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Cancer Head Verse Insurance Cancer Head Verse Insurance

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Unread 04-19-2007, 08:06 PM
Cancer Head Verse Insurance

I had my surgery 3 months ago. This last week, I've had an odd itching of the vagina, but no discharge. I also had several very small bumps on the lapium. I didn't really think it was cancer related, but decided to call the gyn oncologist office. They wanted me to see the nurse practioner. It turns out the bumps are small cysts and the itching they think is a surface yeast infection.

Now my insurance is saying that I didn't get the pre-approval to see the oncologist and should have gone to my regular gyn. Of course, now they tell me. And now they are saying they aren't sure the follow up needs to be done by the oncologist office either.

I decided I'll pay for the office visit that occured this week but I'm going to fight to have the follow up done by the gyn oncologist office. What do you think? Should follow up care remain with the oncologist?

Happy spring Everybody.
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Unread 04-19-2007, 11:21 PM

Talk to the gyn-onc and see if the terminology is correct. He/She may be able to restate it explaining why you went to that office in a way so that it is accepted.

I had a nearly $2000 test/clinic fee thrown out by insurance last year. (I met my $3000 deductable in January.) The doctor was more specific on the resubmission and five months later it was paid by my insurance.

Previously, they paid for all but a couple of my radiation treatments... 2 or 3 in the middle were the ones they decided to dispute. Didn't make any sense.

This year, they approved my Neulasta shots before I started them and now they are requesting more information on the last one. Each shot costs just under $3000 so I hope they don't decide to not pay for them. As before, I've already met my deductable for this year.

I have spent hours on the phone being the go-between for the medical facilities and the insurance company in the past ten months. They should call each other to get it straightened out. They speak medical terms, not the patient.

It just isn't fair to think you've paid your deductable so everything should be ok. Then they start nick-picking. I don't go to the doctor for a picnic. I hate tests and I hate going to doctors. My heart just stops whenever I get a bill from a medical place saying my insurance isn't paying it. I don't need the hassles from the insurance company and I think a lot of you have been in the same boat.

Sure wish insurance companies only employed people who'd have cancer and understand things like cancerhead so the companies were easier to deal with.

As to your last question, follow up care, in my opinion, should be with the gyn-onc so try to figure out ahead of time which hoops you'll have to jump through to play your insurance company's game.

(However, it may be since you're a lucky NFT that they will insist on the gyn. But, you need to know where they stand on this before your next check-up rolls around.)

Best regards.
Unread 04-21-2007, 06:46 PM
Cancer Head Verse Insurance

As if you don't have enough going on . . . Geez!

Personally, I think follow-up with your gyn/onc would be best. You are following-up a cancer diagnosis, after all. This is what they do! You might discuss this with your gyn/onc -- the office may be able to write a letter or appeal on your behalf to your insurance to get the approval for you. Your regular gyn may not even want the responsibility to follow-up for this, anyway. What if he/she missed something? Sometimes I think those darn insurance companies need a good dose of common sense!!!! Or a kick in the pants . . .

Hang in there! Very glad it turned out to be nothing major!

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Unread 04-21-2007, 08:23 PM
Cancer Head Verse Insurance

I agree talk with the gyn/onc office. Sometimes they have case managers that work with insurance companies to help get them to pay for your visits. Also aren't you following up with your gyn/onc for recurrences. I have the same stage and grade as you. I am supposed to be following up with my gyn/onc every 3 months for 2 years and every 6 months for 3 years. I thought that was pretty standard. Maybe by explaining that to insurance company that might help! I work in a hospital and we have a case manager on the floor her only job is to fight the insurance company's on behalf of the patients to get them to pay for what they need! It is a terrible thing to be dealing with cancer and then to fight the insurance company's that you pay so much for to pay your claims. There is something wrong with that! Good luck! I have had to call and fight my insurance company for some of my bills too! Good Luck! Keep us posted!
Unread 04-22-2007, 05:01 AM
Cancer Head Verse Insurance

You'd think that they would want you to do as you did, ratehr than take a chance. It boggles the mind how we can be treated sometimes,
especially with the cancer, and sometimes you feel like these people just don't get it. I'm lucky my Dh fights my battles for me , he absolutley hates insurance and all that goes with it, (he'd make a great case manager) Sorry to hear of you troubles Joyful I hope it all works itself out for you.Just keep fighting for what you know is right, it's too bad that's how we have to do it. Like we're the ones on the wrong,
and all we're doing is trying to do get & stay well.
Unread 04-23-2007, 07:23 AM
Cancer Head Verse Insurance

Insurance companies BITE!!! I'm having trouble with mine as well. They don't think I should have anymore paps because I no longer have a cervix, so they are refusing to pay for them (I'm having them every 6 months currently). My Dr wrote them a letter a couple of weeks ago explaining why I had to have them, not sure what they are going to do at this point. It's just "the run around" all the time. As if we don't have enough to deal with!!!!!

Good luck to you, hope that you get everything straightened out and soon!

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