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Topic: Wife has breast cancer, question about insurance

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Jun 28, 2019 10:13AM

MattD77 wrote:

My wife works part time at a school district and gets free health insurance. We just received a call yesterday that her Nuelasta is not covered. The treatment facility is working to get it covered. I expect that they will want to giver her a biosimilar. I own my own business and can add her as an employee and provide her with health insurance. We have a 60 day waiting period. Should I add her as an employee and get the second insurance policy going? She has worked for the business before and she has helped out with admin functions from time to time so she would be a legitimate employee, but I would be her boss and get to determine her schedule and duties. Meanwhile she can still work for the school district if she wants.

Is two policies better than one? Any opinions on this?

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Jun 28, 2019 11:10AM DodgersGirl wrote:

in today’s insurance world what typically happens is one insurance is considered primary and then the second insurance reviews each bill to see what it would pay if it were primary and pays the difference between what the primary paid and what the 2nd insurance determined it would pay. Long gone are the days when primary insurance pays 80% of a bill and secondary insurance pays 80% of the remaining 20%. In most cases, this is why a lot of working families dropped covering themselves plus their spouses. You would have to know if the 2nd policy would actually ever pay out on a claim beyond what the primary pays

Reference Neulasta, when I was going thru chemo I could get a card from the Neulasta company that paid for each Neulasta pod except for a $25 Co-pay. I ended up not needing it as my insurance did pay for Neulasta.

Dx 3/10/2017, IDC, Right, Stage IIIB, Grade 2, ER+/PR+, HER2- Chemotherapy 4/4/2017 AC + T (Taxol) Surgery 9/10/2017 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Radiation Therapy 10/22/2017 Whole-breast: Breast, Lymph nodes
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Jun 28, 2019 11:15AM kber wrote:

All of the above, except to add getting my Neulesta covered was a pain in the butt, but only once. Once it was approved, it was approved for all 4 shots I needed.

Does your wife's plan have an Advocate? If so, I highly recommend getting in touch with the insurance advocate as soon as possible. My advocate fought my coverage and eligibility battles for me, getting PET scans, Neulesta shots and other stuff approved quickly when it would have taken me or my husband hours or days.

Dx 11/2018, IDC, Left, 5cm, Stage IIB, ER-/PR-, HER2- Chemotherapy 12/7/2018 Adriamycin (doxorubicin), Carboplatin (Paraplatin), Cytoxan (cyclophosphamide), Taxol (paclitaxel) Surgery 5/28/2019 Mastectomy: Left; Prophylactic mastectomy: Right Radiation Therapy 7/17/2019 Whole-breast: Breast, Lymph nodes, Chest wall
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Jun 28, 2019 12:16PM MattD77 wrote:

Thank you for the info. I will check on the advocate.

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Jun 28, 2019 12:31PM hapa wrote:

Your wife's insurance may approve neupogen. It is similar to neulasta except it requires multiple shots and is much less expensive and much less convenient.

Dx 12/14/2017, IDC, Right, 3cm, Stage IIIA, Grade 3, ER+/PR+, HER2- (FISH) Hormonal Therapy 1/2/2018 Zoladex (goserelin) Hormonal Therapy 1/2/2018 Arimidex (anastrozole) Targeted Therapy 2/14/2018 Ibrance (palbociclib) Dx 3/20/2018, IDC, Right, 3cm, Stage IIIA, 3/18 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 3/28/2018 Perjeta (pertuzumab) Targeted Therapy 3/28/2018 Herceptin (trastuzumab) Chemotherapy 3/28/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 8/22/2018 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Radiation Therapy 10/22/2018 Whole-breast: Lymph nodes, Chest wall Hormonal Therapy 12/21/2018 Arimidex (anastrozole), Zoladex (goserelin) Targeted Therapy Nerlynx
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Jun 28, 2019 02:27PM - edited Jun 28, 2019 02:37PM by HappyAnyway

Amgen is the manufacturer of both Neulasta and Neupogen. My MO files the claim with my insurance first, then the Amgen discount is applied.

Check out the PAN Foundation, too. They offer assistance for prescription copays.

❤️ Dx 4/10/2019, IDC, Right, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- (IHC) Chemotherapy 4/26/2019 AC Chemotherapy 6/21/2019 Taxol (paclitaxel) Chemotherapy 7/19/2019 Carboplatin (Paraplatin) Surgery 10/30/2019 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement

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