STEAM ROOM FOR ANGER
Comments
-
Lita~knowing all you're going through, your pretty amazing! Each and everyone of you are something else. Some pretty strong ladies here. Sending my good thoughts to you both. Blue and Lita ! Much love ~M~
0 -
Hugs all around. Thank you for the support. Lita - how was your opera night? Micmel - everyone, how are you doing just for today?
Well no more STEROIDS FOR ME! It's a bomb drug allergy rash from the prednisone and the Benadryl only hurt. My DNP said my body is afire. I would post pics but too complicated to send to email then save and post at least today. She came up w Pepcid and Claritin together twice a day which will block both the H1 and H2 histamines. The safest way not to make me explode. She is the reason I held out all weekend and did not go to the ER. They would have exploded me with more steroids or something worse. She said only my thyroid meds and that for the next 5 days, take pics ea day and send to her. Call tomorrow.
Onc said wait it out, no Xeloda for another week. PET CT brain / body on Oct 2 when he returns. It could be next Monday but I want to wait for him and to have a lot of time between this outbreak and the radiation inj and scan, esp w lupus.
And he will be there to fill in for all Oct and Nov. I am so very happy.
I am better. The inhaler was aggravating, caffeine too. So now I am holding tight and am better except my throat is so scratchy.
0 -
So I'm not sure if this is the place, but I'm so frustrated I need to vent. Received a letter from BC/BS today, who stands by the amount that they paid my PS (less than a third of his bill), leaving me to figure out how to pay the remaining $77,000. The letter was signed by Arthur J.C. It makes total sense that Arthur not give his last name because, well, you can imagine the hate mail he'd receive. I'd already sent in a first grievance and I suppose that now I'll be filing a second one. Backstory is that my PS was paid in full when I had my UMX and TE placed last August. At that time my PS office told me I'd pay my out of network deductible which is $750. Now the insurance co and my doctor changed their tune? It seems cruel. I wouldn't have hired the contractor if I knew how much the siding cost, to use a bad metaphor. Aargh.0
-
Bloody hell Falconer.......$77,000!!!! I had to read that over and over to make sure. I'm sorry, but you live in a crazy country when it comes to health care costs. How can they justify changing things so much after the fact. That must be so stressful for you. I really hope you can successfully dispute it.
The cost of a BMX and reconstruction as a private patient here is less than $20,000. Health insurance would then pay part of that.
0 -
I had a rev of my TE to perm implants sx I had last Dec. I was on pins and needles if Medicare would pay, and not see it as cosmetic. One thing PS told me is it's all in how it's coded. He used the rads for my left foob as part of coding to justify the need for symmetry. I got a new right implant and had fat grafting. I'm 2.5 weeks out from sx so not sure Medicare has approved it but if they don't, he'll re-code and re-submit until they do.
0 -
We can get caught between the rock and hard place with coding, I have appealed and won once I could dig up the right codes - but provider should be the one to re-file for you. That means a lot of ins phone time to gt the right codes though.
But I thought that reconstruction is legally required to be paid for by insurance in full.
Is it because your PS is out-of-network that there is a cost at all?
And yes, Falconer, you are in the right place to vent. But I would also dig into some of the forums that have patients dealing with this same issue here on BCO and the legal forum too.
0 -
Recon should be covered by insurance, but not in full if you don't have a plan that pays for it. You need to look at your policy. The TE-perm implants, no prob. But with revising the perm implants for symmetry, ps needs to code it to where there is a reason for it (like other side rads so wound up uneven) and not just for cosmetic to be safe. When I said before this sx that if it's not right I want another rev, that's where he informed me it doesn't work that way. So thankfully he got it right, and my foobs are very even.
0 -
I believe it is federal law that reconstruction be covered by insurance. That includes re-dos. Of course who knows what's coming down the pike. Get your medical needs done asap is my advice.
0 -
Hi thanks for the feedback. So my PS is out of network because there is no doctor within 50 miles who does DIEP. When I had the MX and TE they paid in full for out of network but for some weird reason he decided to go in network 8 months later. That seems to be the sticking point. I agree that it should be between the provider and the insurance. When his office manager called me she wanted me to contact my HR dept. so they can handle the insurance advocacy piece. Well I am a teacher in a small school district; we don't have HR. Bleh.0
-
Arista, since my reconstruction in 2010 it has shunk and of course with meds gained like 50 lbs on top of it too. MO thinks I should do revision and get it all corrected to make me "match". Really? At this point do I want more surgery? Just got a bill for lab work I had to do and apparently I have a "co-insurance" it falls into and I haven't met my so-called deductible yet and have to pay it all. Hate medical crap and dealing with insurance too.
0 -
So sorry BB, that bites! My day was like that. Spent an hour on hold with Experian, finally hung up. Going to call at three in the morning. What is your insurance co? Did you know you can search ICD-10 for all the codes
0 -
I called them to freeze my credit report, I rarely need to apply for anything anymore. Yes because of Equifax. I hope they go to jail. My son already did so with five credit companies. You never want to let anything get to collections, it's just digging a deeper hole. How much is the bill
0 -
First they said it happened in July. LIARS? Then it came out that it was March, so yes, two. Meanwhile the big execs sold their stock. They ought to do life. 143 million that's all the adults in the USA. All of us
0 -
Hi all - some know about the challenges I have had w our adult daughter living here until she moves back to the UK w husband. I thought I would post a smile-maker too. From the insomniacs thread.... just posted because talking about stress and cancer.... I posted....
STRESS - yes, candy for the cancer cells and for any health issue. I am told over and over to eliminate stress, health professionals say this, I read it, so I believe it. And that would mean to me that it makes the effect even worse since I believe it. Poo.
DAUGHTER - Daughter is taking some huge boxes to the UPS station to have them weighed and get costs. We will be shipping them later when they have the money to do that. But at least they will be packed, taped and stacked. Her father told her (2 weeks or so ago) if she left anything at all for me to sort or pack it was going into HIS file, the huge blue garbage bin at the end of the driveway. She started packing right the next day. Though I had told her often enough for two months prior. She believed him and see the effect it had on her. Which links us to the STRESS belief above paragraph, right? HE STRESSED her out with his STRESSING THAT SHE HAD BETTER PACK OR ELSE and she believed him and packed right. hahaha
She leaves first thing Monday, btw.
Billing - I was almost signed for trials and they put me through many scans and tests. They billed my insurance for a few and so I was hit w the co-pay after ins paid. But they should not have billed me I think, it was their study and the contract said the research group was going to pay. I called and wrote and got no where for months, finally just the right woman answered the phone one afternoon, I explained and she talked to the right person in charge and got the bill off my account. This was a during the time I was also trying to get the onc's med records person to re-do correctly the two labs ins was not covering and I was hit w the 'high' bill. High enough, $$$$ not growing on any ancient tree in this classified forest. And she didn't and it went to collections and I started paying but did appeals w the codes I got from ins and the labs were approved and paid, after about two weeks of honest work on my part for all this - 80 hours that I could have been working on resting and hobbies and even my own business but no, all doing someone's job for them so I did not have to pay. I couldn't type w/o coughing a fit, couldn't talk more than a few words at a time but I did it. Saved my family about 2K that were not even our bills. It seems to be all so complicated the med records clerks do not know what they are doing half the time.
0 -
You know, I really believe the front office people in medical practices should be trained in answering the faq's that practice hears where it's the same answer for everyone, and have some knowledge.
Last night I sat in a talk where a UCSF researcher in cancer, specialty in bc, gave a talk. I interacted and asked questions at the end. He was impressed with my knowledge and keeping up (so good on all of us here) and I told him I worked in a hip/knee replacement surgeon's office for 10 years. He trained us on faq's so we could give the answer right there. We had to read the material and a binder of info given to the pt which gives a lot of details, on not just on sx stuff, about joints and osteoarthritis. We had weekly meetings that were office stuff but also keeping us on our toes and anything knew coming down the pike that a pt may mention, what to say. Can't tell you how pts appreciated us just having the info to most of their concerns. When it was to do with them personally then of course it went to a PA or MD to review their chart. I'm always amazed when I go into doc offices. Wow. My docs would love to have me work in their front office. How can you at least not be interested in the field that medical office is in? I guess they just take the job because it's a job and typically you have great benefits. jeebus
0 -
Hi, I was going to call at three am but I barely got to sleep, so I haven't tried. I suppose approximately 143,000,000 are trying to call. And they can't just hire temps, it's all sensitive material. I got a spam call last night from some guy who said he was from an insurance company. Hang up
0 -
Our insurance phone lines close at 3pm EST.
0 -
Sounds like we in America need heath care like some of your other ladies from Canada, Australia and England.
0 -
Which is what Medicare for all is about. But of course it'll never happen. Too much profit for insurance companies to give up.
0 -
Artista, then we have to ask exactly WHY insurance companies are calling the shots in our government!
0 -
Interesting article that gives some explanations why the costs of prescription drugs are so high in America.
0 -
pupmom- I'm just as pissed as you are. Even though I'm on Medicare now with AARP supp plan F, who knows if they will change this up for disabled and/or seniors. They say grandfathered in if you are already on it but I don't hold my breath. Profit is worth more than a human life, plain and simple in this country. Same with social security benefits that this administration likes to call handout. WTF? We PAID into it with our pay checks 2 x a month so it is NOT a handout! Same with Medicare! Ugh! But no, let's cut all these "handouts" and pay for a billion $ wall we don't need. :X
0 -
Artista, I fear this country is right on the verge of becoming a banana republic. I will refrain from saying more.
0 -
I hear you pupmom, and am sad not for me for I think at 53 I won't be hit or by much (other than premiums going up) but the future generation. I don't have kids and I have never been so thankful for that. Those who have kids and grandkids and are not well off, I pray for them.
0 -
I am 68 and have great insurance from my husband's university. BUT, I do have kids and grandkids, and, unlike the current PTB, actually worry about our not so well off Americans.
0 -
What Does a 20-Something Analyst in London Have to Do with Price of a Drug in the U.S.?
In this week's Revolution and Revelation Milton Packer, MD, explains how a 28-year-old analyst in London is setting the price for drugs you prescribe
https://www.medpagetoday.com/blogs/revolutionandre...- September 20, 2017
Several years ago, I found myself in the office of the CEO of a major pharmaceutical company. These kinds of meetings are very rare. The last thing a CEO wants to do is to meet with a clinical investigator.
Companies have many people whose job it is to talk to folks like me.
The CEO is not one of them.
But this meeting was not about medicine or science; it was about money.
The CEO had to make the final decision about the price of a new drug. His vice-presidents were recommending a price that I thought was too high. So I requested a meeting with the CEO. I wanted him to cut the price by 70%.
If the price were reasonable, more people who needed the drug would have access to it. If the price were low, payers would place fewer obstacles in the path of those wanting to prescribe it.
I wanted people to benefit from the drug, because I had led the major clinical trial that had demonstrated its benefits.
This was not a discussion about ethics. Companies have a fiduciary responsibility to make a profit. They are delighted to make drugs that save lives. But they are really happy if saving lives means making money. That is the CEO's primary job.
I argued that the company would make more money if they lowered the price of the new drug. If it sold for $6000 a year, only 200,000 people would use it, because payers would block access. But if it sold for $2000 a year, 2 million people would receive it.
My argument: the company would make more money if the price were low. I was not there to talk about morality.
The CEO was an amazingly likeable person. He was really smart, made clear-headed decisions rapidly, and had great people skills. No one becomes the CEO of a major pharmaceutical company without these talents.
So he understood my argument within a few minutes. And he agreed with me.
But he said: "Milton, you are absolutely right. But I can't follow your advice." I was stunned. I asked why.
The CEO continued: "You see, I don't determine the price of this drug. There is a financial analyst in London who is looking closely at what I am going to decide. This analyst already assumes that 1 million people are going to receive the new drug. If I price the drug at $2000, that means $2 billion in revenue. If I price the drug at $6000, that means $6 billion in revenue."
Now he looked sad. "The problem is that our stock price is already based on the assumption that this new drug will generate $6 billion annually. That may be ridiculously optimistic, but that is what the financial analysts are saying. If my pricing decision leads them to project lower revenues, they will downgrade the company's stock. As CEO, I can't let that happen. So the price is $6000. That will make the analysts happy."
I tried to argue, but I would not prevail. The CEO was a prisoner of the financial markets, and there was nothing I could do to free him.
As I walked out of the office, I knew that there was one person in the world who was happy with the meeting. She was 28 years old and worked for a prestigious financial services firm in the City of London. I had never met her and never would. But she had just ruined my dreams and the lives of millions of people.
And sad to say, she was just doing her job.
0 -
Everyone complains in America about "socialized medicine" or "directed health care" but guess what? That is what the military has and dependents! I was an Army brat and Army spouse on military care for many years. Had babies in that system as well. Don't get same doc all through pregnancy and had someone else deliver (C section no less) than anyone I had ever seen before. Survived. Our veterans in the VA system see who they are assigned to and get what they get. Don't pay through the nose for medications either. Why can't the rest of America deal with that?
0 -
If you guys want something to get upset about check this..... I couldn't figure out where to post it but this seems like a good place.
/www.patient-safety.com/blacklisting-patients.htm 0 -
BosumBlues, medical treatment through the VA & treatment at military hospitals are entirely different. While both are funded with tax dollars, the programs, funding & staffs are (in almost all cases) entirely separate. The stories about vets dying due to lack of care refers to treatment at VA hospitals. The VA has had tremendous problems that have been extensively covered by the media.
Military dependents are NOT seen at VA facilities. They receive care at civilian facilities (through a TriCare program) or at military hospitals & clinics on the bases & posts. Like medical care everywhere, there are instances of good care & instances of bad care. However, there is much to recommend care through these military facilities since there is usually no cost to the patient (& no insurance paperwork!). In addition, the doctors are free to order the care, tests, etc they believe necessary without worrying about insurance coverage. In fact, many military hospitals offer the same cutting edge treatments found in the better civilian hospitals.
Edited to clarify 1 point.
0
