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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!

It’s Still a Pink Month…some history October 25, 2009

Posted by Admin in Cancer, Women.
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Six more days of Breast Cancer Awareness Month! The first time I had cancer, there were no pink ribbons,

[picapp src=”5/4/3/4/Oakland_Raiders_v_41c8.jpg?adImageId=6650056&imageId=6706065″ width=”234″ height=”148″ /]

Danskin triathlons, no tamoxifen or test for the breast cancer gene mutations, no Race for the Cure, no Susan Love books; the Susan G. Komen Foundation had been established, but I didn’t know about it.  No internet either.

No Save Second Base or the site I found last week-Save the TaTa’s!

[picapp src=”1/d/9/b/Susan_G_Koman_b934.JPG?adImageId=6647561&imageId=4981226″ width=”234″ height=”351″ /]

How did I do my research back then? (more…)

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!


GINA and me October 9, 2009

Posted by Admin in Health Insurance, Healthonymous.
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Preview: In less than one hour I receive the news about my DNA test for two specific gene mutations. I’ll keep you posted. The extended family is anxious to learn the news.

Expenses This Week September 14, 2009

Posted by Admin in Diary, Money.
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Thursday:

Genetic Counseling appointment with family member. I was invited along due to family history. After consultation, decided to allow blood draw for possible BRCA1 and BRCA2 gene testing. This is covered by insurance, but we don’t know my coverage amount (100%, 90/10, 80/20 etc.). The cost of the first test [to locate any gene “errors”] is $3200 and only one lab does this test in the country. One health insurance company used to say it was “out of network”, in order to cover less of the procedure, but we were assured that this has changed. The blood has been sent and the lab will contact my insurance company in order to determine the amount paid for the “allowed amount”. If over $375 out-of-pocket, they will call me to see if I want to go forward. Cost of appointment: $20 for the co-pay (office visit) and $4.00 of round trip bus fare for two people.

Plus, $35.00 for the colonoscopy prescription called Movi-Prep. Let’s just say that name is accurate.

Total $59.00

Friday:

Scheduled colonoscopy. Three CPT codes and one ICD9 code to retrieve from the clinic, before I can get estimates from them and then the insurance company. Possible costs: More than $9,000. Will I have to pay 20% of up to $9000? Scary, especially as I haven”t met my annual out-of-pocket cap of $2000 yet.

Turned out that there wasn’t much to look at and I don’t have to go back for ten years! So only one code needed (and I don’t know which was the expensive code) and it is still an undetermined amount to pay. But if I hadn’t had insurance, they would have asked for a $7000 deposit!

Office visit co-pay $20.00. Discounted patient parking for over 3 hours $8.00

Total$28.00

Total for week: $87

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