Understanding insurance coverage

I think everyone's insurance coverage is different. 

I think everyone's insurance coverage is different. 

I think everyone's insurance coverage is different. 

Hi,

Treatment order and como treatments seem to be a hot topic and knowledge and practice is changing fast.

Keytruda and Nivo are both PD1 and use similar though not identical pathways.

Ipi uses another – but has more side effects- but results from the combo are better than what you might expect .. downside bigger side effects.

Looks like using mutiple approaches may help the immunotherapy identify what it needs to target more efficiently- eg radiation of tumour helps immunotherapy identify and destroy the bad guys esp if at the same time or given in short succession.

As for insurance- thats another ball game but Celeste seems to be very knowledgeable on appeals / insurance issues/ how to navigate insurance and clinical trials so I would have a look on her blog.

You will find that having taken one treatment might exclude you from a trial of another  and depending on your tumour burden and general health treatments might be tailored to individuals depending on if they are likely to withstand greater side effects.

Yes , it is all clear as mud … but try to get your expert to spell out options and pros and cons.

Best of luck

Deb

Hi,

Treatment order and como treatments seem to be a hot topic and knowledge and practice is changing fast.

Keytruda and Nivo are both PD1 and use similar though not identical pathways.

Ipi uses another – but has more side effects- but results from the combo are better than what you might expect .. downside bigger side effects.

Looks like using mutiple approaches may help the immunotherapy identify what it needs to target more efficiently- eg radiation of tumour helps immunotherapy identify and destroy the bad guys esp if at the same time or given in short succession.

As for insurance- thats another ball game but Celeste seems to be very knowledgeable on appeals / insurance issues/ how to navigate insurance and clinical trials so I would have a look on her blog.

You will find that having taken one treatment might exclude you from a trial of another  and depending on your tumour burden and general health treatments might be tailored to individuals depending on if they are likely to withstand greater side effects.

Yes , it is all clear as mud … but try to get your expert to spell out options and pros and cons.

Best of luck

Deb

Hi,

Treatment order and como treatments seem to be a hot topic and knowledge and practice is changing fast.

Keytruda and Nivo are both PD1 and use similar though not identical pathways.

Ipi uses another – but has more side effects- but results from the combo are better than what you might expect .. downside bigger side effects.

Looks like using mutiple approaches may help the immunotherapy identify what it needs to target more efficiently- eg radiation of tumour helps immunotherapy identify and destroy the bad guys esp if at the same time or given in short succession.

As for insurance- thats another ball game but Celeste seems to be very knowledgeable on appeals / insurance issues/ how to navigate insurance and clinical trials so I would have a look on her blog.

You will find that having taken one treatment might exclude you from a trial of another  and depending on your tumour burden and general health treatments might be tailored to individuals depending on if they are likely to withstand greater side effects.

Yes , it is all clear as mud … but try to get your expert to spell out options and pros and cons.

Best of luck

Deb

Hello Anon,

With "Open Enrollment" coming up next month this is a great topic and I hope many chime in.  For me it was simple, I knew I would a heavy user of the system facing a stage IV diagnosis.  Since I was self-employed, I had no choice but to utilize the insurance marketplace established through the ACA and with no health questions, you simply purchase the plan you want, and/or can afford.  Not that I can afford it, but I choose the most expensive "platinum" plan and although it has the highest premium, it also has the most comprehensive coverage.  So despite paying what amounts to a mortgage payment for many people, my coverage has been awesome, and compared to cost of care, a miniscule fraction.  Rates and out -of-pocket deductibles keep going up every year but really, you have no choice if you're late stage and see a future using the most modern drug treatments.  Finally, regarding what triggers an insurance denial, it mostly is "progression".  Insurance does not want to keep paying for a treatment that is not working.  In the care of a specialist, you will keep trying new things whether FDA approved or trials (which still rely on insurance coverage).  My only problems I've encountered besides progression is scan that were not pre-authorized and my doctors have always managed to get after the fact reversals.

Gary

Hello Anon,

With "Open Enrollment" coming up next month this is a great topic and I hope many chime in.  For me it was simple, I knew I would a heavy user of the system facing a stage IV diagnosis.  Since I was self-employed, I had no choice but to utilize the insurance marketplace established through the ACA and with no health questions, you simply purchase the plan you want, and/or can afford.  Not that I can afford it, but I choose the most expensive "platinum" plan and although it has the highest premium, it also has the most comprehensive coverage.  So despite paying what amounts to a mortgage payment for many people, my coverage has been awesome, and compared to cost of care, a miniscule fraction.  Rates and out -of-pocket deductibles keep going up every year but really, you have no choice if you're late stage and see a future using the most modern drug treatments.  Finally, regarding what triggers an insurance denial, it mostly is "progression".  Insurance does not want to keep paying for a treatment that is not working.  In the care of a specialist, you will keep trying new things whether FDA approved or trials (which still rely on insurance coverage).  My only problems I've encountered besides progression is scan that were not pre-authorized and my doctors have always managed to get after the fact reversals.

Gary

Hello Anon,

With "Open Enrollment" coming up next month this is a great topic and I hope many chime in.  For me it was simple, I knew I would a heavy user of the system facing a stage IV diagnosis.  Since I was self-employed, I had no choice but to utilize the insurance marketplace established through the ACA and with no health questions, you simply purchase the plan you want, and/or can afford.  Not that I can afford it, but I choose the most expensive "platinum" plan and although it has the highest premium, it also has the most comprehensive coverage.  So despite paying what amounts to a mortgage payment for many people, my coverage has been awesome, and compared to cost of care, a miniscule fraction.  Rates and out -of-pocket deductibles keep going up every year but really, you have no choice if you're late stage and see a future using the most modern drug treatments.  Finally, regarding what triggers an insurance denial, it mostly is "progression".  Insurance does not want to keep paying for a treatment that is not working.  In the care of a specialist, you will keep trying new things whether FDA approved or trials (which still rely on insurance coverage).  My only problems I've encountered besides progression is scan that were not pre-authorized and my doctors have always managed to get after the fact reversals.

Gary