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All TopicsForum: Employment, Insurance, and Other Financial Issues → Topic: Have to switch to hubby's insurance, billing, etc. Very worried.

Topic: Have to switch to hubby's insurance, billing, etc. Very worried.

Forum: Employment, Insurance, and Other Financial Issues —

Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Feb 5, 2018 11:32AM - edited Feb 5, 2018 11:33AM by sweetp6217

sweetp6217 wrote:

So, my workplace told me that I failed to work enough hours in order to qualify for company paid insurance (current plan ends on 5/31/18 midnight). My plan is to switch both of us to his insurance to begin when mine ends. He is currently on my insurance too. We both work; he's full time and I'm part time thanks to the company cutting my hours (and for many others in the company). Win Win for the company!

I have rads to look forward to but it hasn't started yet (getting a second opinion about treatment going forward). Here's the problem, The doctors' billing departments don't submit the claims quickly and my insurance takes about 4 weeks from the time they get the claims to pay it. I receive Herceptin once every 3 weeks (until July?). I get the feeling that the new insurance will hit me with a new high deductible. I'm still paying off the current deductible and am wondering what I'll have to do. I'm trying not to even think that they may deny pre-existing conditions.

Will the existing insurance pay the claims for procedures, etc. performed prior to expiration of the coverage? Example: Procedure date: 05/15/18, claim sent to insurance date 6/14/18. (Insurance expiration date 5/31/18). Result?

P.S. I'm afraid to ask that of the insurance company.

Dx 7/7/2017, IDC, Left, 3cm, Stage IIB, Grade 3, ER+/PR-, HER2+ (FISH) Targeted Therapy 7/27/2017 Herceptin (trastuzumab) Chemotherapy 7/27/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 1/4/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel; Reconstruction (left): Fat grafting Hormonal Therapy Radiation Therapy
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Feb 5, 2018 12:50PM Beatmon wrote:

if you still had coverage at the time of service, it should be paid

Dx 7/27/2012, IDC, <1cm, Stage IA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ Surgery 8/9/2012 Lymph node removal: Left, Sentinel; Mastectomy: Left, Right Surgery 12/1/2013 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 7/1/2014 Reconstruction (left); Reconstruction (right) Dx 8/9/2014, IDC, Both breasts, Stage IV, metastasized to lungs, Grade 3, ER-/PR-, HER2+ Targeted Therapy 8/27/2014 Herceptin (trastuzumab) Targeted Therapy 8/27/2014 Perjeta (pertuzumab) Chemotherapy 8/27/2014 Taxotere (docetaxel)
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Feb 5, 2018 01:42PM rdeesides wrote:

It goes by procedure date so in above example you would be covered

Dx 6/24/2017, IDC: Medullary, Right, 2cm, Stage IIA, Grade 3, 0/2 nodes, ER-/PR-, HER2- (IHC) Dx 7/3/2017, IDC, Right, 1cm, Stage IIA, 0/2 nodes Chemotherapy 8/15/2017 AC Chemotherapy 10/12/2017 Carboplatin (Paraplatin), Taxol (paclitaxel) Surgery 1/16/2018 Mastectomy: Right; Reconstruction (right): Silicone implant
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Feb 5, 2018 04:08PM gb2115 wrote:

Yes. They should do that, no problem. If your plan was valid on the date of service you had something done they will cover, regardless of how long it takes the claim to go through.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen.
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Feb 5, 2018 06:00PM sweetp6217 wrote:

Thank you! You all made my day better.

Dx 7/7/2017, IDC, Left, 3cm, Stage IIB, Grade 3, ER+/PR-, HER2+ (FISH) Targeted Therapy 7/27/2017 Herceptin (trastuzumab) Chemotherapy 7/27/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 1/4/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel; Reconstruction (left): Fat grafting Hormonal Therapy Radiation Therapy
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Feb 9, 2018 04:29PM edwards750 wrote:

My insurance isn’t all that speedy either sometimes. We have BC/BS but I’m so grateful to have it. We buzzsawed through our deductible in 3 months. It’s $5k.

We were at 100% when I had radiation. Thank goodness. I can’t even imagine how much that would have cost out of pocket or if we could have paid it.

Diane


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Feb 10, 2018 08:53AM arghh wrote:

We are looking at changing to my husband's insurance as well, but he does not have it yet so we don't know everything about the plan.

However, I do know that as others said, date of service is the important part. I would find out about prescription coverage also. My employer changed prescription coverage a while ago, and I had to start authorizations very quickly to ensure no lapse in my medications. You might need to make a lot of phone calls, or order some prescriptions early or in larger amounts before your prescription plan ends.

Another however - I did find that when health insurance changes, sometimes the old health insurance will deny access to their online site. It made my life a lot harder when that happened. There were two health insurances, and one stopped, the other started, then we had to go back to the old one. The old one never cut our online access, but the second one cut out online access after we went back to the old insurance, and we could not access anything including claim information electronically.

I would therefore suggest if you use online access to your plan which will end, you get as many claims and EOBs printed out to pdfs and keep them locally, just in case you lose online access. That is what we plan to do when my insurance plan will be ending.

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Feb 10, 2018 08:10PM sweetp6217 wrote:

Good ideas arghh, Thank you!

Dx 7/7/2017, IDC, Left, 3cm, Stage IIB, Grade 3, ER+/PR-, HER2+ (FISH) Targeted Therapy 7/27/2017 Herceptin (trastuzumab) Chemotherapy 7/27/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 1/4/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel; Reconstruction (left): Fat grafting Hormonal Therapy Radiation Therapy
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Feb 11, 2018 07:15AM gb2115 wrote:

I paid thousands of dollars for radiation because I unfortunately had it over last winter when my insurance out of pocket reset. But then, starting February I had free health care for the rest of 2017 because I had met the out of pocket limit. I was soooo thankful for the out of pocket cap--it was a lot of money but could have been worse. I think the hospital billed something like $65 grand when all was said and done.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen.

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