One of our prominent and local breast cancer surgeons has been doing videos on Facebook about what she has to do to deal with health insurance companies. She was actually pulled out of surgery to take a call from an insurance company that denied coverage for her patient. While I’m grateful to have coverage, it doesn’t change the fact that our system is so messed up.
I feel your frustration, we see it all the time on the provider side in oncology. I’ve had peer-to-peer discussions that were almost hard to believe. Not sure what the answer is, only that we keep fighting hard for what’s right for the patients. The denials and delays are inexcusable.
It's incredible the fight you have to endure aside from your caregiving. Insurance companies are notorious for using "loopholes" to deny coverage with the liberty of using any criteria they want to apply. No wonder there is public uproar over the conduct of medical insurance. So sorry you have to go through this.
My daughter recently had to have a surgery that was denied as "out of network." There are very few hospitals that do this procedure and certainly none "in network" but the still recommended she go to an "in network" hospital (they had no one trained to do this surgery).
The hospital they recommended was a bit further away from our house than the "out of network" hospital and they had no one with the necessary skills.
Her local medical team has a working relationship with the "out of network" hospital for procedures that cannot be done locally. When her local team wrote an appeal. No dice. Denied.
The "out of network" team wrote an appeal letter explaining the complexity of her condition requiring this very specialized procedure. Denied.
A lawyer friend working for my daughter's HIP got to work, sent my daughter instructions for the "out of network" (by then she was already to go to surgery which was the following day). The surgeon made the phone call as instructed. Directly talking to someone in the health insurance providers office broke the impasse.
As you pointed out there is "privilege" involved. I had been telling my daughter for months to reach out to our friend at her HIP. How many people either don't realize there may be work arounds, or do not have someone they can reach out to assist in a work around? It is such a messed up system that we have created.
I so admire your sharing of your life experiences. It is inspiring that you and your husband will do this. I learned of your scientific side when you told your story a number of years ago how you and your team discovered that the mosquito was the primary source of the Zika virus. Your video of that experience is still on our scholarship website and will continue to be until we can post this substack memoir series.
One of the most oppressive anxieties during my extended bout with AML was the insurance question: what good will it do me to survive if I am financially broken afterward? Fortunately, I had purchased an out of pocket cancer coverage plan a few years earlier. The relief from fretting over the expense was a huge psychological weight lifted and I am sure contributed to my recovery.
Oh my goodness! When I read this there was smoke coming out of my ears!! As the mother of a son who died at age 49 from breast cancer, I am upset and frustrated. I live in a small community with limited access to providers who have the knowledge to treat MEN with breast cancer. Men currently get the same treatment as women but are diagnosed much later in the disease process. This blood test would be an a game changer for men and would definitely save lives. My guess is that the cost of this test would be minimal compared to the treatment of a recurrence and end of life care for both women and men! The shortsightedness of this company and health care in general is ridiculous! Thank God you were able to get the test in the first place. This just reinforces the need to advocate for early (earlier) diagnosis for men! God Bless you and have a wonderful Easter❤️
One of our prominent and local breast cancer surgeons has been doing videos on Facebook about what she has to do to deal with health insurance companies. She was actually pulled out of surgery to take a call from an insurance company that denied coverage for her patient. While I’m grateful to have coverage, it doesn’t change the fact that our system is so messed up.
Completely messed up. Agree.
I feel your frustration, we see it all the time on the provider side in oncology. I’ve had peer-to-peer discussions that were almost hard to believe. Not sure what the answer is, only that we keep fighting hard for what’s right for the patients. The denials and delays are inexcusable.
Agree!
It's incredible the fight you have to endure aside from your caregiving. Insurance companies are notorious for using "loopholes" to deny coverage with the liberty of using any criteria they want to apply. No wonder there is public uproar over the conduct of medical insurance. So sorry you have to go through this.
Thank you, Sammie. We all go through some part of this with a loved one who needs health care.
My daughter recently had to have a surgery that was denied as "out of network." There are very few hospitals that do this procedure and certainly none "in network" but the still recommended she go to an "in network" hospital (they had no one trained to do this surgery).
The hospital they recommended was a bit further away from our house than the "out of network" hospital and they had no one with the necessary skills.
Her local medical team has a working relationship with the "out of network" hospital for procedures that cannot be done locally. When her local team wrote an appeal. No dice. Denied.
The "out of network" team wrote an appeal letter explaining the complexity of her condition requiring this very specialized procedure. Denied.
A lawyer friend working for my daughter's HIP got to work, sent my daughter instructions for the "out of network" (by then she was already to go to surgery which was the following day). The surgeon made the phone call as instructed. Directly talking to someone in the health insurance providers office broke the impasse.
As you pointed out there is "privilege" involved. I had been telling my daughter for months to reach out to our friend at her HIP. How many people either don't realize there may be work arounds, or do not have someone they can reach out to assist in a work around? It is such a messed up system that we have created.
I agree. It is very sad that some people can navigate the system and some can’t. And that we need to game the system.
I so admire your sharing of your life experiences. It is inspiring that you and your husband will do this. I learned of your scientific side when you told your story a number of years ago how you and your team discovered that the mosquito was the primary source of the Zika virus. Your video of that experience is still on our scholarship website and will continue to be until we can post this substack memoir series.
Thank you, John!! I appreciate your comment so much. I can’t tell you how much this support means to me and encourages me to keep going.
One of the most oppressive anxieties during my extended bout with AML was the insurance question: what good will it do me to survive if I am financially broken afterward? Fortunately, I had purchased an out of pocket cancer coverage plan a few years earlier. The relief from fretting over the expense was a huge psychological weight lifted and I am sure contributed to my recovery.
I am so glad you did. I have diagnosed many people with cancer - young women with cervical cancer - who had no health insurance. It is heart breaking.
Oh my goodness! When I read this there was smoke coming out of my ears!! As the mother of a son who died at age 49 from breast cancer, I am upset and frustrated. I live in a small community with limited access to providers who have the knowledge to treat MEN with breast cancer. Men currently get the same treatment as women but are diagnosed much later in the disease process. This blood test would be an a game changer for men and would definitely save lives. My guess is that the cost of this test would be minimal compared to the treatment of a recurrence and end of life care for both women and men! The shortsightedness of this company and health care in general is ridiculous! Thank God you were able to get the test in the first place. This just reinforces the need to advocate for early (earlier) diagnosis for men! God Bless you and have a wonderful Easter❤️
I know, Pat. The system is unequal and uneven. I always feel sad when I hear about the lack of good medical care
Too frequently happens!
Yes - it is a maddening system.