Insurance . . . adding insult to injury

[AnnClare]

As if we don't have enough to worry about, guys.

So today I went to get my pump disconnected and was informed that my co-pay, for chemo infusions and for EACH of the 3 Granix shots I get later that week, will cost me a $100 co-pay. When my husband and I looked at our plan online, it clearly states that chemotherapy is a $25 co-pay, but the woman I spoke with today coldly said, "It shows here your copay is $100 for each visit." This equals $800 a month, not counting the two $50 co-pays for when I see the oncologist in my off weeks.

After spending 1 1/2 hours there, my doc (who was unaware of the Gravix cost I'd be paying) agreed to put me on Neulasta, a little pump device the put on your arm at the same time they disconnect your pump, and it apparently starts injecting 27 hours later. It's supposed to only cost me $25 each time. So I won't have to go to the infusion center three times a week (post-disconnect), and it supposedly works the same as Granix. WHY didn't they just start with this?

Anyway, he waived my Granix injections this time. (They were supposed to begin tomorrow, but since insurance can't work out whether or not I'll be on the hook for the $100/injection in that short of a time frame, the doc said I should be fine this go-round and we'll have the Neulasta in place for the next round.)

What's got me concerned now is that the hospital is maintaining that each of my chemo visits is a $100 co-pay, DESPITE the fact that my policy has a co-pay deductible of $800, and $500 has already been reached. They're going to try to bilk me for $1,200 in co-pays - WTF? Of course, now it's after business hours so I have to wait until tomorrow to try to get someone on the phone.

I want off this stupid ride. It's not worth the stress and aggravation. I swear insurance is the devil.

[Kick'nAssCancer'sAss]

When I read shit like this I am grateful that here in Canada no one goes broke fighting cancer or any disease. My doctors told me to date that well over $300k worth of procedures have been performed on me. My biggest expense...parking.

[midlifemom]

Ann Clare,
Insurance can be a hassle, you have to be proactive unfortunately.
My suggestion is to call your insurance company to have them verify your understanding of your financial responsibility. If the hospital is incorrect, ask that the insurance company call the billing person at the hospital to straighten it out.
Good luck!

[jhocno197]

It is unfortunate, and makes me very angry, but you will have to fight with insurance companies & doctor's office staff repeatedly throughout.

It sucks.

[BeansMama]

I second midlifemom, call your insurance company and have them contact the Dr's office.

I recently had an issue with the oncs office billing under an incorrect code, they wanted me to pay 300.00. I looked through past EOB's and found a date where the same office visit had been covered and called the insurance. They took care of it from there. I owe nothing because they got the dr to submit with the correct code.

Look up your out of pocket maximum. I hit mine a while ago, of course last time I looked this dang disease had racked up 1.5 million in charges to my insurance. Not the norm I know, but I ended up with multiple surgeries and a few lengthy hospital stays. I don't pay anything now, and won't until July when my benefit year starts over. Depending on how high yours is your co-pays should be temporary.

[AnnClare]

Just got off the phone with my insurance company and had them contact the doc's office & infusion center directly. Supposedly it's all straightened out now and I'm to pay NOTHING, ZERO, NADA, when I go for infusions (which is what my policy states, since it's classified as an outpatient facility.) The insurance rep said IF they give me grief next time to have them call the insurance company on the spot. At least now I feel like I have back-up. Hopefully it won't come to that. Naturally, I wrote down EVERYTHING the rep said, including her name, the name of the person SHE spoke to, time & date of the call, reference no., all of it.

It frustrates me that we have to be so overly diligent, particularly during a time that we're already under stress and feeling vulnerable. Unfortunately, from reading what you guys have said, this is the 'norm.' What didn't help yesterday's situation was the cold, callous attitude of the woman at the facility. I'm not a violent person, but I had visions of reaching across the desk, smacking her headset off her head, and giving her a good, old-fashioned punch. (Not that I know how to throw one - I've never been in a physical scrap in my life. She probably would've won, but that's beside the point.)

Now I'm off to do some deep breathing and (attempt) meditating to mitigate the effects of yesterday's stress. Om . . .

[midlifemom]

So glad that was resolved in your favor. Enjoy the rest of your day!

[ktwmn]

I hear you. Last year I paid $7000 out of pocket. My out of pocket maximum is $3900, but each co-pay is $70 and there is no out of pocket maximum for those. They add up.

[jhocno197]

ktwmn, copays should be included in out-of-pocket-max....

[weisssoccermom]

jhocno197 wrote:

ktwmn, copays should be included in out-of-pocket-max....

Not exactly correct. IF the plan is grandfathered in, then no, the copays don't have to be applied to either the deductible or the out of pocket max.

[juliej]

AnnClare, I'm glad it got resolved, but you are absolutely right -- we shouldn't have to deal with crap like this at a time when we're under incredible stress to start with!

Totally understand your desire to whomp the woman! But I think we can trust karma to deal with her. And yes, meditate and clean this out of your mind. I find that when I meditate the shitty life stuff gets processed quicker and I am way less interested in it afterwards.

Hugs to you!
Julie

[nkoske]

I've hit my out of pocket max every year since I was diagnosed So I'm in for about $15000 of costs since 2012 not including Xeloda prescriptions and other incidentals. Looking like another $4000 this year (two MRIs, a CT, and a colonoscopy are expensive).

I'm pretty sure my co-pays were included in my out of pocket max. At some point I just told the Doc's office I reach my out of pocket max. May be worth trying for those who aren't sure. No front desk person ever told me I didn't need to pay because I reached my out of pocket max, they would have happily taken my $20, so long as I was willing to hand it to them.

You could also just say you reached your out of pocket max, if you need to pay it they will bill you. A copay here or there may get lost. I've found the person taking your money at the desk has no idea about your insurance coverage.

I'm fortunate to have a wife that use to work in HR/Benefits who knew how to navigate the system.

[ktwmn]

BCBS of NC doesn't care whethet you hit your 3900 out of pocket max. Every " specialist" appointment is $70 copay regardless. So if you're a chemo for lifer that means cha - ching $70 every 2 weeks. I feel we have no recourse. If I don't pay my copay at each appt they will bill me.

[Lydia666]

When I read shit like this I am grateful that here in Canada no one goes broke fighting cancer or any disease. My doctors told me to date that well over $300k worth of procedures have been performed on me. My biggest expense...parking.

I feel the same! Canada's system is not perfect , but it beats this crap for sure!

[SuseB]

I so commiserate with all of this. If anyone thinks we don't need health care reform here they have never been seriously ill. Or they're rich. My husband retired last year, and while we are lucky enough to get a retiree rate for insure it's high deductable HSA, and it's still $450 every month with a $9600 out of pocket max. We hit it last year with my first surgery, thought it was all over, and lo and behold...it's back, right at the first of the new year. Another $9600. And whatever awaits the next year, etc. Who has that kind of money? We're not even halfway through paying last year's and trying to figure out how to fund this year's HSA. And had to fight with them to get Neulasta approved for WBC count. I stress as much about money as I do about the disease.