I am curious as to what insurance others have and whether it covers everything 100%.

I have Medicare which covers 80% and Kaiiser Permanente HMO that covers the other 20% in most cases as I understand it. I am currently in Pittsburgh at the UPMC for consultation and I think I have just discovered a disadvantage to an HMO. I was given a referral to come here and it has been determined that I am a good candidate for treatment that involves Cyberknife type radiation in conjunction with Erbitux. It turns out this is a clinical trial. If it was a Medicare covered clinical treatment, which it is not, Kaiser has no problem with my having treatment here for Medicare covers their part and I am responsible for the balance some how. Since Medicare will not cover anything Kaiser says I have to have the treatment in Atlnta and claims to know a Doctor there that can do the treatment. If that Doctor can do the same or better that is fine with me but I am not sure that he can. My request to Kaiser is to let me stay here for treatment OUTSIDE OF THE CLINICAL TRIAL and Kaisers network because the doctors here specialize in head and neck cancer.

My other question here, other than the one about the insurance others have, is: If the Doctor in Atlanta does not have the same equipment and expertise as the Doctors at UPMC does it seem there is any reason I MUST have some similar treatment done in Atlanta?

Nocam,

A few options to consider;

1) If you go off trial it may be as simple as changing to a different chemo. As chemo is only a small part of the treatment plan, that might work.

2) I was treated in the same trial but they considered me an off trial patient because I live in another state and they could not assure my follow ups would be at UPMC. It may be that simple.

3) Check with the doctors. They know the system and may have an end around. Dr. Heron will call them directly if he thinks he has a chance (he offered to do that for me on a PET scan charge).

4) See if the hospital has their own program to support people like you who fall through the cracks.

5) Sometimes the doctors at one hospital will follow the protocol as prescribed at another hospital. I�m not sure this will work in your situation as targeting is a very important part of cyberknife reradiating. They have a very specific way they target the treatment and need to do that on their own equipment. I know because I asked how much of this I could do in my state (not much).

Kelly

Once again thanks for responding.You are always very helpful.

1)I ask about having the treatment off trial but that does not work for Kaiser says someone in Atlanta can do it. Again,that would be fine with me but I do not know if someone in Atlanta, where I have been told I would have to go, can do it as good or better and I have no idea as to how I can determine whether the person at that hospital can do it as good or better than can be done at UPMC.I assume UPMC has a good trial going but who knows for sure.

2)You were probably not treated based on Medicare and being off trial probably was acceptablle to your insurance company and perhaps the treatment could not be done by someone in you home state. However, I imagine UofM could not or would not do it using cyberknife. I have just discovered, about an hour ago, that the treatment I came here for is not Medicare approved. Now I wonder why I was told to come here. If I would have been innformed of this before I came then I would not be here.

3)I ask if Dr. Heron could call the Atlanta Dr. to discuss my case. Initiallly I was told tht would be a yes. Now I am being told it would not be appropriate for him to call the Atlanta
doctor. I talked to My Kaiser doctor and he said the Atlnta Doctor would be glad to talk to Dr. Heron. I have passed that on to a UPMC rep and, as I understand it, the UPMC rep is going to call my Kaiser Doctor to confirm that what I told them is true. If confirmed to be true then Dr. Heron will call the Atlanta Doctor. We'll see!

4) It seems UPMC has nothing that will help someone like me. I have ask that question and it seems it has beenn looked into but nothing comes up.

5)I thought that was a good idea and I ask the same. That is why I am hoping the Atlanta Dr and Dr. Heron will talk. I feel like you that UPMC proably has the best equipment and technique but who knows and how would I ever know. I guess what happens depend upon whether both Doctors agree upon what would be in my best interest.

Hi Nocam.
I am glad that you asked this question. I am eligible to have medicare now and was going to keep Kaiser only because that is where most of my treatment was done. Now I wonder if I should that. I guess I better really look into what medicare pays and which plan if I stay with Kaiser.
Thank you again and sorry I couldn't be of any help, but at least you helped me!

Itso,

Thanks for replying and I am glad my question benefitted you. If you make a change I look forward to hearing what insurance you gowith. I still look forward to hearing what insurance others have which will maybe behelpful to us and others.