the devil works for the insurance companyMy good friends on ActiveRain have privately (via email) asked me to post an update on my current battle with Stage IV breast cancer...and where I am at with that.

To tell everybody the truth, I feel bad using ActiveRain to post about this topic-- not because I feel that this forum should be about "real estate only" as some do-- but because I have another blog on this subject.

Because I planned on posting once on this topic, which I did, and asked people to visit my other blog at http://www.fighting-breast-cancer.com/ I didn't really want this to take the place of my marketing-related posts here on ActiveRain.

(By the way, my other blog just became number one in Google for the phrase "fighting breast cancer", and on page one for several other phrases I was targeting. I am getting thousands of hits! Thank you!)

However, I figured I would share a little story that will apply to everyone, whether you care less about my fight with breast cancer or not. It's about medical insurance and how I'm convinced that the Devil runs my own insurance company. (Which through the National Association for Self Employed Insurance [NASE] and it's called MegaLife, underwritten by CCN. Just for the record.)

As some of you know, ActiveRainers, who heard about my plight with medical bills and insurance problems have been trying to raise money to help me with medical bills that are absolutely extraordinary. Check out Paula Henry's wonderful post, for one. (She lists more on her site.) Jay Thomas, the Phoenix Real Estate Guy ... What wonderful, caring people ActiveRainers are! George Tallabus, Desiree Daniels, Frank Rubi, Chris Griffith...I can go on and on. Again, I thank you all!

But yesterday (Sept. 25) I got some good news and some terrible news all in the same day.

First of all, for my friends, the good news: They thought that I may have brain cancer (again), so I got an MRI yesterday. I had some symptoms that could indicate a brain lesion and last October, I had 9 tumors in my brain. So they've been on the lookout for that. Anyway, yesterday, the doctor said the results were "amazing" and "fantastic" and he doesn't feel the need to scan me every two months anymore. He said he'll see my in four months, just to be safe. He said he is almost certain my brain has been "sterilized" from cancer with radiation.

So that's the good news!

Of course, I am still going through chemo right now for the cancer I have in my lungs. I have four rounds under my belt and four to go- every Friday.

Okay, I promised that this post would be useful to all readers, not just my friends. So here's the bad news, and it applies to every single person on ActiveRain.

Chemotherapy ranges in price from $5,000 per treatment (injection) to $20,000.

The chemo I get right now costs $6,000 per shot. Since I need 8 rounds, it costs $48,000...this time.

Well check this out! Has anyone ever heard of a maximum allowable lifetime benefit? From what I learned yesterday, my insurance policy has a "maximum allowable lifetime chemotherapy benefit" of $150,000. Sounds good, right? Or maybe you have no idea? Like me...

The first time I battled cancer, 2 and a half years ago, I got 8 rounds of the expensive stuff at $17,500 a pop. Eight rounds multiplied by $17.5K is $140,000.

I didn't even know it then, but I had already used up 93% of my "total lifetime chemotherapy benefit" back in 2005. Ugh!

From now on, including the $48,000 that I need to come up with for my current round of treatment, I will be paying for all chemotherapy from my own pocket. Ain't that something!

Please believe me when I say that I am not looking for sympathy or money (George and Desiree)-- but I hope that everyone of you will take a look at your health insurance policies and examine your "lifetime allowable benefit" for every disease or problem you could potentially face.

Use me as an example. $150,000 is not an acceptable "lifetime allowable maximum" if you have cancer or M.S. or God forbid, anything else that requires expensive treatment.

Call your agent and have them raise those benefits with a "rider" if they don't look acceptible to you. I write this because this is not something that any of us ever tend to think about.

What is your maximum allowable chemotherapy benefit? You have no idea, right? Furthermore, do you know how much chemo costs?

Please, please take my advice and look into your maximums. If they seem too low-- fix them. It's worth the extra $20 per month for the "rider." And take care of yourselves for goodness sakes!

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69 Comments on Think you have Health Insurance? Think Again.

SEP
26
2007
8 Featured Posts Outside Blog
Karen - first off, best wishes in your continued struggle.  Second - I am actually going to look into my insurance today....many thanks for broaching this subject!
3:16pm • #1
407,934 Points 74 Featured Posts Outside Blog

Hi Karen,

I'm going to ask my wife about this,she has been in the health insurance industry for 10-15 years and probably knows about this.

3:17pm • #2
262,081 Points 59 Featured Posts Outside Blog

Hey Karen,

Excellent points to increase awareness.  Thanks for posting this, very important info for everybody.

3:19pm • #3

Karen, thanks for the heads up on the max benefits. I have a meeting with my agent next week and I will definitely ask him about this. Take care and best wishes to you.

3:24pm • #4

Hi Karen, I agree - a lot of people look at the immediate cost of what they pay for their insurance monthly - is the co-pay on doctor visits low? Do I have to pay a ton for my monthly prescriptions?  Very rarely do people take into consideration what the Maximum Allowable Benefit is.  While we're healthy and feeling invincable we don't think that we will ever meet the $150,000 (or whatever it is). As a former employee of a major insurance company, I whole heartedly agree that people should look at their Maximum Allowable Benefit and determine (seriously) if the amount that is alloted to you enough to cover a major illness (or even a serious injury or accident - remember as Realtors/Mortgage Brokers/Appraisers, etc. - we're on the road A LOT! - the chance of a major injury accident occurring to one of us is much higher than someone who just drives back and forth to their 9-5 job every day). 

 On a side note - I'm thrilled for you and your good news!  As for the bad - we're all behind you through this, and even though you aren't asking for hand-outs, the people of AR are angels in disguise.  You'll ge through this. Hang in there!

3:25pm • #5
126,938 Points 29 Featured Posts Hit Router
Couldn't have said it better myself Kelly.  Thanks for commenting so eloquently.
3:27pm • #6

Congratulations on the good news.  I, for one, am so glad you continue to blog no matter what the subject.  I have learned so much from you through your blogs.  I quote you so many times to my fellow realtors, it's as if I know you.

This country needs to get a handle on these obscenely huge charges for chemotherapy.  Even if your insurance doesn't cover it, there must be some place to go for financial help without depleting all your own resources.  I hope someone who reads this can help with managing the cost in a more humane manner.

Thanks for the update, and please know how much I admire your courage and the way you care so much for others.  I will be checking my insurance policy later, for sure... 

3:41pm • #7
126,938 Points 29 Featured Posts Hit Router
That's what I want most of all Linda.  Check your policy!  (And thanks for the nice words.)
3:42pm • #8
600,033 Points 244 Featured Posts Localism Sponsor Outside Blog
Hi Karne, Great to see and I'm very happy to hear your good news. As for the insurance, I will be checking my policy asap. Thanks for the heads up.
3:44pm • #9
126,938 Points 29 Featured Posts Hit Router
Glad to help Sir Bryant.
3:52pm • #10

Hey Karen - glad to "see" you around the rain today - you sound spunky!  I'm so glad for your good news!!!  the bad news sucks... maximum allowables, huh....  we are all probably underinsured if we're all self employed -- we never think about the "what-ifs"...

Question for you... is your other blog being updated regularly?  If so, I must be in the dark (or having caching problems) because I have read and re-read your journey, but there's nothing current...

Pulling for your good health EVERY SINGLE DAY here in Northern Virginia!!

4:04pm • #11
126,938 Points 29 Featured Posts Hit Router

Jennifer--

My other blog is super-behind...  The truth is, it is just so emotionally exhausting that I seem to only add a post a week.  I am really making a super-concentrated effort to move faster on that thing though.  And it only makes me want to work faster when I know that sweet people like yourselves are waiting for updates.

I'll get on the ball!

4:06pm • #12

Thanks Karen for this amazing post, something needs to be done about health insurance in the USA, it is frightening, I am so glad your brain has been given a clean bill of health for the while.

We all wish you the best of luck here in sunny Florida and hope that you recover soon - I do miss your posts equally! No matter what the subject they were always great!

I need to check my own insurance coverage - BHG Blogmaster, personal -(which is lousy but it is still so expensive!)

 

4:14pm • #13
237,908 Points 30 Featured Posts Localism Sponsor Outside Blog

Karen - First off.. glad to see your up too posting... 2 in one day woo hooo that's a good thing.  Secondly,  very happy to hear about the MRI results more good news.

Thirdly,.... the insurance you know how I feel about it.   I think it is absolutely crazy that while a person is struggling with a life crippling disease they should be bothered with such nonsense as receiving a bill for "services rendered".

Like if you had a choice you wouldn't opt not too.......... ughhhhh   Sore subject with me.   I will state for the record... bump em... don't pay the bill....  I wouldn't even if i had that large of a disposable income.   And I am sure someone can clarify for us that a hospital can NOT deny you treatment if you don't' have the means to pay???  

God I hope so..... we do live in America right...??? 

4:59pm • #14
Thanks for posting this!  My father in law has just hit his maximum lifetime limit as well.  It's shameful that they don't educate you better when you get a policy.  They should disclose..."if you get cancer, this is what you can expect to spend", "if you have a heart attack, you should expect to spend this much".  It's similar to problems in homeowners insurance.  You think you're covered until your home gets blown away in a hurricane.  Then it's too late!
5:31pm • #15
126,938 Points 29 Featured Posts Hit Router
It's a damn shame is it not Christopher?  Very shameful.
5:33pm • #16
231,233 Points 64 Featured Posts Outside Blog

Karen, you are so right, I have no idea and yes, that's scary. 

I am THRILLED to hear your good news though!!!   The money ... well, that is secondary, isn't it?  It will work out.  The important stuff is to get you completely well, and you're on your way.  I'm so happy for you, Karen.  :o) 

Thanks for posting this here.   

5:51pm • #17
126,938 Points 29 Featured Posts Hit Router
Sarah-- thank you for being so darn sweet.  Thank you for taking the time to comment and say such wonderful things.  I really appreciate you.
5:52pm • #18
406,061 Points 17 Featured Posts Outside Blog
I have heard of maximum lifetime allowed amounts on different things, but I haven't checked on anything on mine. I had no idea chemo was that expensive! That is unbelievable. Do they want to help people or not? I guess I'd better read my policy and see if I need any riders for anything.
6:02pm • #19
109,021 Points 11 Featured Posts Outside Blog

Karen, Thank you for being here. I've learned a lot from your blog. But I really never expected to learn about medical insurance here.

It is really a shame you had to learn the hard way. Everybody on AR owes you. I don't know what my lifetime maximum coverage limits are but I'm damn sure going to find out.

Thanks again.

Bill Roberts

6:47pm • #20
so were you in Peachtree City recently?  Or are you still catching up from the past?
6:51pm • #21
126,938 Points 29 Featured Posts Hit Router
Still catching up...  Peachtree was about a year ago, I hate to say.  I'm so ashamed!  But I'm so busy!  I promise to work harder!
6:53pm • #22
421,201 Points 47 Featured Posts Outside Blog
Karen - 1st let me wish you all the best in your battle with cancer. I can tell by reading your post that you are a very strong women and I am sure you are going to beat it! This is a post that everyone should read as many of us don't think of things like this until it is too late to do something about it. Thanks for bringing this to everyones attention.
7:59pm • #23
299,520 Points 15 Featured Posts Localism Sponsor Outside Blog
Hello Karen,
My prayers and thoughts are with you as you fight this battle.  Thank you for updating us on where you are with this.
As for the insurance, that is unbelievable.  I'm sure because of this many people will know what their insurance policy holds.  Thank you for alerting us.
8:15pm • #24
127,646 Points 2 Featured Posts Outside Blog

Karen, Congratulations on the great news! 

Hmmm, my health insurance is with the same company your's is with.  I'll be checking my coverage -- funny, rec'd a notification just a week or so ago telling me that my monthly payment was going up again!!! 

8:27pm • #25

Karen.... hear me....  I was only curious b/c we used to live near there and I was cracking up at your airport experience!  I certainly didn't make the comment to make you feel bad or that you had to work harder!!!!!!!!!!!!!!!!!!!!!!  <feeling rotten>

focus on getting and staying better!  I'll keep checking in for updates and antics... :)

8:30pm • #26
103,445 Points 2 Featured Posts Outside Blog

Hey Karen - So happy to hear your good news and distraught to hear the bad news. I know it's only money and your health is of utmost importance, but one more little stressor.

Years ago, we reached our yearly maximum, two years in a row, for one of our children and know how frightening it is to wonder if you will still be able to get care. Funny - even after that, I have not checked mine recently and will do so. Thanks for the reminder! 

I am continuing the prayers for you and Michael and more than anything want for you to be well!

 

9:16pm • #27
201,242 Points 4 Featured Posts Outside Blog

Karen - thank you for bringing this topic up.  I'm sure there are many of us that are going to be calling our insurance companies in the next couple days.

My prayers are with you and your family as you all journey through this dreadful time.  Be assured that we all want nothing but the absolute best for you.  Take care of yourself and keep us posted. 

9:27pm • #28

Karen,

I am so happy for you!  Your good news was indeed good :)  And I agree with you, I think the Devil runs insurance companies as well.  I think we need to adopt Canada's policy on Health Insurance which I think is called Socialized Medicine.  Sometimes I think it really is a better route to go. 

10:49pm • #29
2 Featured Posts
Does this mean you need to shop for another job with different health insurance to cover future costs?  Like you don't have enough to worry about.  This is ridiculous!  My thoughts and prayers are with you.  Sherry
11:39pm • #30
167,709 Points 17 Featured Posts Localism Sponsor Outside Blog

Karen,

It's great to read your posts.  Thanks for caring about all of us.  We all sure care a lot for you.

11:57pm • #31
SEP
27
2007
149,776 Points 9 Featured Posts Outside Blog
Trusting Him for you---for His provision and healing.
1:23am • #32
647,313 Points 108 Featured Posts Localism Sponsor Outside Blog
Karen - I was glad to hear of your good news.  That is a big relief, I'm sure.  As for the health insurance, I have always felt that ours was run by Satan himself.  The premiums are ridiculously high, and the coverage is terrible.  I can't even get real coverage, because of a pre-existing condition.  My wife was recently shopping for new insurance, and we both felt that $1 million was not even high enough.  My mother-in-law has been through three cancer treatments at three different points in her life - thankfully, her medical care was covered by the VA since she served in the military.  Otherwise, she would be utterly destitute.  Thanks for the great reminder to everyone!
1:39am • #33

Karen, It is wonderful to see this post from you.  I am thrilled with your good news and deeply saddened by the bad news.  Fighting for one's health it task enough for anyone; having to fight insurance companies in addition is thoroughly pathetic.  The health care system in this country has been hijacked by those who seek profit in all they do and they bleed they life out of anything good.  It is a sad day when the administration of the system cost more to operate than the cost of the care it is designed to provide.

My heart and prayers are with you in every moment.  Never give up, know that you shall prevail when all is said and done and know that the cheering section here on the rain Roars for you.

1:47am • #34
114,522 Points 9 Featured Posts Outside Blog
Karen: First off, I'm so glad that the news was good. We all love you here and want to see you healthy.  Second, maximum lifetime allowance!?! I haven't seen Michael Moore's film Sicko yet, but I'm sure he would have loved to have you as a guest...that's really broken.
1:51am • #35
368,757 Points 62 Featured Posts Outside Blog
Karen, I'm embroiled in a battle with health insurance and I haven't even gotten sick, yet.  What a shame that a country as great as ours punishes us like this.
5:35am • #36
382,568 Points 1 Featured Post Outside Blog
Karen, I'm new to AR and, of course, new to your situation.  I sincerely wish you "victory" at some point intime, but I most especially applaud your efforts to bring health care issues to the forefront in the public arena.  It takes a special person to contribute in the midst of their own ordeal, Karen
5:53am • #37
411,012 Points 48 Featured Posts Localism Sponsor Outside Blog

Karen, the first part of the news certainly is good.  Thanks for warning us about looking into lifetime caps on policies; I'll do that.  And about the personal side to posting on Active Rain?  It's a good thing; keep it up!

Mike in Tucson

8:00am • #38
133,787 Points 19 Featured Posts Outside Blog
Karen, thanks for taking the time to educate all of us. My insurance is provided by my husband's company and I have no idea what our maximums are. I will check it out ASAP. Glad to hear some good news on the health front and I hope you are feeling great today.
8:36am • #39
1 Featured Post
Karen, I'm really pleased to hear the news and hope for more of the same. Here in Canada we may not have the best system but we can at least get treatment like yours with very minimal costs. The Canadian health care system has it's flaws as in extended wait times but the expenses for most treatments will not bankrupt us.
1:35pm • #40
6 Featured Posts
Karen - it's amazing to me how criminal some (most) health insurance companies really are.  I am not a big fan of Michael Moore or Hillary Clinton for that matter, but their message about health care is being heard around the country and I think it's likely to get us moving in the right direction.  You are such an extraordinarily strong person to be able to look past your own problems and warn others about this.  Keep fighting the good fight.  We're all here for you.
2:10pm • #41
257,453 Points 26 Featured Posts Outside Blog
Karen - this is so important and you are right many do not realize it is even there - I was lucky when I have had major medical issues my lifetime cap was a million.... thank goodness for group policies.
3:23pm • #42
1 Featured Post

Karen,

I am glad to hear that you are doing fairly well.  Don't worry about the bills - your health is the most important thing.  It is sad that health care in this country is in such a broken state.  I don't have any solutions but I do hope and pray that you make a full recovery.

8:29pm • #43

There is a special place with fire and pitchforks for some of the people who run insurance companies.  I know I struggle with them every time I need something.

Continued prayers for you - you sure are a tough girl!

8:33pm • #44
1 Featured Post

Hey Karen,

Great advice as always.  Good to have you blogging no matter what the topic. 

11:52pm • #45
Localism Sponsor Outside Blog

THANK YOU for updating us. Please don't feel bad about posting about your cancer here!

I am happy to hear your good news, and we will continue to pray for greater healing!

As for the insurance, my husband and I went on MegaLife earlier this year, and our son has some medical issues that unfortunately are not covered. He has Hydrocephalus, has had 2 surgeries in the past year, and MRI's every 4-6 months. Although it is only a drop in the bucket compared to what you are facing - it hurts that they won't cover him even when he has NEVER been without coverage in his short 3 years. Thank God we had different insurance for their 3.5 months in the NICU when they were born. I can't even begin to tell you what that would have cost!

11:54pm • #46
SEP
28
2007
316,805 Points 45 Featured Posts Outside Blog

Hi Karen - I'm so thrilled for you, and I'm sorry to hear about the insurance limits.  Thank you for writing this eye-opening post so that the rest of us can check our own policies.  You're right, I've no clue what mine is and certainly would never have thought to even inquire about it.  I will now though, thanks to your post.

Keep bringing us good news about your progress - wishing you many more days of just great news!
Ann

7:33pm • #47
SEP
29
2007
276,338 Points 29 Featured Posts Localism Sponsor Outside Blog
Karen, I am so glad to  hear your good news.  The insurance news is horrifying and seems simply wrong.  I am going to take a good look at my policy.  We never expect or plan for things like this do we?  Take care of yourself!
8:39am • #48
SEP
30
2007
2 Featured Posts

Once again, there you are, taking care of all of US! 

There's a new blogger named Eric Everett.  He began commenting on my posts in such a fresh and eloquent way that I checked him out.  He had not posted anything of his own, so I emailed him to ask why.  Long story short, my encouragement (and that of others) helped him "just post".  It was a great post, and was, by the way, featured.  My comment to him was:  Eric!  My Boy!  Well Done!!, then I went on to ask if I could adopt him on AR, I felt so proud.  He agreed that although he was 28, that I could be Momma Jaynee.  

Now, I turn to you and ask you to adopt ME.  I feel like whenever you share your ideas and your wisdom, I stand in awe.  You are taking care not just of individuals, here, but you're nurturing a COMMUNITY.  I'd like YOU to be my Momma Karen!

 

Cheers! from DC...

    Jaynee
 

4:41pm • #49
Good to hear your positive news... Insurance is such an issue. Many don't have it and for those that do there are always suprises. Thanks- Jill
10:21pm • #50
251,910 Points 25 Featured Posts Localism Sponsor Outside Blog

Karen,

Congratulations on the good news and many prayers and good wishes to you on your remaining struggle.  Lastly, thank you so much for your unselfish desire to reach out and help others, even in your time of need.  Insurance is always one of those things that many people hate to even think about so it's very good of you to bring it to light in an effort to educate others and help them.  Thank you and our best to you.

11:22pm • #51
OCT
01
2007
272,952 Points Outside Blog
Karen, as I was reading I asked my wife to look into our policy max's. You know we worry about business and auto and home owners insurance. Often we forget to insure our personal things are well cover. thanks for sharing your first hand experience.
9:01am • #52
126,938 Points 29 Featured Posts Hit Router
Thanks Jaynee!  What wonderful comments I get on this blog.  Thank you all so much.  And yes!  Check out those policy maximums!
10:37am • #53
Karen - Thanks for pointing out such an important fact about our insurance plans!  My wife and I were discussing this post over the weekend and will be checking on that lifetime benefit this week.  I wish you the best, and enjoy all of your posts!  Keep up th great work!
7:17pm • #54
2 Featured Posts

Karen, I apologize for skipping all the comments, I'll go back to read them, but I just had to comment. First, my heart goes out to you. Being self-employed for the past 12 years, I've had almost every health insurance and unfortunately Mega didn't cover any of our expenses they said they would, so we cancelled. I realize you are not in that situation and I'm sure the higher powers will help make a way for you to cover the chemo. Thank you for sharing this very personal experience and for making sure those of us who shop for our own health insurance are looking out for one another. I think all the thoughts and prayers are healing you. Thanks for letting me rant!

10:48pm • #55
OCT
02
2007
159,232 Points 10 Featured Posts Localism Sponsor Outside Blog

A lot of people have been very critical of me on other real estate forums for promoting NATIONAL HEALTH INSURANCE.  The sad fact is that people THINK they are covered but they aren't. I was a biomedical researcher for 15 years prior to becoming an agent.  Ironically, the money that you are spending never "trickled down" to the Ph.D. in the lab.  We were outsourced and downsized into a corner and most of us consider our Ph.D.'s to be useless for earning a living.  Hi-tech health care is expensive because it is specific and based on molecular biology. There is nothing cheap or simple about it. I routinely would spend over $1000 for a simple experiment.  Yes, we tried to keep it down, but often, there are no short cuts.  I have heard horror stories like yours many times over because many of my colleagues were physicians who had patients that couldn't pay.  Unfortunately, it is the middle class that suffers the most. 

Karen, I wish you God speed in your fight against cancer.  My father was just diagnosed with stage 4 colon cancer this past summer and its a battle every single day for him. You will be in my thoughts and prayers.

  

4:27am • #56
Localism Sponsor

Karen,

Glad to see you posting...and congrats on your good news! I will look into my policy too, I would have never thought to check that out. I appreciate you thinking about the rest of us while your plate is so full!

Hugs and love,

Heather

5:50pm • #57
266,025 Points 18 Featured Posts Outside Blog

Karen - I don't know how I got out of the loop - somewehere I lost your blog subscription :-( (maybe it was a blonde moment - lol)- I've fixed it so I'm not so late to the party in the future (lol)

Glad to hear things are going better physically - the other one makes me want to scream - and thank you for making each of us more aware of "what the right questions are to even ask to see if we're covered" - isn't it typical you don't know until it's too late. I will be checking mine and you're right we've been blessed not to have any serious illness touch our family so we really do have NO idea - I was shocked.

I did hit Jay's pay pal for you though I realize it's just a drop in the bucket - I figured at a time like this practical gifts like "cash" are more appreciated :-) than say flowers.

SEO is going great - I'd love to talk to you and share but I know it's all you can do to blog a little. I am Also building a new blog site and it's keeping me busy. You got off to a great start and it's made all the difference for me and my family - thanks so much.  - Hugs from Clearwater :-)   

11:01pm • #58
166,792 Points 2 Featured Posts Outside Blog

Karen:  I've seen your name mentioned in several member's blogs and started checking out your posts.  I am shocked to learn of your illness.  I am so sorry that I did not know sooner.  Please do not worry about responding to my comment, I know you want to respond to everyone and it has to be very difficult to keep up.  I truly hope and pray that you will be completely healed.  I've bookmarked several of your blogs so I can go back and read them. 

Thank you God, for people like Karen George who help with no thought of recognition or reward. 

Karen you will be in my thoughts and  prayers for your speedy recovery.

11:55pm • #59
OCT
05
2007
2 Featured Posts

Karen, 17 years ago, before I was in real estate, I sold health insurance for NASE.  I learned enough about the health insurance industy that I no longer even believe in health insurance.  I don't have it anymore.

For more than 15 years now I have been a member of a group that shares medical costs.  This is a very large group, (there are thousands of members), and it is christian based.  You actually have your church pastor sign your application and your claims for medical needs.  We send a check every month for $275 to an actual person, a different person every month.  Only once a year we send a check to the organization that keeps things on track.  We have had to use it several times and it has worked well for us and the best thing about is...I don't send my check to an insurance company.

I'm sorry to hear about your problems with coverage.  It was good of you to warn others to check their coverage.

 

3:35pm • #60
OCT
07
2007
132,038 Points 46 Featured Posts Localism Sponsor Outside Blog

Karen:

That is just wonderful news about the clean brain scans. I can imagine the joy shared in your immediate and extended families.

Thanks for the nudge to check our health insurance policy. I'm sure the benefit limitation is buried in the fine print somewhere. 

9:41am • #61
OCT
14
2007
106,329 Points 3 Featured Posts
I hate dealing with insurance companies and you do have to research EVERYTHING indeed.  I never thought about the total lifetime benefits before, thank you for bringing this to my awareness.  I also had no idea how much those shots were!!! 
7:54pm • #62
OCT
15
2007
159,232 Points 10 Featured Posts Localism Sponsor Outside Blog

Hello again, 

I don't know if this info is helpful for any of you. Be VERY careful about medicare HMOs.  If you are in NY stay AWAY from Empire Blue Cross/Shield for medicare.  I'm tearing my hair out and having a nervous breakdown over my father's care for Stage 4 colon cancer.  He was diagnosed earlier  this year. He was covered for hospital and rehab.  But for the chemo - I've been trying for a MONTH to get chemo covered and I'm being given the royal runaround.  Both the oncologist and pharmacist have  spent days of office time trying to untangle this mess.  I STILL don't have the chem for him. It's a total disgrace.  I guess he thought he'd save some money on medication copays with this, but it has been a fiasco. He also has very limited coverage with respect to doctors.

 I'm literally finishing my  taxes...I had an extension, but the entire month - every free minute has been on getting him chemo...I finally called one of my senators and my congressman.  They are trying to help - but no luck. I was able to get one round for him, but the insurer renegged on reimbursing the pharmacist - so now I have to recover $1400 or pay him myself. (I can't let him swallow it - he's a one-man operation.)  Talk about disaster insurance - this is DISASTROUS  INSURANCE.

12:35am • #63
159,232 Points 10 Featured Posts Localism Sponsor Outside Blog

Btw, I wish I could say whether or not this applies to ALL medicare HMOs  or other medicare HMOs. If anyone has another experience with one, it might be a good thing to know about. 

 Thank you Karen, for bringing up this topic - people think they are covered and end up in bankruptcy over health care after paying in for years and years. Its appalling.  I hope everything is going well and you continue to make progress.

12:38am • #64
126,938 Points 29 Featured Posts Hit Router

Ruthmarie--

I responded to you via email.  Let me know if you do not receive it.

I'm so sorry for all of this,

Karen

9:07am • #65
OCT
29
2007
Localism Sponsor
Wow, Karen. I had no idea of the expense level. My mother and aunt both are breast cancer survivors. My older sister by two years was just diagnosed with breast cancer in may. I don't know what stage though. Thanks for the heads up. I am going to be reviewing my insurance coverage this afternoon.
12:50pm • #66
NOV
06
2007

Karen, sorry to hear about your ordeal. I do medical billing and work directly with the insurance companies, it always amazes me to the number of people who don't know what their benefits are. I work for an alcholol and drug recovery group. So many clients present us with their insurance cards, only to be told that they have no coverage for this type of service. Luckily we offer reduced pricing for cash paying clients, but it just goes to show how most people only know that they have insurance, but not what they are entitled to under their coverage. The insurance company is to blame for this as well. They write their policies in a way that most people get lost 10 minutes into trying to figure it out. While still working for a cardiologist, we dealt alot with medicare, and with all the rules and changes, our clients were lost. It then became my job to go over their insurance with them, and inform them of what they were entitled to.

I am sorry to hear about your ordeal, and the situation your insurance company has placed you in. I could go on and on about this subject. I believe medical services are extremely overpriced, and it is allowed to encorage people to purchase insurance. I also discovered, due to the insurance companies, the doctors are not getting a fair reimbursement rate by the insurance companies, it really blew my mind the first time I saw how much the doctor had to write off.

Good luck with your health, may things only look up.

5:48pm • #67
DEC
02
2007
2 Featured Posts

Hi Karen,  I've been advised to read up on your blogs.  I do catch them occasionally but I missed this one. I hope that you are doing well.  I had no idea that there was a 'life time limit' on chemo!  I know of the expense as my youngest cousin fought a 4 year battle from the age of 16-20 (ultimately the cancer won) and thankfully my aunt was able to get him on medicaid because there was NO WAY she could afford the kind of care he needed, being she was a single mom and not even insured...4 thoracodmies, an amputation, multiple rounds of chemo...goes on and on...I think his bills tallied close to $700K once all was said and done.  How could that kind of limit be put on chemo?  Unfortunately, there is a high chance of metastisis (I don't know the actual statistics) or of it showing up again...they have to do better than that.

Thank you for educating us.  No one ever thinks things happen to THEM...it only happens to OTHERS...$20/mo is small price for protection.

Best wishes to you and your family.  You are an inspiration.

12:38pm • #68
DEC
03
2007
143,511 Points 2 Featured Posts
Karen - Thank you for sharing your story and experience. I learned about maximum lifetime benefit for our policy, but did not pay much attention to other maximums. I'll pull out our policy and investigate further. Thank you, thank you! How strong you are with your proactive blogging in the midst of your illness. I pray you win your battles. 
8:36pm • #69

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