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Topic: Co-pay for treatment?

Forum: Stage IV and Metastatic Breast Cancer ONLY — A place for those managing the ups & downs of a Stage IV/metastatic breast cancer diagnosis. Please respect that this forum is for Stage IV members only or those posting on behalf of a Stage IV patient. There is a separate forum for Stage IV Caregivers/Family in "Support and Community Connections".

Posted on: Mar 27, 2011 05:37PM

Kathy36 wrote:

I just got a bill for $571 for Fulvestrand; it appears that was my co-pay and the insurance paid the other $3500.  I was on Fulvestrand a few years ago and wasn't charged a co-pay. I'm kind of shocked. Has anyone else had to pay a co-pay for cancer treatment? If Aetna would scale back the CEO's $24 million salary, maybe they wouldn't have to charge outlandish fees like this. 

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Mar 27, 2011 06:01PM PJB wrote:

Kathy, it sure seems like my copays are going up a lot, too. I'd have to look at my latest bill (which I hate to do) to see how much. I just know if I were forced to pay up all at once, I'd be sunk. Luckily, I'm on an installment plan. 

I'm behind you on the CEOs salaries. It seems obscene for them to be raking in that kind of money. Really? They're worth that much? I clearly made the wrong career choices.

Paula 

May 2004, Stage 2 IDC. Recurrence in 2005. On Femara til mets diagnosis in Feb 2009. On Faslodex 8/11. Brain mets in April 2012. Progression in liver 6/12. On to Etoposide.

Dx mets, ER+/PR+, HER2-
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Mar 27, 2011 06:12PM, edited Mar 27, 2011 06:15PM by sincitydealer

My Mother had to pay $380 co-pay for one Xeloda treatment.  That's how much it would have been for each treatment every three weeks had she been able to tolerate it.  Once a patent expires on some meds/pills you can get generic and the price goes waaaay down; however,  these patents last for years.  It's a shame these drug/insurance companies can put a price on a patient's life.Yell

Peggy

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Mar 27, 2011 06:16PM PJB wrote:

Peggy, when I was on Xeloda, I had to pay $2300 up front for each round of pills then get reimbursed (months later, of course) by my insurance company. Thank goodness I had a credit card. They wouldn't pay the "usual" way because it was not administered by IV. How crazy is that? 

Kathy, I have to say, I had a pretty sweet deal when on Aetna, before my company was sold and we got our newest insurance. But it sounds like Aetna is going the way of all insurers.

May 2004, Stage 2 IDC. Recurrence in 2005. On Femara til mets diagnosis in Feb 2009. On Faslodex 8/11. Brain mets in April 2012. Progression in liver 6/12. On to Etoposide.

Dx mets, ER+/PR+, HER2-
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Mar 27, 2011 06:19PM sincitydealer wrote:

WOW, Paula!  That's terrible!  It's bad enough to even need these drugs, then you have the added stress of figuring out how you're going to pay for them.

Peggy

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Mar 27, 2011 06:44PM JeninMichigan wrote:

Kathy

Wow .. that is high for a co-pay.  Is that above and beyond your deductible and co-insurance.  I have to pay out the first $2650 for my coverage in deductibles and co-insurance and then $25.00 per treatment for a co-pay.  I was able to get help through a co-pay assistance program.  In fact, I got approved for two programs.   If you are intersted in the program, PM me and I will dig up my paperwork.      It helped alot.

Jennifer

Dx 2/22/2008, IDC, 2cm, Stage IV, Grade 3, 4/9 nodes, mets, ER+/PR-, HER2+
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Mar 27, 2011 06:54PM vickib wrote:

Hi Paula - I too am dealing with the sticker shock of treatment. My copay for Herceptin is just over $600 every 3 weeks and my copay for Tykerb is $697 per month. I pay what I can for the Herceptin but I will never get caught up! I was lucky to receive 130 Tykerb pills for free, someone had left overs but I only have a few pills left. I can't afford it and have no idea what we are going to do, it is making me sick.

Vicki B. Cincinnati, OH

Dx 3/3/2006, IDC, 4cm, Stage IV, Grade 3, 12/17 nodes, mets, ER+/PR+, HER2+
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Mar 27, 2011 08:03PM chainsawz wrote:

It just stinks that we have to pay any out of pocket with cancer treatment.  This July will be almost $20,000 out of pocket from my household for my co-pays and deductibles in my 3 years of treatment.

Luckily, we are now on a high deductible health plan and I only pay $4000 a year....only!  It makes me sick to think someone can't get treatment for cancer because of money issues :<  

Lisa -mets to lungs & brain - clear lymph nodes.....the weakest step toward the top of the hill, toward sunrise, toward hope, is stronger than the fiercest storm.

Dx 7/21/2008, IDC, 3cm, Stage IV, Grade 3, 0/2 nodes, mets, ER-/PR-, HER2+
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Mar 27, 2011 08:49PM EnglishMajor wrote:

 These have been posted before, but in case they were missed

Jenn in michigan told us about the CDF:

Established in 2003, the Chronic Disease Fund ensures that underinsured patients have access to the new, breakthrough medications and treatments that help patients live longer, happier, more productive lives.

Chronic Disease Fund quickly became the largest copay organization in the country. In 2009, it helped more then 60,000 people get the medications they needed.

http://www.gooddaysfromcdf.org/patients/process


Other sources:
http://www.patientresource.net/Financial_Resources.aspx


* Co-Pay Relief Program www.copays.org, 866-512-3861
* Health Insurance Assistance Service www.cancer.org, 800-227-2345
* NeedyMeds (links to assistance programs) www.needymeds.org
* Patient Services Inc. www.uneedpsi.org, 800-366-7741
* Patient Advocate Foundation www.patientadvocate.org, 800-532 -5274
Patient Advocate Foundation (www.patientadvocate.org) which provides mediation and arbitration services to patients to remove obstacles to health care, including medical debt crisis, insurance access issues and employment issues for patients with chronic, debilitating and life-threatening illnesses.

CancerCare (www.cancercare.org) whose programs include counseling and support groups, education, financial assistance and the CancerCare Co-Payment Assistance Foundation.
Additional Sources of Information

* American Cancer Society: www.cancer.org/MLT_1x_Medical_Insurance_and_Financial_Assistance_for_the_Ca ncer_Patient.asp
* American Society of Clinical Oncology patient Web site: www.cancer.net/patient/All +About+Cancer/Managing+the+Cost+of+Cancer +Care/Getting+Organized
* Centers for Medicare and Medicaid Services: www.cms.hhs.gov/
* Kaiser Family Foundation: www.kff.org/consumerguide/7350.cfm

Dx 7/6/2009, IDC, 3cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Mar 27, 2011 09:52PM JeninMichigan wrote:

English ... you ROCK with information!!!!!!   What an asset to our group!!

Jen 

Dx 2/22/2008, IDC, 2cm, Stage IV, Grade 3, 4/9 nodes, mets, ER+/PR-, HER2+
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Mar 27, 2011 09:57PM jenn3 wrote:

EnglishMajor - thanks for the information, I've printed it and put it in my folder.

Jenn - June 2009 IDC-TN, Stage III, 02/2011 Stage IV mets to the lungs & spine / Laugh until your belly hurts, then laugh some more...........

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Mar 27, 2011 10:42PM MJLToday wrote:

Kathy -- just a crazy suggestion, you might call your doctor's financial office and just double-check that really IS your co-pay.  Sometimes the paperwork gets filed incorrectly, or you don't have your primary doctor's referral, or some other red tape like that. 

MJ '98 Stage 2 ER+/PR-/Her-, AC+Tam: Sep 08 bone/liver mets. Arimidex,Faslodex,Zometa thru 12/09, Aromasin+Everolimus thru 03/10, Abraxane thru 3/11,Xeloda 8/11,Armed Activated T cell trial 9/11, Taxotere/Gemzar now

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Mar 27, 2011 11:50PM Kathy36 wrote:

Thanks for all these great posts. I'm going to phone Aetna and my doctor's office tomorrow and find out what is going on. Will report back. 

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Mar 28, 2011 05:11AM mcbird wrote:

I was notified Friday that Aetna will no longer pay my onc.  I am going to appeal it but I'll bet it won't do any good. 

Lord, please put your arm around my shoulder and your hand over my mouth.

Dx 6/7/2009, IDC, 2cm, Stage IV, Grade 2, 0/3 nodes, mets, ER+/PR+, HER2-
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Mar 28, 2011 08:20AM 208sandy wrote:

Go to your financial person at the oncs office - also the social worker - you shouldn't be trying to sort through all this on your own - the financial lady at my cancer clinic in SC was wonderful and I had all meds and copay help to be had - even though we had insurance (barely) there was so much help needed, I would never have been able to navigate this by myself.  BTW it's time to go after the insurance companies obscene profits and CEO pay - enough is enough.

Sandy

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Mar 28, 2011 04:05PM jeanne46 wrote:

The last time I had Neulasta (excluding this year) there was no co-pay. Now, I have to pay 20% of the cost (for all injections) until I reach my out-of-pocket expenses.  (That happens pretty quickly with Neulasta) It seems that every year the insurance companies find more and more ways to stick it to us. 

Dx 12/05, Stage IV, Grade 3 ER-/PR-Her2- YOU NEVER KNOW HOW STRONG YOU ARE UNTIL BEING STRONG IS THE ONLY OPTION YOU HAVE. -anonymous

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Mar 28, 2011 06:03PM buccaneersdj wrote:

I had Aetna HMO and my treatments (TAC X6) cost me $50 each time, considered a visit to a specialist, the same payment as if I were just seeing the doctor. Every 3 weeks wasn't that bad until I started 33 rads @ $50 each time, that hurt! CT's and MRI's ran about $300-400 copay.

I recently changed insurance to Humana PPO, my specialist copays are $55 with no referrals!

Dx 6/3/2009, IDC, 2cm, Stage IIa, Grade 3, 0/8 nodes, ER-/PR-, HER2-
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Mar 29, 2011 01:10AM Kathy36 wrote:

I wanted to report back on the upshot:  The guy at Aetna gave me a long explanation about how first I have to meet my deductible, then I have to meet my out of pocket expenses, then we can get the show on the road with no more extortion, er, extra fees. Well, at least that sum wasn't a co-pay. But isn't a deductible pretty much the same thing as an out-of-pocket expense?  So didn't I pay the same fee twice??

Any day now, they're bound to come up with a third way of saying "Give us your money just because we said.":  "...yes, m'am, and then you need to meet your hand-it-over-and-no-one-will-get-hurt surcharge." 

  

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Mar 29, 2011 01:22AM jeanne46 wrote:

It's all a bookkeeping magic trick for insurance companies to pay less and charge you more. Sorry to hear you didn't get any farther with the Aetna guy.  Any chance you can appeal?  In the end it really boils down to how much effort one is willing to put into dealing with a deaf insurance company and a complicit agent. Unless one can qualify for assistance. Ohmmmmmmmmm.

Dx 12/05, Stage IV, Grade 3 ER-/PR-Her2- YOU NEVER KNOW HOW STRONG YOU ARE UNTIL BEING STRONG IS THE ONLY OPTION YOU HAVE. -anonymous

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Mar 29, 2011 01:38AM flash wrote:

It's not just the insurance companies.  My "insurance" is through my husbands company.  Teh company self insures it's employees so they actually pay the real cost.  All of the fees went up dramatically this year because the costs were so much astronomically higher last year and are expected to be higher this year.  It's just a pass through but some of the increase is directly from changes to the requirements for insuring the employees. (don't hit me, I'm not trying to start another discussion. I'm just explaining where the cost increased.)  The co pay is 10% of everything after you meet the 24,000 deductible.  Sigh....  I just keep reminding myself that they're into me for more than 1.45 million so I guess the 24,000 isn't so bad.

multifocal multicentric IDC, DCIS, pagets et al. - er+,pr+ her2+++, mast,chemo, ooph, hyst

Dx 10/10/2007, Paget's, Grade 3, ER+/PR+, HER2+
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Mar 29, 2011 04:50AM Kathy36 wrote:

Holy guacamole, did you say $24,000??? Oh man. I am speechless. 

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Mar 29, 2011 05:28AM agada wrote:

I also pay a copay when I visit my docs.  It ranges from 50 dollars to 300 dollars depending on what will be done.  This is normal, or so I am told, for insurance companies to do this.  I am fortunate that my copays are not higher, but it does hit you in the pocketbook.

Agada

Dx 12/16/2009, DCIS, 1cm, Stage 0, Grade 1, 2/6 nodes, ER+/PR+
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Mar 29, 2011 09:32PM irish22 wrote:

Thanks English Major for the info on assistance programs. I'm embarassed to admit this but this is the first job I ever actually took health insurance with, I was hired in about 11 months before my diagnosis. Otherwise I had never been sick and found no reason to carry it at my age, I just had a cheap policy that only paid if I got in some horrible accident. Talk about divine intervention. haha. I was wondering if anyone here has expended their lifetime cap on their health insurance? With the bills I'm getting it seems like it doesn't take very long to do so.

Keep Calm and Carry On

Dx 1/13/2011, IDC, 1cm, Stage IV, Grade 1, 17/34 nodes, mets, ER+/PR+, HER2-
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Mar 29, 2011 10:11PM MJLToday wrote:

Irish the new health care law abolishes the lifetime caps, so you don't have to worry about that anymore.

MJ '98 Stage 2 ER+/PR-/Her-, AC+Tam: Sep 08 bone/liver mets. Arimidex,Faslodex,Zometa thru 12/09, Aromasin+Everolimus thru 03/10, Abraxane thru 3/11,Xeloda 8/11,Armed Activated T cell trial 9/11, Taxotere/Gemzar now

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Mar 29, 2011 10:22PM Katiejane wrote:

   Kathy,  I had to pay a co-pay for each radiation treatment- $25.00 each time for 25 treatments and that was back in '07.  My Arimidex monthly copay is $262.37 and I will not be off of the Arimidex until November of 2012!  Insurance companies are cutting benefits more and more-monthly premiums going up annually with less and less coverage. It totally sucks and there's not a damn thing we can do about it. Insurance companies control the medical field-good luck.

katiejane

Dx 6/13/2007Dx 6/13/2007, ILC, Stage IIa, Grade 3, 3/28 nodes, ER+/PR+, HER2-
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Mar 29, 2011 11:23PM PizzaDad wrote:

MCbird, you said Aetna stopped paying for ONC.  Did they give a reason?

Husband of Stage IV BC patient. Triple Neg stage II discovered summer of 2007. Surgery, Chemo, Radiation. We thought we were in the clear until Jan 2011. Mets to Lungs, bone and liver. Currently taking Halaven

Dx 1/31/2011, Stage IV, ER-/PR-, HER2-
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Mar 29, 2011 11:46PM irish22 wrote:

MJL I didn't know that! How exciting, I started looking through my bills and freaking because I figured it would be only a couple of years before I ran out of insurance, I can't believe how much they charge for meds or how these people sleep at night knowing they are profiting millions off peoples illinesses.

Keep Calm and Carry On

Dx 1/13/2011, IDC, 1cm, Stage IV, Grade 1, 17/34 nodes, mets, ER+/PR+, HER2-
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Mar 30, 2011 02:56AM, edited Mar 30, 2011 02:57AM by ibcmets

Kathy,

My HR benefits state that normal checkups are 100% covered while treatments for any diseases (such as cancer) may only pay 80 or 90% depending on the treatment.  I have to come up with the 10 or 20% required until my out of pocket max is reached, then everything is covered 100%.

I'm on disability with a very large company and have great insurance.  My out of pocket is $1500 per year.  Believe it or not , being on SS disability even this amount is hard to come up with every year when your credit cards are maxed out.

Last year however, I did have to pay $200 for nuelasta because my medical office would not accept it from my pharmacy coverage as it had to be shipped cold.  It did not matter that I reached my out of pocket max.

Terri

6/2009: ibc,stage IV bone mets, ER/PR+, Her2-, 1/2011: BMX/Recon, Femara & Zometa;10/13 Aromasin/Afinitor

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Mar 31, 2011 01:32PM SoGr8fl wrote:

I'm with Cigna and have been very happy with them.  I didn't have to pay for my chemo (taxotere & cytoxan) or my PET/CT scans but I did pay a co-pay for Neupogen during chemo and I now get monthly Lupron injections and have a co-pay.  I also didn't pay for radiation treatments but I've had a couple random bills arrive recently for small portions of rad onc visits.  All in all I'm very pleased with my insurance - I wouldn't be able to afford these treatments w/o it.

Dx 3/28/08 at 35. IDC 2cm,Stage IIIA, Grade 3, 4/16 nodes. 6 cycles of chemo, 6 weeks of rads, Tamoxifen. 1/10/11 bone metastasis in hip. 6 more weeks of rads, monthly Lupron inj, Femara daily.

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Mar 31, 2011 06:35PM mari55 wrote:

I have a $5,000.00 deductible that I met last year by April ( two surgeries, radiation and expensive lab).  I pay close to $400.00 per month as my copay for zometa. I paid $825.00 of a $10,000.00 bill Copays on testing ( PET, MRIs, range from $100-200).  I have Federal BCBS.  My monthly payments are pretty low for family coverage so it balances out for me.  This year I have a flex spending account ( $5,000)  since I know I will meet the deductible, though it will be more toward the end of the year.   I am thankful for my benefits because I have worked for private physicians in the past and I am afraid my bills would have driven the cost of insurance for everyone way high.

DCIS 1999, R mastectomy. Mets to spine, sternum,ribs,and femurs Jan. 2010 and new primary on left, DCIS, Dec. 2009. I am not afraid of dying, I am afraid of not living

Dx 1/11/2010, Stage IV, mets, ER+/PR-, HER2-
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Mar 31, 2011 07:01PM thefuzzylemon wrote:

Mari....is it difficult to get BCBS federally?  Would you mind telling me how much your payments are a month for family coverage?

The Fuzzy Lemon (including all her personalities)

Dx 1/20/2011, 2cm, Stage IIIc, Grade 3, 14/15 nodes, ER+/PR+, HER2-

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