Cancer Treatment

[redstatebluegirl]

A friend of mine was diagnosed with breast cancer day before yesterday. They wanted to start aggressive treatment right away so she and her husband were called to the hospital business office this morning. Bottom line, they sat them down, showed them a very large 6 figure bill and asked how they intended to pay for the treatment after the insurance was exhausted. They have good insurance through the university but even with that the cost is beyond what any person other than a very rich person could pay. How do people do it? Will they refuse her treatment if they can't pay?

No person should feel their life is in danger because they can't pay for care. She called me in tears and said the meeting felt like they were being shaken down by a loan shark.

Then this morning I see the little toad who overcharged for drugs people needed, pleading the 5th and smirking the whole time, make me physically ill.

[StandingInLeftField]

1. Just a sad indictment of the US "healthcare" system.

I came in through the emergency entrance with my heart attack, so was treated immediately. I received my six figure bill afterwards, but had no insurance. I am paying sporadically, but in South Carolina they can seize my personal property (my house) if they so choose.

Please give my good wishes to your friend - it's a terrible bind they are in.

[Glimmer of Hope]

2. Does she have the option to change hospitals?

This is awful! Stress is the last thing your friend needs right now. I have very good insurance and when I was diagnosed with cancer last spring, my hospital never once contacted me about finances.

There are some organizations that will help with finances if necessary.

[redstatebluegirl]

3. I am not sure, I am going over this afternoon

to stay with her, her husband needs to go to work. I think that is something she needs to investigate for sure. Thanks for the suggestion.

[Sienna86]

4. I thought the ACA installed caps on out of pocket cost.

I wish the best for your friend. How terrible they were put through this.

[redstatebluegirl]

12. I did as well, I am trying to do some research online before I go over there.

Since we have the same insurance I am going to call Blue Cross and ask some pointed questions about our coverage. I think the hospital is doing some kind of shakedown myself.

[jwirr]

51. You could be right. The insurance companies were the ones

who were being limited - not the hospitals. Keep searching. You are on the right track.

[SheilaT]

5. Ahh, yes.

We have the greatest health care system in the world, according to some. No. We have a pretty good state-of-the-art system that pays only some of the bills.

And, as I understand it, around half of all personal bankruptcies are because of medical bills, such as your friend is facing. In all honesty, she should just plan on getting treated and then declaring bankruptcy. Although before that, they need to try to determine if the same treatment elsewhere would be less expensive, if there is some other realistic course of treatment that would cost less, and perhaps challenge the actually charges themselves. Although in other first world countries, people don't go through this bullshit.

[redstatebluegirl]

9. She is terrified they will lose what they do have over this.

She also doesn't want to die and leave her husband with no resources, they are both 55 years old. This is just nuts!

[SheilaT]

18. That's more than understandable.

And depending on what they have, and what the bankruptcy laws are in their state, they could lose just about everything, I'm sure. It's the stories like these that make me crazed when people act as if health care is some sort of a privilege that not everyone deserves.

And even without this sort of catastrophic thing happening, I keep on reading that the typical couple needs to plan to pay something along the lines of $250,000 in their retirement years for out of pocket medical expenses. I realize that's not a sum that's evenly spread out, and some will pay a lot less and others a lot more, but it's probably a realistic average these days, and I find that sum quite shocking.

[redstatebluegirl]

22. This has terrified me today.

We are not prepared for that kind of illness. I guess I never realized how this works. I don't think most people do and that is why they are terrified of single payer. Yes, you may have to wait for non-emergency care, but guess what , you won't lose your house, you won't go into chemo terrified you are bankrupting your family. I think that is worth it.

[Kip Humphrey]

26. $250,000 is more than the average Social Security lifetime payout. Imagine that!

what a country!

[smirkymonkey]

36. God this just makes me so angry! People should not have to make life or death

decisions based upon their ability to pay. We live in a profoundly sick society.

[jwirr]

50. Okay, you answered one question - age. What state are they

in? That often makes a difference. Resources such as savings, luxury items make it even worse.

After the insurance pays what they will if they are not really rich they might try for Medicaid. At least ask what they might be eligible for at the local Department of Human Services. However, Medicaid will place a lien on the house but will not take it until after the husband is gone.

This is one of the bad things about our nation have no single payer health care program.

[redstatebluegirl]

52. Oklahoma

[jwirr]

53. I do not know about that state but since they did not expand

Medicaid my guess is that they do not have much to offer in this situation. However it never hurts to apply for help when the insurance runs out. All they can do is say no.

I have posted about your thought that it may be the hospital that is trying to collect more than the insurance will pay. I think you should continue to look into that.

[Big Blue Marble]

6. What type of insurance does she have?

It is my understanding that under ACA, there are no caps. Once she meets her deductible and
her copay, the insurance company should cover the rest of her treatment. She should talk
to her insurance company directly and find our what they actually cover.

[link:http://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html|

It would be better for her not to be pressured into treatment immediately, she and her
husband should research all their options, seek a second and third opinion, and consider
seeking a health care advisor (usually a nurse) who can give more objective advice.

[redstatebluegirl]

10. She has blue cross blue shield under the university.

I agree I thought that as well. When I go over this afternoon I am going to try and calm her down so we can think rationally about something that is totally irrational.

[hedda_foil]

32. I wonder if the hospital is out of network for her insurance.

That's the only thing I can think of that might be the reason for this.

[phylny]

42. Excellent point.

As a cancer survivor, our initial choice for my radiation was in one city, but my insurance didn't participate with the hospital, so we chose another facility equidistant to our home where we were fully covered. I got excellent care.

My best wishes go to this family.

[Waldorf]

7. As a person who is undergoing cancer treatment I know how expensive it is.

I have United Healthercare thru my work. Deductible is $500 and max. out of pocket is $3k. January starts the cycle over. My treatment is every two weeks. With the insurance negotiated price the cost is about 32k (its around 60k before the insurance discount) for two treatments. So I hit max. out of pocket on my first treatment. They allow me to make a $1k payment in January, when I have treatment next week I will have to pay another $1k and then in March another $1k.

It is a lot of money, that's what, $384k? This does not include the CT scans (every 3 months) the PET scan (once a year) or doctor visits and blood work every two weeks.

[restorefreedom]

19. all the best to you. nt

[Warpy]

8. According to the ACA, plans can no longer enforce caps once the deductible has been met

It sounds like the hospital financial office is behind the times. Contact your state ombudsman for health insurance or even the national ACA line or website for clarification.

[redstatebluegirl]

11. Thanks I will do that this afternoon.

[WillowTree]

16. For that matter, call Blue Cross directly & ask them what's what with that estimate.

Why take someone else's word before you even ask them?

[redstatebluegirl]

24. I think it just caught her by surprise, it did us for sure!

[shrike]

13. That's unbelievable

Last edited Thu Feb 4, 2016, 04:49 PM - Edit history (1)

Though sadly most people don't have as good an insurance plan as mine. No one even asked about money when I arranged for treatment.

I would echo other posters: your friend should not let anyone pressure her into anything. Get a second opinion if that'll make her feel more comfortable. If I were her I'd go to a university hospital, one of the big cancer centers. (And I don't mean Cancer Treatment Centers of America. I mean Sloan Kettering, institutions along those lines.)

I'd also recommend she go to a website, www.breastcancer.org. Lots of information; it's a website maintained by doctors. There're also message boards where your friend can compare notes with others who've been through the same experience.

[DiehardLiberal]

15. I echo your recommendation to breastcancer.org. The forums there are a wealth of good information.nt

[Wellstone ruled]

27. This site help my Spouse's sisters,

yes both of her sisters. One passed in August and the other is terminal and in Hospis care. Information is so powerful when dealing with any Cancer,one sister survived her Breast Cancer for two years and then the Lung cancer popped up and with a weakened Immune System,that cancer was aggressive as all get out. Her medicare paid all but her deductible and I think that was 3k. Number two sister has terminal Lung cancer and was so advanced there is zero treatment available other than pain meds. She has zero assets so the State will have to pick up the tab. There again several of us used various web sites to find any and every piece of info and a plan is in place to make sure she is taken care of. Local volunteers are wonderful to work with.

[DiehardLiberal]

28. I'm so sorry. Information is power... Best to all of you!

[Wellstone ruled]

34. One has to

approach cancer with a positive attitude. Might seem kind of callus,but if your family is proan too or has someone with any cancer,please get your affairs in order. We have been there and done that and that in it's self makes the challenges go much easier. We have had four family members succumb to cancer since 1999. We now know it was two main things,environmental dust and chemicals,mostly pesticides and herbicides. And one family member worked as a Boiler Maker which in it's self is a recipe for lung issues.

[DiehardLiberal]

14. I'm so sorry to hear this. As a breast cancer survivor, I can only say that it's another reason we

need a Medicare for all/Single Payer health care system. I found my own lump 2 months before I turned 65. Had no health insurance as I'd had to let it go as a small business owner after the recession made it impossible to pay the premiums. Might have found it sooner if I'd had coverage.

The good news is that once I had Medicare I had access to great treatment and almost 3 years later I'm doing well. I wish your friend the very best in her journey and a healthy outcome. Mine was also aggressive and it was a year of no fun. Adding financial stress is just so unjust and I'll leave it to others to give you advice on that.

Sending best wishes to you and your friend for a reasonable route to get the care she needs and deserves!

[alarimer]

17. Walter White had a plan.

Not maybe one that work for all of us, but really, it was kind of rational in our irrational system.

But single payer isn't realistic, or something.

But this is weird. Insurance should cover everything after the deductibles, so I think she should go get a second opinion.

[restorefreedom]

20. i was on gofundme the other day

or one of those sites to donate to a specific project. i was stunned at how many people are on asking for help for cancer treatment, surgery to fix a kid's cleft palate, and a child needing extensive burn rehab.

what passes for equitable health care in this country is an embarrassment.

all the best to your friend

[Nye Bevan]

21. By law the insurance can never be "exhausted".

Provided that the hospital is in-network, the maximum out-of-pocket for the year would be $6,850. And this includes physicians, drugs, hospital, everything.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

[redstatebluegirl]

23. Thank you, I am doing some research and so is my husband so we can make her feel better.

I don't trust the healthcare industry one bit, it is a business and they lie!

[Nye Bevan]

25. Good luck.

Of course with a civilized and humane system, no worrying about or researching into the financial side would be necessary.

[TexasMommaWithAHat]

29. I've never heard of that happening to anyone

especially with insurance! And I haven't heard any stories like that from my survivor friends, either. (Yeah, I know lots of horror stories, but not like your friend's. And her situation seems to be moving very fast.)

I was treated using BC/BS as my insurance provider, and nothing like that ever remotely happened to me. (I did have problems with a disputed lab bill much later, but that's another story. )

First off, I would be hesitant about how very quickly things are moving. Yes, you don't want to wait unnecessarily, but taking a week to get another opinion, waiting for lab results that tell you more about the nature of the cancer, etc....this all takes time.

Normally, something suspicious is found in a mammogram or your physician finds something suspicious through a physical exam. "This could be cancer."

Next, a biopsy is ordered. The results of that biopsy will tell you if you have cancer, and likely what kind of cancer it is. "You have cancer."

Then, surgery is usually scheduled, but not always, depending on the type of cancer. The cancer is then staged. The aggressive nature of the cancer cells and the size and location of the tumor will determine the stage. More lab tests.

It is only at that that point, will an oncologist determine the appropriate course of action in consultation with the patient and, perhaps, with the surgeon or any other doctors deemed appropriate.

Even after all of that, no one sat me down and gave me a monetary amount. I had insurance, and that was that. Down the road there was a stupid paperwork error which caused weeks of fighting with the insurance company to pay the bill, but in the end the lab used the wrong code! arggghhhh

Does your friend live in a small town? Does she have other options? Something doesn't seem right.

[redstatebluegirl]

31. It is a smallish town.

She had a biopsy on Tuesdy

[TexasMommaWithAHat]

33. Sounds like it.

Thankfully, most breast cancer treatments are pretty standard today.

Please send your friend to the discussion board at www.breastcancer.org. I found a lot of support there, and by the time my oncologist sat me down with my treatment plan, I pretty much knew what was considered standard treatment for my type of cancer. That gave me a sense of control and confidence in him, although he had an excellent reputation. (Houston area has many fine oncologists.) Had he deviated from things I'd read, I would have wanted to know why and would have gotten a second opinion. No, we shouldn't diagnose nor look for our own treatment plans on line, but when faced with something like a cancer diagnosis, the more knowledge you have the more you can participate in making the right decision.

I wish your friend the very best. Please tell her that the nausea drugs are usually very, very helpful, and not to fear the side effects too much.

[redstatebluegirl]

35. Thank you..

[Orrex]

46. It happened to a DUer ten years ago, as a matter of fact

Johns Hopkins refused to begin treatment until confirming the ability to pay.

Apparently The Oath boils down to this:

1. First, secure payment
2. Second, do no harm

[TexasMommaWithAHat]

47. I've heard horror stories

but not quite like this one, although I'm sure there are thousands of ways to get screwed by the medical establishment. :

[Orrex]

49. I was lucky with my insurance after a brief hospital stay in 2014

And I was lucky enough to recognize how lucky I was. What a god-awful racket the whole thing is.

[LeftyMom]

62. It happens.

My dad is waiting on a liver transplant, which is the long-term treatment for his type of liver cancer. Radiation is used to keep the cancer small and contained to his liver while he bobs up to the top of the transplant wait list.

Talking about cost is a major part of the intake process. There's a series of slides about it in the canned introduction, and it's a big part of the interview with the transplant nurse.

Here's what your surgery costs. Who's your insurer? Ok. Here's what your ongoing drug regimen will cost. You'll need to take these every day for the rest of your life. Who's your insurer? Oooh. Can we get you to switch before your surgery? We've had good luck with this one. Technically they could reject you- preexisting conditions are still in effect for medicare supplements- but in our experience they generally won't. Let us know if they do, we'll try to con you on to a different one. What happens if you don't get a good drug plan? Well, nobody can afford the drugs you'll need to stay alive out of pocket, and we don't want to risk a transplantable organ. Yes, we'd deny you your transplant. Yes, you'd die.

And no, not a small town. Big city, major public hospital, regional transplant center. Not a long time ago. November.

[hedda_foil]

30. Doesn't the ACA prohibit caps like this?

[Waldorf]

38. Yes, the ACA removed the lifetime caps that used to exist. I've been with United Healthcare for

years thru my employer and I believe the lifetime max. was $1,000,000. Sounds high and not reachable but when you get a serious disease (like the cancer I've been dealing with the last 5 yrs), you will reach that amount in a few years.

[Nye Bevan]

40. $1 million lifetime cap is pathetically small and very easily reachable.

One of the very best things about the ACA was to make such caps illegal.

[Waldorf]

37. Earlier I posted that I have cancer and am going thru chemotherapy treatment.

I thought I would show how expensive it is. I get two chemo treatments a month, so this bill is the cost for 2 treatments (one month). I only see this once a year because I meet my out of pocket on my first treatment of the year. Crazy expensive. I've erased my personal information.



[IMG][/IMG]

[Nye Bevan]

41. Wow.

All I can say is (1) the $3000 is way better than the $60,747 and (2) that ZIV-AFL thing is very expensive stuff at $44,000 for 1 mg.

The very best of luck with your treatment and recovery.

[area51]

39. Only in America ...

Unlike what Clinton thinks, single-payer isn't pie-in-the-sky fantasy.

[redstatebluegirl]

43. Update

I found a nurse who serves as a go between (it has another name) between insurance companies and providers. She works almost totally with cancer patients. She has been fabulous! She met with my friend Paula and put her mind at ease as much as possible. Will they still have the yearly cap of $5000, yes, will it reset each year, yes, but I think they can manage that.

It will be tough, they will not be able to help their two kids in college as much as they have been, but they had a meeting with the kids and they totally understand.

I found a doctor in the city that will give her a second opinion on her options, she sees her on Monday of next week.

BTW the breast cancer website you suggested is wonderful!

Thanks to all! Both of us are sleeping a little better this week! Our healthcare system is still a mess, but for now she is feeling much better!

[Nay]

54. That nurse is called an ombudsman, or maybe a patient advocate.

I had one as a breast cancer patient and she was invaluable. Your friend's hospital is acting very weird, so I'd def ask the advocate to keep an eye on them. I had BCBS and I never got shit like that from the hospital.

You are a great friend; one thing you can do for her is go with her to her appts and treatments and keep notes on them for her. She'll be too distracted to do it. I kept an Excel spreadsheet of every appt, where appt was, the doc's name, what was done, what doc said, etc. It was invaluable for when I was asked questions and had to come up with dates of treatment, who did treatment, etc.

Edit: Can you tell us how advanced her cancer is? I know they only stage it after surgery, but usually the x-ray/MRI/biopsy gives them a good idea of how big it is and if it has spread.

[redstatebluegirl]

56. She was told it was aggressive

and it appeared to have spread. She is scheduled for a second opinion next week before she decides what to do.

I will be with her all the way. I met her right after we moved down here, I love her like a sister! Thanks for the ideas on how to be the most help, I will do whatever I can to ease her way... This just makes me sad. She is a fabulous person.

[Nay]

57. Oh, dear. That doesn't sound good. If it has spread into her body, I

believe it will be called Stage 4, the worst stage. This does not mean that she can't recover somewhat and live a number of years. It's not an immediate death sentence, nor does it mean she can't have a long remission.

My love and hugs to you and your friend.

[redstatebluegirl]

58. That is what we have been told...

Her husband is looking into a cancer hospital in Dallas if this ends up being what it looks like. I am taking her daughter to dinner tonight, she is pretty upset, going to try my best to bring her down a little. I lost my mom at age 19 so I know how she feels....

[PasadenaTrudy]

55. Glad to hear this!

When both my parents were hospitalized, the social workers really helped. Sounds like she now has similar help, someone on her side

[TexasBushwhacker]

44. There are maximum out of pocket caps

For a silver plan they're usually $7K for an individual and $15K for a family.

[redstatebluegirl]

45. I am sure we will learn more as we go along.

I also have a call in to the hospital administrator, I want to talk about that person in the business office. We found out that what she had written down for them was totally not true in any way. It may have been the total cost, but what she showed as Paula's part was not true at all.

[MoonRiver]

48. Really sorry for what your friend is going through. That just totally sucks.

Four years ago I was diagnosed with breast cancer. I went through surgery, radiation and reconstruction. My insurance, Blue Cross/Blue Shield, paid for everything except a few small co-pays. (Our insurance is also through the university my husband teachers at.) I've also never had an issues paying for the follow-up cancer medicine. Your friend should not be going through this. The fact is her insurance may NOT max out. She should call her insurance company and check on coverage. Sounds like there are a lot of assholes working for that hospital, who just want to intimidate people. Maybe she should check into another place to get treatment. All my best to your friend. She has a some tough times ahead, depending on the Stage, etc., of her cancer. No way should she have to worry about money on top of everything else!


Edit: Should have read the rest of this thread first. Others have already offered helpful suggestions. Oh, and the phrase you were looking for above was "nurse navigator."

[redstatebluegirl]

59. Thanks Everyone!

All of the advice and support was wonderful. With all of the angst on this board, the heart is still there! Her appointment for a second opinion was moved up to yesterday afternoon. The second doctor agreed with the course of treatment the first doctor suggested. They both suggest surgery, followed by chemo and radiation, her preference is to not take any chances and do a double mastectomy with reconstruction. The nurse she is working with has provided her with a ton of information and she has found the website suggested here to be very helpful.

Her daughters are coming home from school next week, her surgery is scheduled for Tuesday morning. Good Karma and prayers are welcome for her and her family.

Thank you all so much!

[PasadenaTrudy]

64. Best wishes! n/t

[malaise]

60. They were being shaken down by a loan shark

There is no distinction. Indeed some loan sharks are more sensitive that these corporate hospitals.

[redstatebluegirl]

61. Yes they were in my opinion....

After we looked into her options, decided to use a different hospital everything changed. I have to wonder how many people don't question, they are so scared they will sign anything. Thankfully they had lots of friends to help them see what was happening. The people here helped me get the strength to fight for them.

We need single payer NOW!

[spanone]

63. there's your death panels.

healing through profit

[redstatebluegirl]

65. Update

She had surgery yesterday after talking to three doctors and her family. She had a bi-lateral mastectomy and lymph nodes removed. She will undergo radiation and chemo due to the aggressive nature of the cancer.

Thanks to all of you for your help. Please keep Peggy and her family in your prayers...