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Medical Forum / Diseases and Disorders / Cancer / February 2005Joe-46er How are you doing??
Joe, How are you doing, I haven't seen an update in a while, since our cases are so much alike I'd like to touch base just to make sure things are going OK. All the best. George Hi Geoge! Thanks for asking. I'm doing well, I think. I'm having more trouble with my insurance company than with my body. The onc I've been w for over a year now at U Penn Philly is to quote them "No longer in the system" and I have to find a new hospital and onc. The guy I'd been with up to now (Dr. Daniel Haller) is super-great, in expertise and in bedside manner, so I'm nervous about switching to an unfamiliar person especially now that my first diagnosis (Nov 2003) is moving further behind me.. I'm on my 16th chemo treatment now and the toxins are catching up slowly. I'm zombied-out for a few days after infusion is over (every-other week FOLFOX4 + avastin) pretty sickly sight, but I rebound quickly and have a very good week afterwards when I can do pretty much what I want (as long as I'm not in the car too far away from a rest-stop!). I'm on the receiving end of a totally loyal and loving wife and family. My church covers meals for us during my bad weeks and countless friends are praying. BTW I am a follower of Jesus and have had some interesting faith-generating experiences that remind my that either way, I win. Not meaning to clobber you or anyone with preachments, but in my personal life it works. How you doin'? --Joe >Joe, > [quoted text clipped - 3 lines] > >George _________________________________ "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 Timothy 5:23 (adapted) Actually I just finished my 25th treatment (I lose track). I reviewed some of your previous posts. You are a truly remarkable person. I see Jesus in you. Prayers, --Joe >Hi Geoge! > [quoted text clipped - 38 lines] > >"Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 Timothy 5:23 (adapted) _________________________________ "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 Timothy 5:23 (adapted) > Actually I just finished my 25th treatment (I lose track). I reviewed > some of your previous posts. You are a truly remarkable person. I see [quoted text clipped - 3 lines] > > --Joe Sad that dealing with insurance can be more painful than cancer!!! Alex > Hi Geoge! > [quoted text clipped - 40 lines] > "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 > Timothy 5:23 (adapted) Hey Joe, Don't give up the ship, how do you feel about giving some back to the insurance company? If you are game I'll let you in on what worked for me. When my liver specialist went "out of network" I was pretty hacked. I started asking questions and pretty soon he was back "in". Start with a certified return receipt letter to your insurance company, no phone calls or e-mails, and ask them why your onc. went "out of network". Ask for the PERSON who made the decision and who designated him "out". Ask if there was some reason, like a malpractice case, or a lawsuit, or a reprimand from the board that admitted him to practice. Ask why other are "in" and your physician is out. Tell them you want the name of the PERSON who made the decision, or you will file a complaint with the insurance commission or commissioner in your State. Put a copy of your next letter into the envelope with the letter to the insurance company, make sure the two letters have the proper CC's to each other. Next send another certified return receipt letter to the medical board that admitted your physician to practice. Ask them if there is anything that has happened to cause them to remove your doctor from active practice, like malpractice, a reprimand or some such problem. Include a copy of the letter you sent to the insurance company in their envelope. Last take copies of both letters to your physician and let him have them. Don't let him assist in writing them, that is unethical, but you can let him see what you are up to, if nothing else to let him know a storm is brewing. The insurance company probably won't answer your questions and you will probably get a form letter back letting you know that it is just the way things are. After that write a letter to the insurance commissioner, state legislators, and your governor asking why you can't be treated by a doctor who you trust to heal you of cancer. You will be amazed by how fast your doctor comes back "in" to the fold. I've had to do it twice and it's worked both times, but even if it doesn't work it's good clean fun. I'm doing pretty well. I'm gaining energy every day and the nerapathy is resolving itself slowly [just the last knuckle of each of my fingers and the bottoms of my feet are still affected]. Coughing and sneezing is still an adventure every time it happens, but I've been off all pain meds for 4 days now. The fingernails are problematic, since the shred and bend so easily, but in 6 months my doc said they will be good as new. I'm nervous heading in for my first CT scan since surgery, but optimistic, since my energy levels are coming back. I've made it through leading a monday night fellowship 3 times now and feel stronger each time. The preacher who was supposed to give the message bailed on me, so I had to deliver the sermon, henceforth to be known as "The Cat Sermon", it involved a cat named Fluffy who nailed an animal control officer who was trying to fine him/her a new home, the David and Goliath, and Davis and Absoloum [sp unsure]. Anyway I was pretty punk about delivering such a strange message but 3 folks who were there said it was exactly what they needed to hear, so I guess the Lord worked it for His own purposes. I reminded them that God's way always produces a win/win situation and satan's way always produces a loose/loose. Keep a stiff upper lip, Sir, and ask some questions - I think it will produce the desired effect. All the best. George > Hey Joe, > [quoted text clipped - 46 lines] > > > George That is great advice for commercial insurance, but Socks is in a Medicare HMO which has a different set of rules almost impossible to fight. Of course, socks could elect to go back to original Medicare, but then he would loose the benefits the HMO gives him ( like RX, not paying deductibles etc), Medicare HMO have been challenged many times unsuccessfully. Alex >> The insurance company probably won't answer your questions and you will >> probably get a form letter back letting you know that it is just the way [quoted text clipped - 9 lines] >> >> > George I stand corrected great advice since Joe has a HMO.. they tend to bend towards political pressure but it is time consuming and mental exhausting. Alex We've done pretty much what was suggested re letter-writing and we did win about 6 months additional care w my original onc. We learned however that the real problem is money. My current onc (& his hospital I assume) charge more per visit/treatment than others, and they wouldn't drop their prices to be more competitive. So it appears to be a problem of economics. I can't blame my insurer in that respect. They are in the profit-making business. Some good may come out of this however. I learned that some younger oncs (who studied under my present onc) are in my insurer's system and are associated with Fox-Chase hospital which has an excellent reputation. We'll see. Watchin' the snow fall. Hope we get trounced. I love it! Snowmen fall from God's heaven unassembled. --Joe >>> The insurance company probably won't answer your questions and you will >>> probably get a form letter back letting you know that it is just the way [quoted text clipped - 12 lines] >towards political pressure but it is time consuming and mental exhausting. >Alex _________________________________ "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 Timothy 5:23 (adapted) > We've done pretty much what was suggested re letter-writing and we did > win about 6 months additional care w my original onc. We learned [quoted text clipped - 34 lines] > "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 > Timothy 5:23 (adapted) Joe, Hang in there. You won an additional six months. Can your present Onc make any recommendations who he would see if he were in your shoes? My insurance company has just informed me that my surgery didn't actually happen in December, since the anesteologists [sp?] didn't bill until January, and I'm going to have to cough up all of my deductible right now. Looks like my streak of good luck ran out. Gotta break out the 'ole baseball bat and do some educating for some rascals. I'm still doing good and am coming up on my first post op CT scan in the next month or so. I'm feeling better every day, and the mental and physical leftover symptoms are slowly resolving. All the best. George > My insurance company has just informed me that my surgery didn't actually > happen in December, since the anesteologists [sp?] didn't bill until January, > and I'm going to have to cough up all of my deductible right now. Looks > like my streak of good luck ran out. Gotta break out the 'ole baseball bat > and do some educating for some rascals. Can the anestheliologist (sp?) send them a "corrected" bill ? Write Correction in big letters on the bill and put :Procedure date : December XX, 2004? I'm so sorry they're putting you through this George. > I'm still doing good and am coming up on my first post op CT scan in the next > month or so. I'm feeling better every day, and the mental and physical > leftover symptoms are slowly resolving. Good to read that you're starting to feel better. Keep in touch, J J wrote, >> My insurance company has just informed me that my surgery didn't actually >> happen in December, since the anesteologists [sp?] didn't bill until [quoted text clipped - 18 lines] >Keep in touch, >J It is very odd how the insurance companies operate. I had bills, like an emergency room visit, which they would not cover. They also gave me a difficult time about paying for the pump use. Supposedly, I used up my allowance for home care and they consider taking the pump home as home care. I paid insurance premiums my entire life, and never had to go to the doctor (until last year), so they can go f.ck themselves. People have insurance for a reason, and it is not for getting your nuts busted. I wouldn't pay anything until you argue with them for a while. The hospitals have a way of collecting off the insurance. I would let them handle it. I do not think, legally, that the insurance companies can put a lein on your home or affect your credit. > I wouldn't pay anything until you argue with them for a while. The hospitals > have a way of collecting off the insurance. I would let them handle it. I do > not think, legally, that the insurance companies can put a lein on your home or > affect your credit. I agree that you should pursue this to see if the insurance will pay, as it appears you may have a valid complaint. The insurance companies are not the ones to worry about when it comes to credit reporting. The hospitals and doctors (creditors) may report you to the credit bureaus if the bills go uncollected for a long period. You need to talk with the creditors and try to work out an agreement until this is settled. Most of the time they will work with you to resolve the problem. Sometimes they will write off a portion of the bill if there are circumstances that warrant it. Good luck. Jerry See my earlier post re latest CRC info. I've got another scan coming up next week. I hope it assures me that the higher CEA levels are just a fluke. The medical staff is so great, but it's the administrative staff that lack understanding. Here's an example. My treatments typically average 7 hours. After a treatment I get my next appointment and sometimes they usually schedule me for late in the morning. I ask for an earlier one because of the many hours I spend in the chair but they say first come first served. So two weeks later I arrive at the late morning appointment then sit around waiting for another 3 hours until a chair/room finally opens up. By then it's 1:00 or 2:00. My treatments will then take me beyond their closing time and some nurses will have to stay after 7:00 just to tend me. They (the nurses) say there's nothing they can do, that it's a beaureaucratic problem. I don't understand why the schedulers can't give preference to people like me who have to spend the whole day. I get my next appointment time after everybody else has gotten theirs! So it's an endless loop with no way out. It would save the hospital many hundreds of dollars each time. But nooooo. Go figure. Sorry to hear about your encounter with administration crapola. Hang in there. All things work together for good to ...etc you know. --Joe >> We've done pretty much what was suggested re letter-writing and we did >> win about 6 months additional care w my original onc. We learned [quoted text clipped - 53 lines] > >George _________________________________ "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 Timothy 5:23 (adapted) > See my earlier post re latest CRC info. I've got another scan coming > up next week. I hope it assures me that the higher CEA levels are just [quoted text clipped - 16 lines] > out. It would save the hospital many hundreds of dollars each time. > But nooooo. Go figure. Looks like they're doing what I call "cattle call by appointment". If you got there early in the am, you might get in fast or they'd tell you to wait until your appointment. Maybe it's a good thing that you're changing centres and starting fresh. J > See my earlier post re latest CRC info. I've got another scan coming > up next week. I hope it assures me that the higher CEA levels are just [quoted text clipped - 89 lines] > "Take a little 5FU, leucovorin and oxaliplatin for thy stomach's sake." -- 1 > Timothy 5:23 (adapted) Joe, I had the same problem with my chemo treatments twice. I made an appointment with the hospital's Chief of Staff and the Chief Nurse as well as the hospital Administrator - the time was during one of their staff meeting, so there were a bunch of other folks there as well. I explained the problem and showed that I had kept my appointments, but that the staff had messed them up, without notifying me, and then had expected that I would know about it somehow. I do remember that the triggereing event was the day when I was scheduled for my blood draw after my chemo treatment, and a CT scan during the treatment, all by the same person. As soon as they figured out what was going on, POOF, no more problem. The staff had to work a little harder at coordinating everything but the message came through to all departments to double check what was going on with patient care instead of reading a People Magazine. Hope it works out. All the Beas. George |
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