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Goodbye to 2009 January 11, 2010

Posted by Admin in Blog Math, Health Insurance, Money.
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Now I see why calculating this total was hard for me.

I had an eventful year in 2009, including unanticipated dental work (a cracked tooth that could not be saved), an age related procedure (colonoscopy), a DNA test covered under GINA, and an infection that was treated as if it was MRSA. In contemplating this post, I realized that I have postponed the next visit to my physician, due to the expense.

My expenses  since I began the blog total $$1249.81, divided by 14 weeks. That is a daunting $89.27 per week.Annualized, that is $4,642 spent on health care appointments, premiums, co-pays and out of pocket expenses.

Are there any lessons from 2009?

  • I did a good job managing my lymphedema with exercise, massage and diligent use of my compression sleeve.
  • However, in the last six months, partly since I did not do the 2009 Danskin triathlon, I really fell off the exercise wagon. You won’t read my exercise intentions here for a while (as this is not a fitness blog!) , but I do realize that returning to a regular exercise plan will provide immediate benefits as well as potentially decrease expenses…
  • As far as managing my expenses, some of my out-of-pocket costs could not have been avoided. I look forward to decreasing the other ones in 2010!

GINA, Coverage and Me Update November 5, 2009

Posted by Admin in Cancer, Health Insurance, Money.
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Wow! I opened an innocuous, slim envelope from my insurance company yesterday-an Explanation of Benefits or EOB. My DNA test from September to discern whether I have the  (Breast Cancer) BRCA mutations is covered in full! No more funds out of pocket! (search under DNA or GINA for previous posts)

I could have been liable for up to $350, and the blood test bill was  $3120. After a provider “adjustment”, the insurance company will pay them $2964.00.

No deductible, no co-insurance, only the two co-pays for the office visits of $40.

If you are going to have a system that keeps cancer patients alive long enough to be survivors, then these follow-up procedures should be covered (with appropriate privacy for the patient) in order to practice further early detection and possibly even prevention.

[picapp src=”3/9/1/1/Rep_Hoyer_hosts_7c52.JPG?adImageId=7129555&imageId=6278902″ width=”234″ height=”388″ /]

I waited eleven years for this test.

Relief is spelled GINA!

Weekly Expenses and Musing About Procedures October 24, 2009

Posted by Admin in Blog Math, Diary, Healthonymous, Money.
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Money, Money, Money. This week some of the ER expenses came in from my visit on Oct. 5th (see blog post)-the fee for the examining physician there  was $266).  Plus I was billed for mail order meds-a prescription I take daily. I don’t think I am saving much money. $23.31 for three months for pills picked up in person and now $19.91 for meds in the mail. A savings of about 14%-ok maybe that is some savings! Plus not going to a pharmacy three times is a timesaver.

(One thing I hate about keeping up with these bills is the paperwork):

  • first the papers from the office visit and the receipts for parking etc.
  • the EOB’s or Explanation of Benefits (sometimes it feels like Exclusion of Benefits). These are the gross numbers (pun intended)
  • finally the provider and facility charges giving you the net due.
  • File, burn or shred?

However, this diary is helping me keep track of things in a way that I haven’t before and that is– what could I and the medical establishment have done differently? Should I expect better from them and from myself?

  • Should I have gone to the ER at all?
  • Why did I receive medical advice from 5 different providers in one week for one problem (either staph caused MRSA suspected cellulitis or shingles)
  • How does that affect continuity of care?
  • Will there be translation errors (on my side or theirs) like the old game of Telephone with so many people involved?
  • What if I wasn’t a persistent person and didn’t have a person to fetch my meds and drive me around?
  • What if I didn’t have paid sick leave?

Prescription meds: $19.91, my four visits the week of Oct 5th were billed at $1001-before the negotiated discounts, less my co-pays of $160. Net bill TBD

Keep reading for more thoughts on the issues. Maybe not all the answers, but I can sure ask a lot of questions!

Weekly total: $19.91

The DNA Test Results… October 10, 2009

Posted by Admin in Cancer, Health Insurance, Healthonymous, Women.
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Here is the news I received yesterday. To recap, I have waited about 11 years to be tested for the two known gene mutations that go with breast cancer. Why did I wait? Privacy and non-discrimination protection for genetic testing did not exist in 1998.

In an earlier post, I described what I learned about the GINA legislation, passed in May 2008.

The test results are…..drum roll… negative. Meaning that I don’t have those mutations. Whew. While my lifetime risk is still elevated (for ovarian cancer), the BRCA genes have been ruled out for now or until the test changes (it has changed twice in the last 11 years).  If I had the mutations, then I would have been asked [again] about considering oophorectomy (removal of the ovaries).

The insurance company has requested the results (which they are legally not entitled to), and the testing lab says they “have my back” on this. So not to worry, right? Nonetheless, I will worry about it a little bit. It is so rare to hear “we have your back” in the context of an insurance conversation.

NIH public domain photo

NIH public domain photo

If you want to make someone in your life feel good, tell them that you have their back!


Branches or Tangled Polymers? September 26, 2009

Posted by Admin in Cancer.
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Spruce Tree

Spruce Tree

Thanks to GINA-Testing Day is Now September 26, 2009

Posted by Admin in Diary, Health Insurance, Women.
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Double Helix

After eleven years of waiting, I have finally submitted my blood for a DNA test. Even now, this was not an easy decision to make. However, in 2008, legislation which limits the opportunities for discrimination in employment and health insurance. http://www.ornl.gov/sci/techresources/Human_Genome/publicat/GINAMay2008.pdf. The law is called GINA-Genetic Information Non-Discrimination Act of 2008. http://rarediseases.info.nih.gov/GARD/GINA/ is also a good source for specifics.

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Title One went into effect this past May and covers discrimination by insurance companies. Title Two goes into effect this November. This one has to do with employment discrimination.
Normally, I love tests. I even took the Foreign Service exam for fun-twice. Since I became a cancer survivor, my attitude towards these tests is different. There isn’t any way to study to do better. Responding to the outcome is always what is at stake. And do you really want to know the answers? One of my friends once told me that she would never do the test for the BRCA gene mutations. I asked why and her response was  that she probably wouldn’t do anything different when she had this new knowledge.  This test is to see if I have the BRCA1 or the BRCA2 gene mutations. These are known as the ”breast cancer genes”. Ironically, the researcher who is the pioneer in this field works at the UW-just down the road.

Her name is Dr. Mary-Claire King. “Mary-Claire King, Ph.D., is American Cancer Society Research Professor of Medicine and Genome Sciences at the University of Washington in Seattle. She was the first to prove that breast cancer is inherited in some families and the characterization of inherited breast cancer remains her primary research focus.” From her  web page

In a couple of weeks, I will know whether I have either one of those mutations or not. My vial of blood is at the only lab in the country which does this work. The reason this test was approved as “medically necessary” is that both I and my maternal grandmother had “early-onset” breast cancer (pre-menopausal). This means that there is a higher chance than normal of my family having this gene mutation but not the highest. The real reason to have this test then, is to eliminate a risk factor; not just for me, but for other family members. What GINA will do for me is not allow my insurance provider to see the results unless I disclose them and also they cannot use the results to deny me coverage.

If I do have the gene, then other decisions will present themselves. One will be to decide on a prophylactic surgery for me. More on that in a couple of weeks.

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