INSURANCE COMPANIES are the devil
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EXPERIMENTAL??? Here in the best liver-center in Sweden ALL CC-patients go through this now, if possible. Often combined with chemo, and often as neoadjuvant therapy, if resection not is an option. There is a lot of evidence of the effiency, publicated in scientific journals. (Pubmed)
I would suggest having the doctor talk to the insurance company’s medical director. The procedure is clearly not experimental, but uncommon, since CC is so uncommon. It should be covered. Some carriers will do almost anything to weasel out of paying a claim!
Jim–agreed! However, this insurance company is absolutely AWFUL to deal with. First it was fully covered, then 70%, THEN yesterday the director of Keystone Insurance REJECTED the chemo embolization procedure, calling it EXPERIMENTAL. We are furious! And came down to Hopkins anyway and are getting the treatment regardless.
It is just so horrible that people like my mom who already have to battle the cancer, have to worry about battling the insurance companies as well. Just Awful.
I would not consider second best in cc treatment. There are major differences between the major cancer center hospitals and local regional hospitals. I would try to get the best payment arrangement from the carrier and stick with JH. Sometimes it’s just one more battle to be waged. Sad, but true.
Have the doctors at JH write a letter. One of the doctors my dad saw was out of network, but they were designated as a BCBS treatment center for rare and difficult to treat cancers. It worked for us.
I know how this goes. On one occasion, BCBS sent a notice that my dad owed a particular bill, once I called and told them he want’ paying, they backed down. Sometimes, I swear they trying to see what they can get away with.
Thanks so much everyone! I really appreciate your responses more than you can know.
Margaret–yes, Hopkins is out of network, but I was told they are the best in the area and are the only ones that gave us the option of chemo embolization, which they think is our best bet. It’s hard enough dealing with this horrible form of cancer, to have to fight the insurance company about paying for her necessary treatment almost makes it unbearable
I will definitely ask about the mileage waiver! And we are waiting to hear back from Hopkin’s insurance contact to see what she can do. Again, thank you so much for you information!
~Katie
I work for a Medical Insurance company. It sounds like the hospital you are considering is an out of network hospital. Can you work with your insurance company to find a In Network Hospital that could do the procedure?
You always have better in network benefits than when you use an out of network provider.
You may want to see if you can get a mileage wavier. Most medical policies have something regarding a mile radius. If there are no in network providers that can supply the service then they will do a waiver for the out of network provider, paying the same price as they would for an in network provider.
You could also have the hospital contact your insurance company and they can work out an agreement that for your treatment they will agree to a negotiated price that they will accept.
If I can offer any further advice, please let me know.
Margaret
Hi Katie,
Sorry to hear that you and your mum are having troubles with the insurance company. You both have enough to deal with right now and having these problems with insurance should not be something that you have to worry about. I can’t offer any personal experiences here as we don’t have this in the UK, but we do have an insurance board here that may be of help to you with this –
http://www.cholangiocarcinoma.org/punbb/viewforum.php?id=22
Hopefully someone will be along soon that can offer more help to you here than I can.
My best wishes to you and your mum,
Gavin
Aw, Katie, it’s just not fair to have to deal with Insurance along with all we have to go through but sometimes it’s just there! I would call one more time and see what a 3rd person tells you and always get the name of the person and the date you talked. Perhaps some more members will chime in on possible solutions for you. I just feel for your family and hope you can come up with an idea. Have you talked to the financial department at the Hospital? Best of luck!
Now we’re told that they’ll only cover 70% of our costs at Johns Hopkins…that could get expensive very quickly and is something we’re not really prepared for. Especially since the last time we talked with them, we were told my mom would just have a larger copay. That and covering 30% of all the MRI’s and chemo embolization is a BIG DIFFERENCE!
Does anyone have experience dealing with this? Is there anything else we can do? Bottom line is, my mom needs the best treatment there is, and our Hopkins team thinks Chemo Embolization is it, so that’s what we need to get done.
Any insight would be helpful…thanks
Extremely frustrated,
Katie
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