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MD Anderson/BCBS Billing Battle
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MD Anderson/BCBS Billing Battle

› Forums › Cutaneous Melanoma Community › MD Anderson/BCBS Billing Battle

  • Post
    • November 3, 2015 at 4:01 pm
    AshleyS
    Participant

      Hey folks,

      When I was diagnosed Stage IV in December of 2014, my doctors at Mayo Clinic in Rochester, MN put me on chemotherapy.  After doing my own  research and visiting MPIP, I switched my care to MD Anderson and found a melanoma specialist. 

      My doc discussed many different treatment options with me. I had mets throughout my liver and subcutaneous tumors in 3 different locations. We decided I would go on the Ipi/Nivo combo (then) trial. We also decided to use TIL as a backup. 

      On March 6 of this year I had surgery to harvest a tumor for future TIL use. It was successful and my melanoma cells are sitting in some lab in Texas in case I ever need it. 

      However, the bill (over $4,000) is still circling among MD Anderson, Blue Cross Blue Shield, and us. Here are my questions:

      1) Since it's MDA's research, should they pay for part. 

      2) Since it is technically part of my long-term treatment, should BCBS pay?

      3) Did we not ask the right questions at the time and now need to pay for this experimental Mopath procedure?

      I'd appreciate any thoughts or advice. Right now I'm trying to decide if I should file a grievance letter with BCBS and MDA since the circling has come to a halt – it's no longer in the "pending" column on our insurance statement. We are coming up on one year and want to get it taken care of before it goes to collections. 

      Thanks,

      Ashley

    Viewing 5 reply threads
    • Replies
        • November 3, 2015 at 4:34 pm
        arthurjedi007
        Participant

          No idea. 4000 is a large bill but considering the huge cost of ipi and pd1 that is tiny. Insurance is weird. It might be part of your annual deductible but I doubt it. The cost of til harvest probably was more than that but I dunno. They did thst for me at mda but I haven't seen the costs yet plus since it was all necrotic it didn't work. Stupid biopsy doc wouldn't listen and take what was on he edges and only took the center which I told him was necrotic. I'm still very upset about that.

          Long before this nightmare I argued a bill and they pulled some different rate change thing on me so I ended up having to pay more. So any more I just pay it and thankful I only have to pay a small part. But I haven't had them say I owe that large of an amount yet. So I dunno what I would do.

          Artie

            • November 3, 2015 at 4:44 pm
            AshleyS
            Participant

              Thanks Artie. I'm sorry I haven't responded to some of your recent posts. (I have an 11 month old who is starting to walk and a three-year-old who thinks she's his boss. Life is busy!) However, I'm mad at MDA on your behalf. I so badly hoped you'd have the experience I did. 

              This is the only billing issue we've had. You're right though, it's not the entire bill. This is just for the "Mopath Procedure." I did Google that and found this source:

              http://genomeinformaticsalliance.org/clinical/diagnostics/reimbursement/education.

              Thanks for the reply, Artie. 

              Ashley

              • November 3, 2015 at 4:44 pm
              AshleyS
              Participant

                Thanks Artie. I'm sorry I haven't responded to some of your recent posts. (I have an 11 month old who is starting to walk and a three-year-old who thinks she's his boss. Life is busy!) However, I'm mad at MDA on your behalf. I so badly hoped you'd have the experience I did. 

                This is the only billing issue we've had. You're right though, it's not the entire bill. This is just for the "Mopath Procedure." I did Google that and found this source:

                http://genomeinformaticsalliance.org/clinical/diagnostics/reimbursement/education.

                Thanks for the reply, Artie. 

                Ashley

                • November 3, 2015 at 4:44 pm
                AshleyS
                Participant

                  Thanks Artie. I'm sorry I haven't responded to some of your recent posts. (I have an 11 month old who is starting to walk and a three-year-old who thinks she's his boss. Life is busy!) However, I'm mad at MDA on your behalf. I so badly hoped you'd have the experience I did. 

                  This is the only billing issue we've had. You're right though, it's not the entire bill. This is just for the "Mopath Procedure." I did Google that and found this source:

                  http://genomeinformaticsalliance.org/clinical/diagnostics/reimbursement/education.

                  Thanks for the reply, Artie. 

                  Ashley

                • November 3, 2015 at 4:34 pm
                arthurjedi007
                Participant

                  No idea. 4000 is a large bill but considering the huge cost of ipi and pd1 that is tiny. Insurance is weird. It might be part of your annual deductible but I doubt it. The cost of til harvest probably was more than that but I dunno. They did thst for me at mda but I haven't seen the costs yet plus since it was all necrotic it didn't work. Stupid biopsy doc wouldn't listen and take what was on he edges and only took the center which I told him was necrotic. I'm still very upset about that.

                  Long before this nightmare I argued a bill and they pulled some different rate change thing on me so I ended up having to pay more. So any more I just pay it and thankful I only have to pay a small part. But I haven't had them say I owe that large of an amount yet. So I dunno what I would do.

                  Artie

                  • November 3, 2015 at 4:34 pm
                  arthurjedi007
                  Participant

                    No idea. 4000 is a large bill but considering the huge cost of ipi and pd1 that is tiny. Insurance is weird. It might be part of your annual deductible but I doubt it. The cost of til harvest probably was more than that but I dunno. They did thst for me at mda but I haven't seen the costs yet plus since it was all necrotic it didn't work. Stupid biopsy doc wouldn't listen and take what was on he edges and only took the center which I told him was necrotic. I'm still very upset about that.

                    Long before this nightmare I argued a bill and they pulled some different rate change thing on me so I ended up having to pay more. So any more I just pay it and thankful I only have to pay a small part. But I haven't had them say I owe that large of an amount yet. So I dunno what I would do.

                    Artie

                    • November 3, 2015 at 10:32 pm
                    geriakt
                    Participant

                      I would think your biopsy would fall under "Standard of Care" and sent to your insurance. I do not think it would be covered by the Trial.  Before any surgery could happen it needs to be pre approved by your insurance. Did someone not get the approval?

                      Insurance would not pay for "cosmetic" surgery and I would not see how this would not be a standard of care for diagnose and treatment if you need to have the tumor gene tested.

                      Tom

                      • November 3, 2015 at 10:32 pm
                      geriakt
                      Participant

                        I would think your biopsy would fall under "Standard of Care" and sent to your insurance. I do not think it would be covered by the Trial.  Before any surgery could happen it needs to be pre approved by your insurance. Did someone not get the approval?

                        Insurance would not pay for "cosmetic" surgery and I would not see how this would not be a standard of care for diagnose and treatment if you need to have the tumor gene tested.

                        Tom

                        • November 3, 2015 at 10:32 pm
                        geriakt
                        Participant

                          I would think your biopsy would fall under "Standard of Care" and sent to your insurance. I do not think it would be covered by the Trial.  Before any surgery could happen it needs to be pre approved by your insurance. Did someone not get the approval?

                          Insurance would not pay for "cosmetic" surgery and I would not see how this would not be a standard of care for diagnose and treatment if you need to have the tumor gene tested.

                          Tom

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