Comments on: They Call This Insurance? http://btan.org/index.php/2009/05/13/they-call-this-insurance/ Putting Our Heads Together Thu, 10 Sep 2009 07:30:20 +0000 http://wordpress.org/?v=2.9.1 hourly 1 By: sharon gay http://btan.org/index.php/2009/05/13/they-call-this-insurance/comment-page-1/#comment-1393 sharon gay Sun, 26 Jul 2009 14:25:03 +0000 http://btan.org/?p=379#comment-1393 Hi Mark, We had the same problem. At the U W pharmacy, I went to pick up my husband's Temodar. The day before, my "representative" at our insurance company told me that it would be 100% paid for, since we had met our stop loss. My husband was having a seizure in his wheelchair behind me at the pharmacy window, just as the pharmacist told me that I had to pay for ALL the Temodar -right then and there. I threw my Mastercard at her, grabbed the medicine and wheeled him down to get him hospitalized as the seizures wouldn't stop. A very traumatic day, in all aspects. After protesting to my insurance company and being refused for my first appeal, we "lawyered up" and won the second appeal and they repaid us for several months of Temodar. Sadly, my husband's glioblastoma has returned and he was removed from Temodar and now on IV infusion of Avastin and Carboplatin. So far, the insurance company is paying, but I worry that they will have a "limit" as to how many treatments they will pay for. I would call them and ask, but I merely get the flying monkeys who read the basics off a coverage brochure and get no real answers, so we are just hunkering down, waiting for the insurance to someday refuse, and go back to having our attorney make them bleed. It's ridiculous that at a time in one's life when everything should be easier on the patient instead of harder, we are trying to swim through the quagmire of red tape and legalese. As my husband's caregiver and representative, I have had a crash course on pharmaceuticals, medical jargon, ethics and law issues while trying to keep up with a dwindling stock market, a dirty house, and still find time to ask the heavens and universe for prayerful answers. I am hoping that your tumor is under control and that you are doing well. My husband is struggling, but has made it past the one year mark for glioblastoma multiforme and we hope he continues to fight this for a long while yet. Take care Sharon Gay Hi Mark,
We had the same problem. At the U W pharmacy, I went to pick up my husband’s Temodar. The day before, my “representative” at our insurance company told me that it would be 100% paid for, since we had met our stop loss. My husband was having a seizure in his wheelchair behind me at the pharmacy window, just as the pharmacist told me that I had to pay for ALL the Temodar -right then and there. I threw my Mastercard at her, grabbed the medicine and wheeled him down to get him hospitalized as the seizures wouldn’t stop. A very traumatic day, in all aspects.

After protesting to my insurance company and being refused for my first appeal, we “lawyered up” and won the second appeal and they repaid us for several months of Temodar.

Sadly, my husband’s glioblastoma has returned and he was removed from Temodar and now on IV infusion of Avastin and Carboplatin. So far, the insurance company is paying, but I worry that they will have a “limit” as to how many treatments they will pay for. I would call them and ask, but I merely get the flying monkeys who read the basics off a coverage brochure and get no real answers, so we are just hunkering down, waiting for the insurance to someday refuse, and go back to having our attorney make them bleed. It’s ridiculous that at a time in one’s life when everything should be easier on the patient instead of harder, we are trying to swim through the quagmire of red tape and legalese. As my husband’s caregiver and representative, I have had a crash course on pharmaceuticals, medical jargon, ethics and law issues while trying to keep up with a dwindling stock market, a dirty house, and still find time to ask the heavens and universe for prayerful answers.

I am hoping that your tumor is under control and that you are doing well. My husband is struggling, but has made it past the one year mark for glioblastoma multiforme and we hope he continues to fight this for a long while yet.

Take care
Sharon Gay

]]> By: Trueda Gooding http://btan.org/index.php/2009/05/13/they-call-this-insurance/comment-page-1/#comment-1197 Trueda Gooding Wed, 20 May 2009 05:34:26 +0000 http://btan.org/?p=379#comment-1197 Mark, A great post about a huge problem, one of many, with our current health insurance system. I relate to your situation as my 28 year old son has been battling a grade 3 astrocytoma for about 2 1/2 years and is also treated at the UW, though by Dr. Mrugala. Brain cancer is a miserable and wily beast, and the treatments aren't that much better! Then to not have it covered by insurance is a real downer with devastating financial impact. It is time for the US to face the fact that our current health insurance system serves the system and not the people who need it and expected it to be there for them. BTW, are you aware that the UW has a brain tumor support group that meets the first Wednesday of each month. The group is full of wonderful, talented and funny people dealing with brain cancer. We have found it to consistently be a high point in our month. Dr. Spence's office should have more info about it if you're interested. Thanks again for addressing this issue. Trueda Gooding Mark,

A great post about a huge problem, one of many, with our current health insurance system. I relate to your situation as my 28 year old son has been battling a grade 3 astrocytoma for about 2 1/2 years and is also treated at the UW, though by Dr. Mrugala. Brain cancer is a miserable and wily beast, and the treatments aren’t that much better! Then to not have it covered by insurance is a real downer with devastating financial impact. It is time for the US to face the fact that our current health insurance system serves the system and not the people who need it and expected it to be there for them.

BTW, are you aware that the UW has a brain tumor support group that meets the first Wednesday of each month. The group is full of wonderful, talented and funny people dealing with brain cancer. We have found it to consistently be a high point in our month. Dr. Spence’s office should have more info about it if you’re interested.

Thanks again for addressing this issue.

Trueda Gooding

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