On 7/1/2009
570sheila wrote:
Hello Shotgun....
PLEASE do NOT give up......try the American Cancer Society also. They are wonderful people and DO have lots of programs. I think IT IS AWFUL being in this day and age that we MUST fight for the medicine we NEED to survive. Its all about money AND I will say the INSURANCE COMPANIES SHOULD BE ASHAMED. Its SAD that people who are very sick and scared....HAVE TO fight for the meds that could save them and HAVE TO worry about HOW to pay for them. They want your money but could give two cents ABOUT THE PEOPLE that PAY them.....I guess they FORGOT if it wasn't for us ...THEY WOULD NOT have a company.They need customers to have a business....paying ones at that.
I do understand that they are offering you another medicine....well you should consider it IF that is your only choice....IT MAKES ME MAD that they want you to take another med ......YOU DESERVE THE BEST....I HOPE AND PRAY that President Obama DOES something GOOD for this country and WE DO NEED CHANGES in our insurance companies.
I will tell you our nightmare with Blue Cross.....They paid for my husbands raditation treatments....TomoTherphy which has to be set with a short CatScan. They would NOT pay for the setting of the lazer with the CatScan so he could have the raditation. Paid for 32 raditaion treatments but NOT the 32 catscans. I send them 25 dollars a month...all we can afford and they except it. Ted ALSO had 5FU in a pump...chemo treatment. They paid for the chemo BUT NOT the rental of the pump.....They also get what I can afford. We have to pay for the oncologist visits when he sees the doctor.....it went from 95 dollars to 155.....for the EXACT SAME visit at 95.
We ARE very THANKFUL to the Roch Company for helping us with Ted's Xeloda...chemo pill. They are providing it to him FREE of any cost....If it wasn't for them.....we would have been in trouble since we could not afford to pay for it. Shouldn't the INSURANCE company pay for it....IT IS CHEMO?????? Pill or not ....its chemo. There IS a serous problem with our insurance companies.....SOMETHING needs to be done. NO ONE should have to decide IF they can afford to have the treatmnets they NEED to survive.
Shotgun... Keep your head up and KEEP FIGHTING......IT WILL ALL work out. Please keep us posted...WE DO CARE ......
Hugs Sheila
GOOD NEWS....I called Pfizer again yesterday (Wed) to be sure they received the information I faxed to them on Tuesday, and to query about the impact of the holiday on things. I pointed out that since Pfizer will be closed Friday, if we didn't get this done quickly we would get into the holiday closing and if approved, I wouldn't be able to start the treatment until next week some time and the cancer has already had over a week to grow unchecked while we worked on this. I got a very sympathatic lady on the phone and she said she would personally expedite my request for help. And she did. About 30 min later I got a call from "Zack" with Pfizer who said I was approved for receiving Sutent free of charge and they would even send it by Fedex overnight service so I'd have it to start today (Thursday). What good news that was! So unless some thing goes wrong in the Pharmacy div of Pfizer, it should come in today. If it truly shipped yesterday, by now they should have a "tracking" number issued. I'll call back today and see if I can get that number as with that, I can track it online and be sure it didn't get hung up in the pharmacy or shipping depts.
I am sorry to hear about your problems with Blue Cross. My wife used to work for a doctor and she did all the insurance and Medicare submittals for payment. She said that job is an art more than a science, and knowing how to "code" the procedures when you submit the claims can make the difference between it getting paid or rejected for payment. I hope you didn't have some little inexperienced 'airhead' who didn't know how to code it properly.
I agree we need some reform in the health care situation as you pointed out, but I'm not sure Obama's plan is it. I'm concerned it will turn out like it is in Canada and Europe where health care is rationed. Last year when I had the cancerous kidney removed I had one complication after another and wound up spending two months in ICU followed by 2 weeks in a rehap hospital to learn to walk again. I saw the bill for the first hospital and it was $652,000. Although Medicare pays less than the billed price, under a rationing plan I suspect at some point a government bureaucrat who would be approving the expenses on Obama's plan would say this guy is costing too much money and just let him go. A good look at how socialized medicine would be is to look at the VA healthcare system. I won't critize the VA as they saved my life in '07 when I went to the ER at the VA hospital in Dallas with what I thought was just a respiratory bug going around. Turned out I had viral pneumonia and I promptly dropped dead in the ER. They resusitated me and a week later I came to so they saved my life. Under their system, I have a 'primary caregiver' who is the doctor where I must start for everything. Then if you need a Specialist she refers you up to one. I can call any morning and get right in to see my primary that day or no later than the next day, but the system breaks down when you need a Specialist. As a back up to what I now have going on with a private oncologist, I also went to my primary and she referred me on an "urgent" request to see an oncologist on June 17th. I finally got a letter from the VA last week saying they have scheduled me for lab work on July 8th followed by an appt with an oncologist a week after that. So that's their idea of "URGENT REQUEST". That would be a month lost if I depended on them and my oncologist predicted I will die in 6 months if I go untreated, maybe less. I've now got the Sutent covered, but that may not be the only cancer drug I need over time and I may be able to get some help with meds. I can take scripts written by a private doctor to my Primary and she will re-write the script on her prescription pad so I can fill it from the VA pharmacy for only $8 per month for all meds. Only problem is the private docs tend to prescribe the latest and greatest drugs and the VA doesn't have many that are new.. All cancer scrips must be written by an oncologist not by a primary, so I need to get established with one.
Regarding the chemo pills for your husband....that's the same thing I've been fighting with the Sutent. If it were injected instead of a pill, Medicare and my AARP Plan F supplement would pay it all, but since it's a pill, it falls over to my weak little Humana Plan D pharmacy policy who first said they would cover Sutent, but with a co=pay of $4,800 per mo, then they later reniged and said they wouldn't pay for Sutent and tried to switch me to a cheaper drug the doctor didn't want. Sounds like you don't have a Plan D supplement. Is that correct?