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PLEASE HANG IN THERE! YOU WILL GET THROUGH IT ALL!
PLEASE STAY STRONG & DO NOT LOSE THE FAITH!
You have lots of people rooting for you, thinking about you, caring about
you, praying for you!
TRY NOT TO BE DEPRESSED, EVEN THOUGH ITS HARD NOT TO, BUT
REMEMBER THAT HAPPY GOOD FEELINGS WILL GET YOU BETTER A LOT
FASTER!!
Take gentle care,
GOOD LUCK WITH IT ALL!
Please keep us posted!
PEACE & BLESSINGS TO YOU!
((HUGS))
Countrylv22
Quote:
Originally Posted by Roma
You guys are so sweet!!! Thank you for thinking of me.
I have seen 2 different doctors in the last week. (I like them both!!!)
One was the Oncologist. (I saw him last Wednesday). He is having an Oncotype DX test done on my tissues to see if chemo therapy will benefit me. I will know the results in about 2 weeks or so.
We will also have a Pet scan done (if my insurance will cover it). If the insurance doesn't cover the Pet scan then I will have to pay for it. So we are waiting to see what the insurance says. Come to find out, my old doctor should have had a Pet Scan ordered for me but he never did. We did several other test but never that one.
Today I met with a new Breast Cancer Surgeon. I really liked her and her staff and feel pretty confident about her. I'm glad because I did not like my old doctor or his staff. The only problem is, she is "out of network" with my insurance and we have already met all of our deductibles and going to her will be another $5,000 then 60/40 after that.
This has cost us so much money already even though we have insurance. We had a high deductible and we met that. But she doesn't' take our insurance and we are very limited to who we can go to for this procedure because we live out in a rural area. The one lesson I learned from this is that I will never live so far away from good health care again. I had no idea at age 42 that I would get such a serious disease.
I actually went to California. I flew out Thursday and flew back Sunday. I just had to get away. This whole thing has been very stressful on my husband and I, that I just needed some time away by myself. It worked. I went to Newport Beach and enjoyed the coast along Orange County. We are wanting to move there anyways once our home sells. It was beautiful and now I just keep picturing all the places I went to instead of my mind just focusing on breast cancer.
I was even thinking of staying there and getting my treatment there but I would be all alone. Once I got there I realized how hard that would be and costly so I decided that wasn't going to work out. I think I really just wanted to run away for awhile.
Next week I have an appointment with a plastic surgeon. I will be seeing two plastic surgeons to see who I like the best. They are also very vital as you don't want them to mess up on the reconstruction.
My lump is mostly cut out (except for the non clear margins, microscopic). The issue now is the DCIS. That is the problem. I have time thankfully to find all new doctors. That is good news because I did decide to find all new doctors. So time is on my side there.
So now things are moving along the way they should of been. I asked my doctor today, when will I be able to have the mastectomy and she said that after I pick my plastic surgeon and after the Pet scan comes back (that no cancer is found elsewhere in the body), then I would be able to have the surgery about 2 to 3 weeks after all of that. (Scheduling it with the other doctor and the hospital.)
So here I am, still waiting, still depressed, feeling like I've been going sideways not forward but finally things are inching along. I'm trying to focus my thoughts on beautiful Calif. I can still smell the Jasmine along PCH in Newport. I rolled my car windows all the way down the whole time to smell them.
Hugs, hugs and more hugs,
Roma
Last edited by countrylv22; 05-21-2008 at 11:23 PM..
Reason: PEACE, HEALTH, HAPPINESS!:0) SMILE & WE WILL SMILE WITH YOU! :0) BLESSINGS EVERYONE! :0)
Location: Lots of sun and palm trees with occasional hurricane :)
8,293 posts, read 16,160,105 times
Reputation: 7018
Quote:
Originally Posted by bibit612
Roma - good to hear from you. Please ask your new doc if there is a substitute for a PET. My DH had one and the insurance denied it..we got the doc to write that off since there was supposedly another procedure that would have been acceptable. In any case, if you get a precert for the PET, there's a good chance it would be covered.
Vpcats - I don't know why you think that if her doc waived her coinsurance, that is considered fraud? Her doc is out-of-network, which means she does not have a contract with the insurer at all. The 60% that she is paid by the insurance company is what the insurance company considers reasonable and customary and anything over that is the insured's responsibility. If the provider agrees to waive Roma's 40%, that is like the doc saying to Roma that she considers the 60% as 100% payment for the services. Am I missing something? My radiologist waived the 20% coinsurance. The insurance company is not privy to what the provider bills the insured.
"Insurance Only" is a no-no, unless you have documentation of financial hardship and there are forms you fill out and it has to do with the poverty level guidelines. Physician may be non-network but he is still filing a claim to the insurance to collect its portion.
The mentality behind it is that if patients are responsible for a portion of their expenses, there will not be overutilization of services or medically unnecessary services performed.
The physician has the right to waive co-insurance but in limited situations. If he waives 100% of the charges, then that's easy. Routine waiver of co-insurance or co-payments (they're different) is the most dangerous.
Not all physicians/clinics are aware of all the rules but they do exist and all you need is somebody talking too much and, before you know it, auditors will be knocking on the door.
Not charging is one thing. Not collecting is another. The physician has to make a honest attempt (3 statements) to collect, even if they write it off eventually, and there should be no documented "insurance only" agreements.
The other problem.........Medicare. Because of Medicare, policy has to be uniform across the board. If you don't charge, or reduce your charges to a non-medicare patient, then you need to do the same for Medicare patients. HMOs are another ballgame unto themselves.
Location: Lots of sun and palm trees with occasional hurricane :)
8,293 posts, read 16,160,105 times
Reputation: 7018
Quote:
Originally Posted by bibit612
I learn something new everyday! Thanks for the clarification, vpcats!
Goes to show you can still teach (very) old dogs new tricks!
I wrote that a little bit early today. I just wanted to emphasize the "routine" part. If the physician writes off patients' portion ROUTINELY, that's trouble (fraud). If he does it sometimes, without financial hardship documented (per service btw), then it's abuse. Either way, you're better off following the rules. Just like with the IRS, ignorance is no excuse.
The usual and customary concept is not really valid anymore. There are so few "indemnity" type coverages these days that it's almost a obsolete methodology. There are other data used to establish what a physician is paid/allowed.
I think we're going off topic a little here but this may help Roma to negotiate some services/fees.
Her situation is not your run of the mill office visit and yearly bloods. There is too much involved here and it can literally make anyone go bankrupt so it's good to know how much you can try to stretch the payors/physicians.
Yes her hospital is in network. It's just her that isn't. So I will be paying for her out of pocket but the hospital, plastic surgeon and the anesthesiologist will be covered by my insurance. My old doctor took my insurance. I was taken back that she didn't take my insurance but after talking it over with my husband we decided that out of all of the options, this is the best.
Glad to hear everything else is covered.
You've been given good advice, I also would call to see if they will accept what the insurance will pay. If you are happy, you will refer people to her which means more money in her pocket.
I do not need Chemo therapy!!!! My Oncotype DX test came back and the score was very low. It was a 6. They score it ..0-17 chemo will not benefit you, 18-30 chemo might benefit you, then 30 and above chemo will benefit you.
My cancer blood test also came back a 14. I don't know much about this but the nurse said anything over 38 then they take and monitor you more or something like that. So a 14 is good. Maybe someone on here knows about the cancer blood test and can explain it better. I will talk to my oncologist next week and find out more info on this. The nurse is the one that called.
With all this information and that the cancer hasn't spread to my lymph nodes is all great news.
I go Monday for my PET Scan that my onco ordered. (Insurance approved my PET Scan). Then after that is done, my breast cancer surgeon also wants to review it. After it's all reviewed and okay we then can proceed with the double mastectomy. They were even talking about as early as the 10th.
I also found a plastic surgeon that I liked. I met with her yesterday after meeting another one the day before. She seems to be someone you can talk with and that's important to me. My husband said that she seems like someone I would be friends with. He said that we seem to be on the same wave length.
I plan to have a great weekend after hearing all this great news.
AMAZING NEWS!!I will continue to PRAY for you ROMA!!
Take gentle care ROMA!
((HUGS))
Have a wonderful weekend everyone!
Countrylv22
Quote:
Originally Posted by Roma
I have some good news to report!!!!
I do not need Chemo therapy!!!! My Oncotype DX test came back and the score was very low. It was a 6. They score it ..0-17 chemo will not benefit you, 18-30 chemo might benefit you, then 30 and above chemo will benefit you.
My cancer blood test also came back a 14. I don't know much about this but the nurse said anything over 38 then they take and monitor you more or something like that. So a 14 is good. Maybe someone on here knows about the cancer blood test and can explain it better. I will talk to my oncologist next week and find out more info on this. The nurse is the one that called.
With all this information and that the cancer hasn't spread to my lymph nodes is all great news.
I go Monday for my PET Scan that my onco ordered. (Insurance approved my PET Scan). Then after that is done, my breast cancer surgeon also wants to review it. After it's all reviewed and okay we then can proceed with the double mastectomy. They were even talking about as early as the 10th.
I also found a plastic surgeon that I liked. I met with her yesterday after meeting another one the day before. She seems to be someone you can talk with and that's important to me. My husband said that she seems like someone I would be friends with. He said that we seem to be on the same wave length.
I plan to have a great weekend after hearing all this great news.
I hope all of you have a great weekend too!!!!
Last edited by countrylv22; 05-30-2008 at 05:36 PM..
Reason: SMILE & WE WILL SMILE WITH YOU! :0) PEACE & BLESSINGS EVERYONE! :0)
Wonderful news all around, Roma! Everyday is a blessing! Hugs to you!
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THANK YOU FOR YOUR POST ROMA!!
Her doc is out-of-network, which means she does not have a contract with the insurer at all. The 60% that she is paid by the insurance company is what the insurance company considers reasonable and customary and anything over that is the insured's responsibility. If the provider agrees to waive Roma's 40%, that is like the doc saying to Roma that she considers the 60% as 100% payment for the services. Am I missing something? My radiologist waived the 20% coinsurance. The insurance company is not privy to what the provider bills the insured.
Hello ROMA!!!!!!!!!
