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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.

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I waited eleven years for this test.

Relief is spelled GINA!

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October Expenses-Scary! October 31, 2009

Posted by Admin in Blog Math, Cancer, Diary, Health Insurance, Money.
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  • ER visit week of 10-5-09:   co-pay before entering the treatment room $100, Dr. fee $266-my percentage of 20% after “negotiated adjustment” =  $34.02, IV drugs ?
  • Co-pays for 2 Office visits for cellulitis and 1 for DNA Test results: $60
  • Flu shot (regular)-no separate bill yet (I think)
  • Plus antibiotics (2 different types), extra pain meds (neither of which worked) $40
  • DNA test-not yet paid by insurance company $3100 (my maximum will be $350) but I haven’t been billed yet because the insurance company is hassling the lab that performed the service (the one that said they had my back). Classify this one as: “hanging over my head”
  • Regular Rx renewals $39.91 (for three months each)
  • Office visits for Ovarian Cancer research study: annual ultrasound of ovaries and CA 125 blood Test : FREE (classify this one to rule things out). More on the CA 125 test in a future post.
  • Bill for September dentist (annual exam, X-rays and cleaning) $45.40 out of pocket (insurance paid $181.60)
  • Co-pays for two therapeutic lymphedema massages: $60

Scary total: $513.00

Weekly Expenses October 30, 2009

Posted by Admin in Blog Math, Cancer, Diary, Money.
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This week’s expenses were not as scary as Halloween week could be. I had a regular massage for my back and my lymphedema on Monday.  One side effect of blogging is that I spend more time in front of the computer. This causes my shoulders to hunch over and my chest muscles to contract. The massage helps to loosen them back up. (But I probably need to get back in the pool.)

Co-pays this week only $30.00 for the massage. I ordered a refill of the other prescription I take by mail. A three-month supply is around $19.00. But I overpaid the company last month so it won’t cost anything-they already have my money! Great for cash flow-but poor planning, nonetheless.

Weekly expenses: $30.00

Monthly total coming this weekend-that might be scary!

Colonoscopies ‘R Us Update 2009 and 2013 October 8, 2009

Posted by Admin in Cancer, Diary, Health Insurance, Healthonymous, Money.
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2009: The reckoning has come in the mail. The colonoscopy will only be $267.30! I guess you have to amortize it over the ten years of not having to go back.

Only $26.73 per year or  just pennies per day…… Can you tell I’ve listened to a public radio pledge drive?

To learn more about colon cancer, visit the STOP colon cancer site.

2013: Are my friends who have refused to have colonoscopies wrong? At least in 2013, we know that alternatives are being investigated. As a cancer survivor, I find the idea of a ten-year pass very appealing. However, you must still pay attention to things like diet, exercise and  your family medical history.

I may have mentioned this in another post, but I did not learn about my family cancer history, until being diagnosed with it myself in my 20’s (the immortal decade).

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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