CancerCompass message board discussion started by luckykl on 3/6/2008 http://www.cancercompass.com/message-board/message/all,21720,0.htm Wed, 20 Aug 2008 00:00:00 GMT Wed, 20 Aug 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ I recently posted a message about my uncle who has stage 3 MM. He finished his last treatment of Revlimid about 2 weeks ago and has been sick as a dog since. We just got the terrible news that he has reached what is called a life cap and his insurance is terminating his coverage effective March 1, 2008. Has anyone run into this problem?? I know the various treatment for MM are pricey, but how can an insurance company cut you off when your life is depending on the treatments you are getting?? Any advice? As if the diagnosis has not been enough on the family :( luckykl Thu, 06 Mar 2008 00:00:00 GMT  Unfortunately they can, and do. o. It is a sin to deny really ill people the peace of mind that insurance takes.  Because of his stage 3 most insurance companies will not touch him but where I am it is not an option to refuse insurance. Why not try and talk to the insurance company and see what they say.  Is there a senator or someone with some power to help.  I think you can go on disability and medical in this situation, if he has no funds...look into that he is definitely eligible for disability.  I will also write you a private email with some information. mms.  On 3/6/2008 luckykl wrote:I recently posted a message about my uncle who has stage 3 MM. He finished his last treatment of Revlimid about 2 weeks ago and has been sick as a dog since. We just got the terrible news that he has reached what is called a life cap and his insurance is terminating his coverage effective March 1, 2008. Has anyone run into this problem?? I know the various treatment for MM are pricey, but how can an insurance company cut you off when your life is depending on the treatments you are getting?? Any advice? As if the diagnosis has not been enough on the family :(  mmsurvivor Thu, 06 Mar 2008 00:00:00 GMT Hello- In addition to being the worried wife of an SMM patient, I have owned and operated a 'patient advocate' medical claim management service for more than 18 years. I will happily tell you what my experience has taught me. In the years I have been advocating for patients, auditing bills, solving problem claims, and filing appeals, I've seen many ugly things out there with the insurance industry.First, yes, his plan may have a lifetime max. Many do, in fact, most do. Several questions come to my mind immediately. Is this a plan from an employer? If so, do you know if they're self insured (they don't broadcast that, it may be hard to find out). If so, they may pay claims 'outside the contract'. If that's the case, you'd want to contact his employer, not the insurance company. The insurance company can do nothing. Self insured or not, a plan limit is a plan limit, and nothing is going to change it. But if the company is self insured (definition: they pay all their employees claims themselves rather than paying premiums for traditional insurance. They hire a third party administrator, often a large company like BC/BS, Cigna, or United Healthcare, which is why you may not realized it's self insured)., then they can make exceptions as they like, and instruct the third party admin (TPA) to waive the cap and pay his claims. Almost all large employers are self-insured, but it's a well kept secret. Whether or not it's self insured, another question is this: Has someone audited his bills to see if they really add up the cap, or are you just taking the insurance company's word for that? It can be hard to audit, if the charges go back very far, but may well be worth it. Only charges they 'allow' are applied toward this cap. Do you know what the cap is? You'd have to know this audit it.In some cases, a congressman may be willing to go to bat for you, but he has traditional insurance, and the cap was clearly listed when he bought the policy, or was in his employer's benefit plan booklet, there's just no fighting. It's black and white, period. His employer chose to only pay for x benefits, and x benefits is what they're going to get. Equate it to going to a restaraunt,, paying for a cheeseburger, and they saying that you ate it all, still feel hungry, and feel you should be given a lobster dinner without any further payment. Not gonna happen.I'd talk to the Department of Public Welfare (even if you think he doesn't qualify, call anyway, you'd be surprised), to see if he qualified for Medicaid based on his condition and the loss of his benefits due to exhaustion.Is he disabled? If he is on SS Disability, then he will eventually get Medicare (after 2 years, I believe), which has no cap. If he's not yet been declared disabled, you may want to work toward that. Medicaid may fill in for now, but overall you have less choice of docs and treatment than you would with Medicare.So now that I've written the book.....(sorry, I do this all day, so I'm very well versed in giving advice...), please let me know if there is anything else I can answer. I'm sure others here on this board may also benefit from some 'benefit' advice!1worriedwife   On 3/6/2008 mmsurvivor wrote: Unfortunately they can, and do. o. It is a sin to deny really ill people the peace of mind that insurance takes.  Because of his stage 3 most insurance companies will not touch him but where I am it is not an option to refuse insurance. Why not try and talk to the insurance company and see what they say.  Is there a senator or someone with some power to help.  I think you can go on disability and medical in this situation, if he has no funds...look into that he is definitely eligible for disability.  I will also write you a private email with some information. mms.  On 3/6/2008 luckykl wrote:I recently posted a message about my uncle who has stage 3 MM. He finished his last treatment of Revlimid about 2 weeks ago and has been sick as a dog since. We just got the terrible news that he has reached what is called a life cap and his insurance is terminating his coverage effective March 1, 2008. Has anyone run into this problem?? I know the various treatment for MM are pricey, but how can an insurance company cut you off when your life is depending on the treatments you are getting?? Any advice? As if the diagnosis has not been enough on the family :(   1worriedwife Sat, 08 Mar 2008 00:00:00 GMT Good Evening Luckkl;"I know the various treatment for MM are pricey, but how can an insurance company cut you off when your life is depending on the treatments you are getting?? Any advice"Find comfort in knowing that God has reserved a special place in Hell for Insurance Company Executives!You may want to also contact the pharmaceutical companies to inquire if they would be able to assist you in this difficult time.Take care;Kevin K. C. Sat, 08 Mar 2008 00:00:00 GMT Good Evening Lukykl;I found this on page 4 of CC homepage:The Leukemia & Lymphoma Society Offers Crucial Help At A Critical TimePR Newswire February 26, 2008WHITE PLAINS, N.Y. -- The lymphoma diagnosis was terrifying enough. But when Charlotte Kostakos, 75, and her husband, Steven, 74, began struggling with the spiraling costs of paying for her treatments, they were overwhelmed. "As far as we're concerned our income is Social Security, period, and therefore we were extremely anxious," said Steven. Still reeling from the shock of learning that Charlotte had B-cell lymphoma, the Kostakos's, who live part of the year in Claremont, Fla., and the other half in Edgarton, Wis., couldn't imagine how they would manage the costs, even with Medicare coverage. The Kostakos's turned to The Leukemia & Lymphoma Society's co-pay assistance program for help. "I don't know where we'd be without this program -- it's been a huge help to us," Steven said. "Every little bit that we can get is a relief for us." The program provides support for prescription drug co-pays and health insurance premiums for patients who meet certain income requirements. Since launching the program last year, LLS has expanded it to include more disease categories. The program currently covers patients with Hodgkin lymphoma, non- Hodgkin lymphoma, chronic lymphocytic leukemia, waldenstrom macroglobulinemia, acute myelogenous leukemia, myeloma and myelodysplastic syndromes. Patients with private insurance, Medicare beneficiaries under Medicare Part B and/or Medicare Plan D, Medicare Supplementary Health Insurance and Medicare Advantage premium are eligible. "Receiving a diagnosis of a blood cancer is overwhelming and that devastating news can be compounded by an inability to afford the treatments," said Anita Welborn, director, LLS's Information Resource Center, and administrator of the program. "LLS is trying to do what it can to help alleviate this burden for the neediest patients that it serves." For more information, visit www.lls.org/copay or call 877-LLS-COPAY. About The Leukemia & Lymphoma Society The Leukemia & Lymphoma Society(R), headquartered in White Plains, NY, with 68 chapters in the United States and Canada, is the world's largest voluntary health organization dedicated to funding blood cancer research and providing education and patient services. LLS's mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. Since its founding in 1949, LLS has invested more than $550 million in research specifically targeting leukemia, lymphoma and myeloma. Last year alone, LLS made 5.1 million contacts with patients, caregivers and healthcare professionals. For more information about blood cancer, visit www.LLS.org or call LLS's Information Resource Center (IRC), a call center staffed by master's level social workers, nurses and health educators who provide information, support and resources to patients and their families and caregivers. IRC information specialists are available at (800) 955-4572, Monday through Friday, 9 a.m. to 6 p.m. ET. Take care;Kevin K. C. Tue, 11 Mar 2008 00:00:00 GMT