Nelie - Did you strike a particular argument with your insurance company that tipped them to help pay for your peg supplies?? I have been battling my company with no luck for two and half years. What worked for you? What I've been doing hasn't worked. The stuff is really expensive and I'll likely have a peg till whenever. Tom

Well, I called them to begin with and asked if my policy would cover the Jevity and they said yes, with a letter of medical necessity from my doctor. My medical oncologists' office took care of the letter, although really it seems to me either the radiation oncologist or the ENT could have done it. But the MO's office has the most experience, I think, in terms of knowing what insurance companies want ro hear, they're willing to call the insurance companies and argue about a decision too, and they offered to do it (they also successfully got my prescription drug insurance company--a different policy--to pay for twice as many Zofran pills as they were going to pay for at first--not totally sure how).

So they sent a letter of medical necessity to the medical supply company that ships the Jevity to me (called Lincare, I'm not sure if they do this nationally or not) and Lincare claims they sent it on to the insurance co. Two months later the insurance co. was saying they didn't get it. So the MO sent the letter again directly to the insurance co. Just to eb safe I also had Lincare send another copy of the original letter.

Another two months go by and still no payment of the growing Lincare bills. My husband calls the insurance co. (it was still pretty painful for me to talk then) and they say they can't tell him the status of a claim because he isn't me (which is wierd because he's called them with questions about other claims related to all the gazillion bills we've gotten for my treatment and they gave him the info. he needed) BUT they DO say that IF they got a letter of medical necessity there should be no problem. Two more weeks go by, another unpaid bill, and I call them and after a LOOONG time on hold I'm told that the reason they haven't paid is ebcuase Lincare added somehting to their bill that "made it look like the wrong billing code. It's stuck in our system because of that". Well could they change it to the RIGHT billing code so it unsticks? Yes, he THINKS they could do that.

At last some of the bills get paid.

They're now holding up payment on the MRI and PET scan I had as a followup to treatment back in Spetember. They requested extra justification from my ENT, his office sent it but now its under review and the "the review process is backed up".

It seems so unfair that when you're feeling really sick is when you have to spend so much time checking bills and argue with insurance companies over things!

By the way, I'm not sure how long my insurance will cover it. When I called and asked to begin with I remember they said someting about limits of coverage and I can't recall if it was a cap on the amount each year or maybe if it was a cap on how long following a treatment because I was so sure that wouldn't be an issue but now of course it may be.

I'm still waiting for a personal email or whatever giving me a person's address who can use my extra feeding supplies. I found out the nursing school will take them to use in the student's training. I would certainly prefer that they go to a person that has no insurance coverage for these things.

Lowanne

Lowanne, If there is a hospice near you I would recommend calling them and seeing if they'll take it. I know someone who is a social worker at our local hospice and PEG tubes are really common at the end of life and there are always folks who don't have insurance to cover the expense. Nelie

I am a relative newbie here, just finished my second week of radiation (ten shots down, only 27 to go!), so I might be barking up the wrong tree here, because y'all may be talking about very specialized canned meals...

However, in one of the guides and pamphlets I was given, published by a prof at the H. Lee Moffitt Cancer Center in Tampa, under Nutritional Supplements (like Boost and Ensure) was the following statement, "A economical alternative to canned supplements is powdered Carnation Instant Breakfast. Glucerna may be recommended for diabetics."

Additionally, one of my RadOncNurses recommended CIB.

Be kinda hard to say Carnation Instant Breakfast didn't qualify for food stamps

It really pays to read the labels on this stuf also because there are a whole bunch of different Boost and Ensure products out there, as well as store brands like Wal*Mart, Safeway, etc,.

Also, the ones marked Plus seem to all be 350 calories in the same size container at the same price, so one can get more for less money, less swallowing or less time, whichever tends to be most important to you at the current time.

Helps to make the rounds of these stores (be sure to get a store discount card if they have them -- Use a fake name if you don't want to be ID'd in marketing systems) to see what's on sale as something usually is somewhere!

Pete

Nelie, Would you consider putting your experience with your Ins. Co on the Ins. Issues board? I have been fighting weekly with John's Ins co-John Alden since April. It's been a nightmare. Maybe we can give people some ammunition to use when they run into road blocks.
Lowanne, John's oncologist said he would take the unused 2CalHN that we were using, and give it to patients who were in need. Amy

Amy,

I'd be glad to put my experience on the insurance issues but I don't know how helpful it would be to someone who doesn't have my insurance plan. I don't seem to have run into as many roadblocks as some people. They have very clear provisions about covering the prescription PEG food if it's medically necessary. I have no idea what my medical oncologist's office put in the letter of medical necessity that convinced them it was/is in my case but it seems to have worked once they got several copies of the letter!

I just had to call them again, Friday, about a new statement where they had again refused to cover the latest shipments of Jevity because there is some kind of incorrect billing code that Lincare is using. When I call, they take the billing code off and send it through the system again and it gets paid (at least so far).

Nelie

Here's one of the things that bugs me. There is a small print disclaimer in John's policy that states "not all coverage questions can be addresed in your policy", which leaves them great latitude in the midle of an illness to define what they will and will not cover. Even tho John's surgeon\oncogolist wrote John Alden Ins. and explained that John's feeding tube nutrients were absolutely necessary to his survival and by prescription only, they have refused to pay for them. This is only 1 battle of many with this company. I just think maybe if we pool our experiences and battles we won or lost- it might help someone down the road. And, John Alden[now Assurant Health] is actively advertising to sell new medical ins. policies on national T.V. I could not recommend them to anyone. Amy

Amy,

I'm sure my policy has that in small print somewhere too but apparently prescription PEG food is soemthing that IS addressed directly in their policy. Its a good lesson, but too late for most people who find their way here, if you have a choice of insurers. Pick the one that spells out coverage for many contingencies!