• Insurance Companies, The Good, Bad and Ugly of your experience. What has this part of your journey been like? Got any tips?

    Asked by steve70x7 on Tuesday, April 24, 2012

    Insurance Companies, The Good, Bad and Ugly of your experience. What has this part of your journey been like? Got any tips?

    I have been blessed with our insurance situation, but.......... Judy has to check and double check every charge. We have gotten many bogus bills, charging for services not rendered and my wife spends several hours a week on the phone getting these worked out.

    We are also VERY thankful that we have prescription coverage! The Nexavar that I may end up taking is $10,000 for a three month supply! It makes me wonder about pharmaceutical companies???

    6 Answers from the Community

    6 answers
    • GregP_WN's Avatar
      GregP_WN

      times have changed! 24 years ago when I was first diagnosed I was an agent for an insurance company. Used to be, when you had an 80/20 major med policy, thats exactly what it was, and it didn't take 6 months to get paid. Now, every charge is scrutinized by the ins. company, they have people hired to try to deny your claim, what little does get paid takes 6 months, and then you have to call them constantly to put a fire under them. On the other side, the Dr.s and hospitals used to be here primarily to provide health care and be sure you get better. Now, it's "insurance card please" first, then we will see if you get anything. Test's are ordered to make sure the million dollar machine gets paid for. In three different cancer journeys, I have seen it slowly go downhill. It's sad now.

      almost 5 years ago
    • CarolLHRN's Avatar
      CarolLHRN

      I am very fortunate that I haven't had any bad experiences with my insurance company. In a past life, I was a case manager at an insurance company and I can give a few tips:
      1. Keep all of your receipts from the MD offices and all of the EOB's that come from the insurance company. Be sure they are correct.
      2. Obtain a booklet or look on line for specific coverage information including out of pocket expenses, copayments and annual max out of pocket. The booklet should also give you information on what is covered and what is not.
      3. If at all possible, stay in network. Not only will this save you money but claims are handled much better. A contracted doctor can not balance bill you but an out of network doctor can.
      4. If you feel like you are lost with coverage or with your treatment plan, ask for a case manager. This is a free service. The case manager can help you walk through the process, find out specific coverage information and be a source for health information. Oncology patients are very expensive to insurance companies so they encourage work with a case manager to help manage the costs but there are benefits to the patient as well.

      I hope this information helps. Good luck!

      almost 5 years ago
    • abrub's Avatar
      abrub

      My insurance has been fantastic. United HealthCare has a program on some of its policies called "Cancer Resource Services". If you enroll in that program (and if your policy offers it, you can enroll) if you are treated at one of the UHC "Centers of Excellence" your care is covered at 100% - no copays. If you need to travel over 100 miles to get to the facility, your travel expenses (for you and a caregiver) are also covered. I travel 170 miles to Sloan Kettering, get superb care, and need no approvals for anything they want to do. I'm very fortunate.

      almost 5 years ago
    • Cindy's Avatar
      Cindy

      I have Blue Cross Blue Shield and they have been excellent. Since my doctors' and the hospitals I used were preferred providers, my treatments were at their negotiated rates and my insurance paid at a higher percentage. I only protested them not paying for all of my mammogram. They said they did not pay all of it because they only pay all of the price for preventative mammograms not diagnostic ones. But they paid for all of it after my husband explained that I had ovarian cancer with no symptoms of breast cancer.

      I did have a problem with my oncologist's receptionist who knew very little about insurance when I came in for my first chemo treatment. After waiting about 2 and a half hours or more in the waiting room and seeing people go in that came after me, I asked if she forgot to call me in. She said that she was waiting to figure out how much co-insurance I needed to pay. She insisted that I needed to pay thousands of dollars for my co-pay or set up a payment plan. After all was straitened out it was a few hundred dollars I needed for the co-pay for each chemo treatment. She got my co-pay mixed up with my catastrophic insurance and told me the percentage I needed to pay that was for a non-preferred provider rather than a preferred provider and probably did not account for the negotiated rate. I was very upset having to get this straightened out when I was already stressed out worrying about what side affects I would have with my first chemo treatment. So, I would recommend getting the insurance straightened out prior to someone getting their first chemo treatment.

      almost 5 years ago
    • mykidshavepaws' Avatar
      mykidshavepaws

      I am in an HMO Medicare Advantage Plan. It's pitiful what they actually pay for the services provided. It's no wonder that volume is the norm - that less time with physicians, more waiting, etc. I have become very stressed over billing issues and like Cindy, was overcharged for 2 co-pays, which will not be refunded at this time because the hospital is disputing the amount paid for my port surgery. So my money is held hostage while they work it out. They actually wanted me to pay on smaller bills and I informed them I would not do that while they had over $400 of my money. They are now saying they will credit them from that sum. I contacted CLAIM our states SHIPP program who told me I am NOT required to pre-pay for procedures. I compare all EOB's against bills but it's time consuming and frustrating. I've had to learn how to interpret the EOB's and bills and if a bill doesn't indicate the service provided, I have to call, wait on hold etc. It's fortunate you have someone to help with this because it is stressful and the last thing one should have to cope with when in treatment for cancer. Good Luck to you!

      almost 5 years ago
    • mykidshavepaws' Avatar
      mykidshavepaws

      I am in an HMO Medicare Advantage Plan. It's pitiful what they actually pay for the services provided. It's no wonder that volume is the norm - that less time with physicians, more waiting, etc. I have become very stressed over billing issues and like Cindy, was overcharged for 2 co-pays, which will not be refunded at this time because the hospital is disputing the amount paid for my port surgery. So my money is held hostage while they work it out. They actually wanted me to pay on smaller bills and I informed them I would not do that while they had over $400 of my money. They are now saying they will credit them from that sum. I contacted CLAIM our states SHIPP program who told me I am NOT required to pre-pay for procedures. I compare all EOB's against bills but it's time consuming and frustrating. I've had to learn how to interpret the EOB's and bills and if a bill doesn't indicate the service provided, I have to call, wait on hold etc. It's fortunate you have someone to help with this because it is stressful and the last thing one should have to cope with when in treatment for cancer. Good Luck to you!

      almost 5 years ago

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