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Jan 13, 2020 10:35AM
I previously asked others here if they had experience going through the COBRA insurance process. Unfortunately, apparently no one did. As a result, I thought I'd provide an update of what we're going through. It's not been fun especially given the high cost of Ibrance!
Obviously, her old company has to send her the COBRA application in order for her to start COBRA. We tried to expedite this, but they said they can't send her the application until after her termination from the company. Although she retired at the end of the year, she still hasn't received the COBRA application. After she fills that out, she'll have to wait for approval from the 3rd party who implements COBRA for the insurance company. This will likely take weeks. Once approved, her insurance will be retroactive to her last day of work (along with our premiums), but in the meantime, it appears to medical providers as though we have no insurance.
So far, it's been quite difficult and costly. We ordered her next cycle of Ibrance, but had to pay out of pocket for that. The cost was also $3,000 more than what the insurance company has been paying. Once she's approved and on COBRA, we can submit a claim for it, but it's not clear to me if we'll be reimbursed for the difference between what the insurance company has been paying and what we had to pay (the $3,000).
Then today we had an oncologist appointment to verify her blood work was OK to start the next cycle. Their initial position was that since we don't have insurance (yet), we have to delay the blood work and exam, which, of course, would delay her next cycle indefinitely. We pushed back on this and finally, they agreed to charge us for the visit (and the blood work), and we'll just have to fight it out with the insurance company once eventually COBRA kicks in retroactively to January 1, 2020.
All of this is requiring an awful lot of out of pocket expenses with no guarantee that the difference between what the insurance has negotiated and normally pays and what we have to pay will be reimbursed. We tried unsuccessfully to coordinate all this ahead of time with her former employer, the insurance company, the 3rd party COBRA administrator, and her Ibrance pharmacy, but simply got the run-around. This seems like a huge problem especially for expensive life-critical drugs such as Ibrance. I just thought I'd let folks know what we're going through. I'll provide a separate update when we have to submit all of these out of pocket expenses to the insurance company.
A member to gather information for my wife
2009, DCIS, Stage 0, ER+/PR+, HER2-
2016, IDC, Stage IA, 0/5 nodes, ER+/PR+, HER2-
4/20/2019, IDC, Stage IV, metastasized to lungs, ER+/PR+, HER2-
Lumpectomy; Lymph node removal: Underarm/Axillary