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Insurance Issues Don't know What 2 Do! Insurance Issues Don't know What 2 Do!

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Unread 04-12-2004, 05:25 PM
Insurance Issues Don't know What 2 Do!

I am so made I just want to scream at the top of my lungs and cry. I am so sick of being in pain, having to deal with the pain and having to fight the insurance and the doctors for treatment. I am beging to wonder is this all really worth it. I spent the last 6 yrs trying everything under god's creation to have a child and find some way to releive my pain. So I had the LAVH on 8/22/03. I begged for them to take my ovaries no, your to young.

I have been in pain every month since and have had almost every test possible done. CT, Colonoscopy, 2 Cystoscopys, IVP, the scope down in to my stumack, MRI and 2 ultra sounds done only to conclude yes that my ovaries are full of cysts and yes they belive the endo is back, which I could of told them all & have been saying all along since Oct.

Instead I am being left w/large doctor bills and insurance that is not wanting to pay as bennifets state. I have no clue how I am going to pay for all this. As it stands right know I owe about $2000 in doctor bills and still climbing.

My new GYN wants me to go on lupron for 3 months to make sure that my problem is the endo. Was first told by insurance that by mail order all I would have to pay was $30 for 3 months supply, Called today to see where my meds are well they could not find the script took them 10 mins, then she tells me I have to pay $95.30 per month for this drug. I am like what. So I call my insurance and am told my them that yup they told me wrong, because it is such an expansive drug they don't ship out 3 month supplies for a couple of reasons 1 - it cost to much to insure 3 vitals at once 2- maybe my doctor will deside not to have me take it for all 3 months. So what she will do is have them bill me for $95.30, but send me a check in two weeks for $50.30 and for the next few months I have to pay $95.30. I about hit the roof.

I called my health bennifits rep and she said she would check into it. I don't understand why I should have to pay the higher rate because they don't want to pay to insure the medication for shipping. So because of that I pay more, I alwasy thought mail order was so post to be cheaper. I don't think I will be able to pay for this medication more then one month. With all the meds they have me on it's going to be over $150 plus I have to make doctor payments which equal to be about $300 a month. DH is getting mad about the bills. I am ready to believe I have to call it quits and just suffer with the pain. Would get a part time job, but I don't think I could keep care of all the house hold responsiblities and work my full time job. As it is DH complains when I am not feeling well and he does not have a dinner made for him when he gets home or his favorite shirt clean when he feels it should be done.

Sorry just had to vent.

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Unread 04-12-2004, 06:27 PM
Insurance Issues Don't know What 2 Do!

((((Kim)))))) I'm so sorry life is so rough for you these days

I do not have any experience with dealing with the insurance companies, as I live in , but I do know that paying for meds and other treatments can get very, very expensive. These days, meds for DS and myself (including PT therapy) costs around $200.00 a month... sometimes more. Thankfully, I have group insurance that pays 80% of the costs... still: we still have to pay out front, and sometimes gets to the point where we have to forego some other "luxuries"

Hopefully, someone will come along with some insight. In the meantime, could you discuss this with your doctor? There might a way around the bureacracy that might help you through this.

Sending lots of s your way. Please keep us posted.
Unread 04-13-2004, 06:09 AM
Insurance Issues Don't know What 2 Do!

Hi ((( Kim )))

I'm awfully sorry that you have been in such pain and now are having insurance problems, too.

Depending on what kind of insurance plan you have, Lupron might not be one of their approved meds, and your doctor's office might need to contact the company and request that an exception be made. I checked my insurance company's formulary and neither Lupron nor its generic name is on it.

Also - most insurance policies do have what is called an "out-of-pocket" limit. In my case, I believe it's $2,000.00. Once you have met your deductible, and have been billed for the out-of-poket limit, the doctors and other contracted providers can't balance bill you for what insurance doesn't pay. (You would still have to pay your co-pays, though, like maybe $30.00 each time you see the doctor)

It's more complicated than that, so please be sure to check with your insurance company to find out for sure how your plan works. Most doctors and hospitals will also accept payment plans, or may even waive some of their charges, if you talk with them about your financial situation.

I'm also sorry that your DH isn't being very understanding right now. Have you asked him to come to a doctor's appointment with you? Or do you have someone like a minister or other trusted friend who could talk with him to help him to understand the pain that you are in?

I hope that you're feeling better today - please keep us posted on how things are going.

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Unread 04-13-2004, 07:33 PM
Insurance Issues Don't know What 2 Do!

Thank you both for your responces. I just get so fustrated with our insurance company sometimes. When one pays almost $200 for insurance one expects the service. It seems like I have had to call them on almost everything the last 8 months.

We do have a deductable of $250 per person & then we have to pay 20% until we reach the maximum out of pocket for the calender year which is $1500 not including the $250 deductable. I am still trying to pay off last years bills and this years bills are starting to pile on.

The bad thing where I live is they make you sign paper work saying you will give them $75 per month until the bill is paid off, well when the family doctor does their test & then send you to lab & then sends you to the hospital for test & then the x-ray people have to read them & then the send you to the GYN, that's 5 people I have to pay $75 to that month and boy that adds up fast. Not all of them have made me sign the $75 thing, but 3 of them have. I am going to call them when I get my next bills and see if they can take a lower payment until I can get a handle on this stuff or if they can bill some of these together.

My lupron had been pre approved my the insurance, the doctor did that last week, and when it was pre approved that's when I was told it was cost $30 for 3 months supply my my insurance provider. With all the furstration yesterday I called in spoke with our beniffets department manager and she agreed that something was not right. She called me back this afternoon and advised me that she was not able to rectify the hole situation but did find that their was a loop hole and they the insurance where over charging us. That since I was getting the meds from mail order service they can not charge me 20% of the cost only my copay which is $30. I will have to pay $30 each month as long as I go through mail order. Which is fine with me that's alot better then $95.00. The insurance is still working on getting things changed in their system & has not billed me yet, but my bennifets manger said if they charge me over $30 while I am on this medication she will see to it that something is done. I am so much more relaxed knowing that it will be $30 per month vs $95.00

Prior to my LAVH DH came w/me to a great deal of appointments. He kept telling me up untill about 2 months ago that I was more then likely still healing from my sugery. I don't think he belived my pain to be real until my family doctor sent me home with vicodine. I would love for him to come with me to my appointment this week with me, but we both can not afford to take off of work. Sometimes I think he understands, but still expects me to be supper woman and do everything.

Unread 04-13-2004, 08:48 PM
Insurance Issues Don't know What 2 Do!


I'm glad that you found out that the Lupron will be $30.00 a month, and not the $95.00 that they told you yesterday. I'm sure that was a great relief to get that straightened out!! I hope that you'll be able to work something out with the doctors and labs, too.

I think some men find it very hard to know what to do or say when we are hurt or in pain - they are afraid and don't know what to say to us, and sometimes their way of dealing with it is to pretend it isn't happening - that everything is normal. Maybe that's what your DH is doing, because it really does sound as if he cares about you very much.

You'll be in my thoughts and prayers.


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