Questions about Health Insurance

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Rikimaroo
Posts: 257
Joined: Tue Dec 20, 2016 8:48 pm

Questions about Health Insurance

Postby Rikimaroo » Tue Aug 13, 2019 5:42 pm

So I currently have Myblue HMO with BCBS...Through Healthcare.gov as I own my own business and its more cheaper, but a hell of a good plan, myblue Silver, i pay $200 a month for it. It's actually really great. The only downfall is that it doesn't cover out of state, it doesn't have the bluecard option.

My surgeon after reviewing my MRI this week, suggested I go to Cleveland Clinic in OH to see Dr. Scott Steele to get surgery and IORT (intraoperative radiation) and this is the best chance for cure. I currently go to Cleveland Clinic Weston, FL....I live in Florida. I am waiting for the CC OH people to call me to see if we can work something out with the insurance giving the nature of the situation being a medical emergency and see if they will work with them.

Anyone ever dealt with this and have any tips to tip the scale in my direction on going out of state and getting in network coverage?

Here is a link to the plan

http://www.bcbsfl.com/DocumentLibrary/COC/2016/IU65ACA/ONX%5C/Plan_1603C_ONEX_01JAN16.pdf


Rikimaroo
RC T3N1M0
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
Port Scheduled for 12/2017, folfox - avastin 12/2017
Blood Clot in Neck 1/2018, stop avastin, continue FolFox
LAR/Liver Resect 4/2018
Chemo Finish 8/2018
Reversal 10/18
CEA - 12/16 26.1, 1/17 32.2, 3/17 6.6, 11/17 500.5, 12/17 638.5, 1/3/18 424.8, 1/16/18 163.5, 1/31/18 62.2, 2/18 21.1, 3/18 14, 4/18 .8, 10/18 1.2, 12/18 3.2, 2/8 11.4, 3/6 22

margiej
Posts: 88
Joined: Sat Apr 14, 2018 8:46 am

Re: Questions about Health Insurance

Postby margiej » Tue Aug 13, 2019 7:41 pm

I, too, have insurance with healthcare.gov. While looking for some other info on my insurer's website, I found that if a certain critical treatment weren't offered in my network, I could go another clinic and still be covered. In my case, they would allow me to go to Mayo Clinic for specialized treatment. Otherwise, I generally have no coverage out of network. Perhaps, the place to start is with your Florida insurer and see if something is available to you for specialized treatment.
Wishing you all the best,
Margie
Dx CC 12/2015, age 57 at Dx
Stage IIIb: T3N1b
Adenocarcinoma, sigmoid colon, 2.5 cm - low grade, moderately differentiated
3/6 positive lymph nodes
laparoscopic colectomy 1/20/2016
Capox started 3/4/16 - Six rounds
CT-suspicious lymph 2/22/16
PET scan 2/24/16 clear
CT 6/8/16 clear
Clear Colonoscopy 3/17
CT 10/3/17 clear
CT 10/17/18 clear
CEA 12/17 1.7
5/16 3.8
7/16 1.9
3/17 1.3
10/17 1.2
4/18 1.6
11/18 1.2

retiredteacher
Posts: 107
Joined: Sat Oct 21, 2017 1:34 pm

Re: Questions about Health Insurance

Postby retiredteacher » Sat Aug 17, 2019 11:42 pm

Hi - not out of state, but out of network here in Northern California. My oncologist spoke with a review physician to get the approval for out of network coverage. Took some time. Try to get a nurse case manager to help walk things through.
RC, F, 63 at diagnosis, Sept. 2017
Adeno 6.3 - 7 cm tumor (PET) MSS, G2,
Est. T3N0M0 PET
2500 Cap/RT Oct/Nov18; 25 treatments
"Near complete metabolic response" PET Jan 2018
CEA 0.5 Oct. 2017, Jan. 2018, 0.6 Oct. 2018
MRI Feb. 2018 Presurg yT2 N0 12 cm from AV 3 cm
LAR Feb 20 yT1N0M0 0/21 G1 0.3 cm
CAPEOX March 2018, oxi and cap reduced to 80% at cycle 3
Completed 4 cycles CAPEOX; stopped due to gut issues, liver enzymes
Clear CT and colonoscopy November 2018. NED. :-)


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