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Well this is a pain in the you know what…
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Well this is a pain in the you know what…

› Forums › General Melanoma Community › Well this is a pain in the you know what…

  • Post
    • September 9, 2016 at 3:26 pm
    miaka618
    Participant
      Hey all. I have been a relatively quiet observer of this forum since I was diagnosed back in March. My primary was on my right temple. I had a wide local excision and a sentinel node biopsy, 3 nodes coming back positive, and a neck dissection, all coming back negative. We discussed my next step and decided to go up to Madison to the UW Madison Carbone Cancer Center for a clinical trial.

      My first sign of trouble was when I drove up there to get an MRI and a pet scan, 2 hour drive. I get there I was told there was none scheduled for me even though I had a letter in my hand with all of the appointment info. After some calling around it was discovered that my insurance company wasn’t going to cover the scans so they canceled them but forgot to inform me. I ended up getting the scans locally and everything seems honky dory for me to start the trial. I get randomized and find out I was put in the ipi arm of the trial. Now at this point I assumed I would have to receive my infusions locally because of the insurance thing but they informed me that I was pre-approved and could get my infusions at the UW hospital. Cool. Fast forward 3 weeks to my second scheduled infusion. (yesterday) I get there and do all the normal appointment stuff and head to the chemo room. My cancer coordinator grabs me and says the doctor wants to see me again. I sit down in his office and he informs me that I have a $270,000 bill because the insurance was not covering my care at the hospital and he had to cancel my infusion to prevent more unnecessary charges. I was floored by this. I guess what had happened was when they called to get approval they called the wrong insurance and instead of looking up my information, the insurance company told them there was no prior authorisation necessary for this particular treatment…. Sheesh…

      I am told they are working with my insurance company and my primary care doctor to try to work this out, but that is a hell of an expensive mistake. Is this my fault for not calling the insurance company to make sure I was approved? I have no idea what I need to do to fix this and there is absolutely no way I can pay it. If I would have skipped the trial, I wouldn’t even be here, but nobody is psychic. I’m at a loss.

      April

    Viewing 5 reply threads
    • Replies
        • September 9, 2016 at 4:14 pm
        Bubbles
        Participant

          Sorry April!!

          Can I just say (for the zillionth time)???  I HATE INSURANCE COMPANIES!!!!  Keep fighting the insurance company!!!  Your doc and the oncologist and his team can appeal…and re-appeal, and re-appeal.  A good thing about the Affordable Care Act (among many things) is that is made it illegal for an insurance company to refuse to pay for patient participation in clinical trials. Insurance companies know this….but like to pretend to they do not!!!  And it your scans were needed for your care…they should be covered.  And if scans were needed for trial participation…another reason..they should be covered.  It is not right for patients to deal with disease, side effects, AND insurance battles…but sadly….there you go.  Hang in there.  Keep fighting!!!

          In case it helps to feel that you are not alone…  Here is a loooong post about my most recent battle with Blue Cross Blue Shield who denied coverage of my brain MRI.  (After many hoops and appeals…I finally gained coverage.)

          http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/08/and-then-theres-me.html

          I wish you my best.  Celeste

            • September 10, 2016 at 1:36 pm
            miaka618
            Participant
              Thanks Celeste! I think we may have a solution, but it’s going to take time. In the meantime I’m missing out on my treatments and I don’t know how it will effect my outcome.
              • September 10, 2016 at 2:17 pm
              Patrick O.
              Participant
                Praying it gets resolved fast for ya Miaka!
                • September 10, 2016 at 2:17 pm
                Patrick O.
                Participant
                  Praying it gets resolved fast for ya Miaka!
                  • September 10, 2016 at 2:17 pm
                  Patrick O.
                  Participant
                    Praying it gets resolved fast for ya Miaka!
                    • September 10, 2016 at 1:36 pm
                    miaka618
                    Participant
                      Thanks Celeste! I think we may have a solution, but it’s going to take time. In the meantime I’m missing out on my treatments and I don’t know how it will effect my outcome.
                      • September 10, 2016 at 1:36 pm
                      miaka618
                      Participant
                        Thanks Celeste! I think we may have a solution, but it’s going to take time. In the meantime I’m missing out on my treatments and I don’t know how it will effect my outcome.
                      • September 9, 2016 at 4:14 pm
                      Bubbles
                      Participant

                        Sorry April!!

                        Can I just say (for the zillionth time)???  I HATE INSURANCE COMPANIES!!!!  Keep fighting the insurance company!!!  Your doc and the oncologist and his team can appeal…and re-appeal, and re-appeal.  A good thing about the Affordable Care Act (among many things) is that is made it illegal for an insurance company to refuse to pay for patient participation in clinical trials. Insurance companies know this….but like to pretend to they do not!!!  And it your scans were needed for your care…they should be covered.  And if scans were needed for trial participation…another reason..they should be covered.  It is not right for patients to deal with disease, side effects, AND insurance battles…but sadly….there you go.  Hang in there.  Keep fighting!!!

                        In case it helps to feel that you are not alone…  Here is a loooong post about my most recent battle with Blue Cross Blue Shield who denied coverage of my brain MRI.  (After many hoops and appeals…I finally gained coverage.)

                        http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/08/and-then-theres-me.html

                        I wish you my best.  Celeste

                        • September 9, 2016 at 4:14 pm
                        Bubbles
                        Participant

                          Sorry April!!

                          Can I just say (for the zillionth time)???  I HATE INSURANCE COMPANIES!!!!  Keep fighting the insurance company!!!  Your doc and the oncologist and his team can appeal…and re-appeal, and re-appeal.  A good thing about the Affordable Care Act (among many things) is that is made it illegal for an insurance company to refuse to pay for patient participation in clinical trials. Insurance companies know this….but like to pretend to they do not!!!  And it your scans were needed for your care…they should be covered.  And if scans were needed for trial participation…another reason..they should be covered.  It is not right for patients to deal with disease, side effects, AND insurance battles…but sadly….there you go.  Hang in there.  Keep fighting!!!

                          In case it helps to feel that you are not alone…  Here is a loooong post about my most recent battle with Blue Cross Blue Shield who denied coverage of my brain MRI.  (After many hoops and appeals…I finally gained coverage.)

                          http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/08/and-then-theres-me.html

                          I wish you my best.  Celeste

                          • September 11, 2016 at 3:14 am
                          JoshF
                          Participant

                            Don't think you're in the wrong at all. Dealing with this disease for over 5 years I've hit speed bumps with insurance. Celeste said it perfectly. The oncologist office should work with insurance company to get this resolved. Sorry you have to deal with this…especially while you're going through treatment etc… 

                            Josh

                            • September 11, 2016 at 3:14 am
                            JoshF
                            Participant

                              Don't think you're in the wrong at all. Dealing with this disease for over 5 years I've hit speed bumps with insurance. Celeste said it perfectly. The oncologist office should work with insurance company to get this resolved. Sorry you have to deal with this…especially while you're going through treatment etc… 

                              Josh

                              • September 11, 2016 at 3:14 am
                              JoshF
                              Participant

                                Don't think you're in the wrong at all. Dealing with this disease for over 5 years I've hit speed bumps with insurance. Celeste said it perfectly. The oncologist office should work with insurance company to get this resolved. Sorry you have to deal with this…especially while you're going through treatment etc… 

                                Josh

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