little tablet w/ keyboard just for insecure networks (e.g. in hospitals) I have a huge thumb drive that I can plug in (secure connection) or unplug (insecure) that has all of ET's info on it. Ask me for any document, and I can fax you a pdf in a couple of minutes with a few clicks. I imagine our typical day would take a week if I didn't have our information organized this way!
I like your "see attached" approach. We'll have to do that!
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- September 16, 2015 at 3:08 am
Wow, you're organized! We haven't been getting everything preauthorized, but we'll start doing that. So far we haven't hit any snags. Surgery was $20k, and we were billed for $200 of it, which we expected. Office visits have been $15. Our biggest fear is that some new administration tears the Affordable Care Act apart, such that we are subject to pre-Obamacare insurance practices. That would really hurt right now!
Like you, we carry our records with us. We have about an inch of paperwork so far that we haul around with us, and I've bought a little tablet w/ keyboard just for insecure networks (e.g. in hospitals) I have a huge thumb drive that I can plug in (secure connection) or unplug (insecure) that has all of ET's info on it. Ask me for any document, and I can fax you a pdf in a couple of minutes with a few clicks. I imagine our typical day would take a week if I didn't have our information organized this way!
I like your "see attached" approach. We'll have to do that!
-
- September 15, 2015 at 1:00 pm
I make sure I've received authorization from my insurance company prior to my MRI's, CT Scans, surgery, infusions, and so on. I check the authorizations carefully to make sure they are covering what was requested. I take the hard copy(ies) with me to the appointments just in case. For Keytruda, I was authorized for a year at time of treatments. I also take a copy of my list of medications, doctors, and surgeries to all my appointments. It makes filling out the paperwork much easier because I just write "see attached" where they ask to list medications, etc. I keep all my info in binders.
Best wishes!
Terrie
-
- September 15, 2015 at 1:00 pm
I make sure I've received authorization from my insurance company prior to my MRI's, CT Scans, surgery, infusions, and so on. I check the authorizations carefully to make sure they are covering what was requested. I take the hard copy(ies) with me to the appointments just in case. For Keytruda, I was authorized for a year at time of treatments. I also take a copy of my list of medications, doctors, and surgeries to all my appointments. It makes filling out the paperwork much easier because I just write "see attached" where they ask to list medications, etc. I keep all my info in binders.
Best wishes!
Terrie
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- September 16, 2015 at 3:43 pm
For what it's worth, my insurance has been fantastic. I have Blue Cross Blue Shield, and my out-of-pocket max is $2100. I'm stage 3a, had two surgeries, did 4 weeks of daily interferon infusions (M-F) that were about $5K-$6K per day, and am now doing interferon injections (over $5000 per month). Once I hit my out-of-pocket max, I haven't paid a dime (aside from the insurance year resetting July 1st and having to max out again).
I have had no issues at all with them trying to weasel out of paying for anything! I hope things go as smoothly for you!
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- September 16, 2015 at 3:43 pm
For what it's worth, my insurance has been fantastic. I have Blue Cross Blue Shield, and my out-of-pocket max is $2100. I'm stage 3a, had two surgeries, did 4 weeks of daily interferon infusions (M-F) that were about $5K-$6K per day, and am now doing interferon injections (over $5000 per month). Once I hit my out-of-pocket max, I haven't paid a dime (aside from the insurance year resetting July 1st and having to max out again).
I have had no issues at all with them trying to weasel out of paying for anything! I hope things go as smoothly for you!
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- September 16, 2015 at 3:43 pm
For what it's worth, my insurance has been fantastic. I have Blue Cross Blue Shield, and my out-of-pocket max is $2100. I'm stage 3a, had two surgeries, did 4 weeks of daily interferon infusions (M-F) that were about $5K-$6K per day, and am now doing interferon injections (over $5000 per month). Once I hit my out-of-pocket max, I haven't paid a dime (aside from the insurance year resetting July 1st and having to max out again).
I have had no issues at all with them trying to weasel out of paying for anything! I hope things go as smoothly for you!
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