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#132391 - 04/02/11 02:37 AM Meds $51.50...co-pay $50
MaineWill Offline
Senior Member (100+ posts)

Registered: 03/01/11
Posts: 124
Loc: Portland Maine
How does Blue Cross get away with it. I pay $462 a month and when I went to get some meds to help me swallow. It came to $51.50. The co pay was $50. They paid $1.50. Then the Roxicet was $42.50... co-pay was $30. I called to complain and even the supervisor basically said tough s#!t. Oh well. Like my wholistic doctor says "cancer feeds on fear and anger so don't sweat the small stuff". I guess I can take solice in the fact that I enrolled in my company's insurance plan 10 days before I got my DX.
_________________________
Lump in left side neck discovered Sept 2009
Misdiagnosed & FNA inconclusive
Large lymph node removed Nov. 2010 SCC and HPV16 pos
PET pointed tonsilectomy Feb. 2011
1ml tumor left side tonsil
Rads scheduled March 14th 2011. 2X36 GY's (72)
CarboTaxol once a week X 4 or 5 starting 4/5/11
No PEG

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#132402 - 04/02/11 10:32 AM Re: Meds $51.50...co-pay $50 [Re: MaineWill]
Anne-Marie Offline
Patient Advocate (old timer, 2000 posts)

Registered: 11/03/06
Posts: 2671
Loc: TN
When I got my Dental Insurance after years of not having either dental or health insurance, I was so thrilled until I found out my dental plan only pays about 10 percent of the cost. It's really good that you got your company's insurance when you did, though. When you or someone close to you survives cancer, "don't sweat the small stuff" is a good plan.
_________________________
Anne-Marie
CG to son, Paul (age 33, non-smoker) SCC Stage 2, Surgery 9/21/06, 1/6 tongue Rt.side removed, +48 lymph nodes neck. IMRTx28 completed 12/19/06. CT scan 7/8/10 Cancer-free! ("spot" on lung from scar tissue related to Pneumonia.)




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#132433 - 04/03/11 01:35 PM Re: Meds $51.50...co-pay $50 [Re: Anne-Marie]
cbhh Offline
Supporting Member (50+ posts)

Registered: 12/13/10
Posts: 60
Loc: SC
That does seem ridiculous but so like insurance companies. I was just prescribed a 15 gram tube of zovirax (acyclovir) for a mouth ulcer that has crept up along the edge of my scar. When the pharmacist told me it was $177.01 I said, 'would my pharmacy card help with this?'. She said, 'It did, we have it on file, it saved you $53'. Well, I guess that's better than full price?

My insurance has a $5,000 deductible and I'm then responsible for 20% of the next $20,000 in network expenses. I've been careful to stay in network. To my mind that should mean a $9,000 outlay on my part but I've racked up nearly $20,000 in expenses and not all the bills have come in. It's a scam!
_________________________
Catherine, SCC floor of mouth DX 2010,unclear margins, PET scan clear, no chemo or rad,biopsy in 9/2010, 2nd excision 10/2010 didn't get all carcinoma in situ; partial gloss & excis. right floor 2/2/2011 margins clear. Part.gloss-10/5/2011 sev dys clean marg. HPV neg. Don't smoke or drink. SCC floor of mouth left side 4/2016.

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#132495 - 04/05/11 07:39 PM Re: Meds $51.50...co-pay $50 [Re: cbhh]
MaineWill Offline
Senior Member (100+ posts)

Registered: 03/01/11
Posts: 124
Loc: Portland Maine
My Riteaid card frequently saves me more money than my insurance but I can't use them together. What a rippoff!!!!
_________________________
Lump in left side neck discovered Sept 2009
Misdiagnosed & FNA inconclusive
Large lymph node removed Nov. 2010 SCC and HPV16 pos
PET pointed tonsilectomy Feb. 2011
1ml tumor left side tonsil
Rads scheduled March 14th 2011. 2X36 GY's (72)
CarboTaxol once a week X 4 or 5 starting 4/5/11
No PEG

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#144588 - 01/07/12 03:41 PM Re: Meds $51.50...co-pay $50 [Re: MaineWill]
campo Offline
Member

Registered: 01/07/12
Posts: 2
Loc: veracruz
Blue Cross? I have standard option and suspect the possibility of
surgery, perhaps chemo maybe rads would run into "catastrophic range"... that's $7,000. Is that a correct assesment. Does that mean if I use a participation hospital/provider- I fork over 7 gran and BC pays the rest?

I've never used my plan in over 25 years. Cost is a big factor for me- I may not be able to afford tx.

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#144589 - 01/07/12 05:18 PM Re: Meds $51.50...co-pay $50 [Re: campo]
Cheryld Offline
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)

Registered: 12/22/10
Posts: 5260
Loc: Toronto canada
You all need to move to Canada! smile
_________________________
Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan

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#144590 - 01/07/12 06:43 PM Re: Meds $51.50...co-pay $50 [Re: campo]
debandbill Offline
"Above & Beyond" Member (500+ posts)

Registered: 07/12/07
Posts: 939
Loc: Punta Gorda, Florida
Originally Posted By: campo
Blue Cross? I have standard option and suspect the possibility of
surgery, perhaps chemo maybe rads would run into "catastrophic range"... that's $7,000. Is that a correct assesment. Does that mean if I use a participation hospital/provider- I fork over 7 gran and BC pays the rest?

I've never used my plan in over 25 years. Cost is a big factor for me- I may not be able to afford tx.


Campo,

I would have to look at your particular policy to see what your coverages are. There is usually a deductible you have to meet and pay before they pay. There is usually an "out of pocket max" that you meet before they pay everything. There are different coverages for hospital visits vs doctor visits...so on and so on.

Find your BCBS card and call the number listed on the back and get guidance on what your coverages are and what you can expect. Your doctors' offices can help you as well..they usually have someone that can sort thru how you are covered.

Good luck.

_________________________
Deb..caregiver to husband, age 63 at diagnosis, former smoker who quit in 1997.
DIAGNOSIS: 6/26/07 SCC right tonsil/BOT T4N0M0
TREATMENT START: 8/9/07 cisplatin/taxol X 7..IMRT twice daily X 31.5.
TREATMENT END: 10/1/07
PEG OUT: 1/08
PORT OUT: 4/09
FOLLOWUP: Now only annual exams. ALL CLEAR!

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#144601 - 01/08/12 01:11 AM Re: Meds $51.50...co-pay $50 [Re: campo]
Charm2017 Offline
Patient Advocate (old timer, 2000 posts)

Registered: 03/03/08
Posts: 3082
Loc: Alexandria VA
Campo
While you do need to check with Blue Cross , I had their standard (it's the old high plan) and yes, once I hit the catastrophic limit of co pays, BC paid it all. Actually I hit the catastrophic limit for both TXs. Remember that the $7K limit does NOT mean $7K worth of bills, but rather YOUR co=pay and deductible out of pocket expenses hitting $7K.
I do know that you do need to use a participating hospital and doctors. I had to double check that the hospital had assigned participating anesthesiologists for my operation because some don't.
Others have posted here about not being able to pay and how they dealt with it, but I paid only the $5K catastrophic limit of 2007 for about $250K worth of hospital bills the first time and the second round cost me $6K for about $180K (no inflated & over expensive Erbitux bills), Plus of course my monthly premiums. ( Yet another reason, I still have an old CRT TV that even charities won't take and my stereo speakers from law school. )
It is mind boggling how expensive cancer TX is.
Charm



Edited by Charm2017 (01/08/12 01:13 AM)
Edit Reason: typos
_________________________
65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13

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#144604 - 01/08/12 03:24 AM Re: Meds $51.50...co-pay $50 [Re: Charm2017]
campo Offline
Member

Registered: 01/07/12
Posts: 2
Loc: veracruz
You all need to move to Canada!...no cold for me/ I-ve had the chills & a fever for the first time in 15 years.

Your doctors' offices can help you as well. Nope! I've seen 1 doctor in the last 20 years & he was a quack. (I do respect many med pros).... about 1200 km to any hospital provider.

Charm- what is a frack? ...Your bcbs answer is what I was lookin for. I'm pretty sure that's my limit on payouts- about 7g. exactly...no special drugs-ibuprofeno. Could that stretch into 2 surgeries if i skip or refuse rad/chemo?

Thanks. I like to do charity while alive.

" Can't swallow to eat or drink ". I'm really sorry and hope that goes away in my own special way.

Meanwhile, since I'm sure you can't choke or throw up your coffee, have you tried shotgun bong hits?

I am campo a former narc & attorney at USSC & I approve laughter.





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#144623 - 01/09/12 09:59 PM Re: Meds $51.50...co-pay $50 [Re: campo]
Charm2017 Offline
Patient Advocate (old timer, 2000 posts)

Registered: 03/03/08
Posts: 3082
Loc: Alexandria VA
Campo

Thanks for the good wishes. Unless all the SLPs (speech language pathologists and MBS (modified barium swallowing) tests are wrong, I'll be like Roger Ebert in never swallowing again. Surgery did me in.

Even though you were a "narc", I hope you beat this. My heartfelt advice is that you do NOT skip radiation and chemo if that is what your doctors recommend.
Frack is Battlestar Galatica's futuristic version of the F word and I was a big fan of the new series and Caprica.
I wanted to use George Carlin's phrase:
Quote:
I'm not an old fart but an old f***
but you can't use that word on any major internet forum/

If you do decide to use medical marijuana, do NOT use a bong or any smoke delivery device including have a fellow perp shotgun you. Use a vaporizer instead which does not reach combustion temperature so no smoke and no irritation. Smoking of any type and of anything is a big NO NO for any oral cancer patient ever and nothing to joke about.


Edited by Charm2017 (01/09/12 10:25 PM)
Edit Reason: typos
_________________________
65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13

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#144636 - 01/10/12 01:38 PM Re: Meds $51.50...co-pay $50 [Re: Charm2017]
Cheryld Offline
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)

Registered: 12/22/10
Posts: 5260
Loc: Toronto canada
Hey hey - not all of Canada is cold! smile actually i live in torpnto and we've had 1 day of snow ! and I agree with charm if your dr recommend rads and chemo - despite the possible fall out - do it. Particularly if your dr. has a good reputation, and know his/ her stuff... smile
_________________________
Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan

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#144637 - 01/10/12 03:31 PM Re: Meds $51.50...co-pay $50 [Re: Cheryld]
Pandora99 Offline
"OCF Canuck"
Patient Advocate (1000+ posts)

Registered: 09/14/06
Posts: 1328
Loc: Winnipeg, Manitoba Canada
I have many US friends, and those that are employed staunchly endorse the U.S.'s medical system. Those that are not employed or are continuing to work just to get to a medicare age are not so happy with it. In general however, the feedback I get is that people hold great FEAR of "Universal HealthCare". I don't understand why. I just don't get it, and I would love to find out from a US citizen what their thinking is.

Anyone who would care to enlighten me can send me a PM and we can discuss.

I will, off the top, agree that no system is perfect. I know of horror stories from both sides of the border.

The USA has another election soon, and your Canadian friends have these questions. Anyone care to discuss via PM? I suggest PM as I think this may be an issue which isn't appropriate for the general forum as it has political implications/undertones.

Donna
_________________________
Donna,61,SCC L Tongue T2N1MO Stg IV 4/04 w/partial gloss;32 radtx; T2N2M0 Stg IV.New primary R tongue-2nd partial gloss w/graft 10/07; 30 radtx/2 cispl 2/08. 11 yrs from 1st dx, 7 yrs since 2nd dx. Surviving isn't easy,but grateful for EVERY day.Proudly Canadian - YES, UNIVERSAL HEALTH CARE IS WONDERFUL!

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#144651 - 01/11/12 02:05 PM Re: Meds $51.50...co-pay $50 [Re: Pandora99]
Cheryld Offline
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)

Registered: 12/22/10
Posts: 5260
Loc: Toronto canada
smile agreed - mostly I was just teasing... However the one thing I do appreciate is not having to choose between living and "living" for some having poor health care or no health care (in a non social medicine cointry) drains the wallet in a big way... Even if you have coverage - my husband has extra insurance through his company. It runs maybe $100 a month from his paycheque... Covers everything, dental, glasses, prescriptions, braces, massage, physio - etc... For the whole family - I've never payed more than $5 for any prescription - and if I get them filled at Walmart (lower dispensing fee) I pay nothing... smile also I'm free to choose which hospital, and which dr. I will be treated by... Mind you the states has 10 times more people than we do! Hugs all.
_________________________
Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan

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