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Lakeshore
An author of no particular popularity

Jay Lake
Date: 2010-02-22 15:20
Subject: [cancer] The long and grinding road
Security: Public
Tags:cancer, health, healthcare, personal, politics
Another hard swerve on my cancer journey. Finally got the insurance benefits statement for session one of chemotherapy. They're allowing about 9% of the $16,100 pharmaceutical cost. (This is before clinic charges, lab fees and physician fees.) Of the $1,500 they're allowing, about $600 is being billed back to me as out-of-pocket and deductible.

While my out-of-pocket and deductible is limited to $2,000 per year, that leaves $14,600 per session, of 12 sessions unaccounted for. As it stands today, the hospital will be looking to me to make up about $175,000 in shortfall over the next six months.

So to my conservative friends who oppose HCR because our current system is 'the best in the world'... my advice is to fall on your knees and pray to whatever god you believe in that you're never in my position. Because it ain't conservative principles and leadership that will rescue you from this. Even by your own standards, I've done everything right — good job, good insurance, good income. This will bankrupt me in a few months if I don't fix it. Or kill me in 2-3 years if I can't keep it going. Which of those choices is 'the best in the world'? Please tell me, so I can really understand the rosy worldview of conservative America.

In my case, hopefully a hell of a lot of phone calling will help. But guess what I don't have the time, energy and resources for? Full scale battle with my carrier, that's what.

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triskelmoon
User: triskelmoon
Date: 2010-02-22 23:29 (UTC)
Subject: (no subject)
Jay, this is the OHSU worker on twitter.

As I understand allowability issues, if the insurance only allows 9% of the claim due to an insurance contract with OHSU, then OHSU is _not_ allowed to bill you the balance. It's considered a contractable "write-off."

I'm sure with all your struggles with the billings this may not be how it was explained, but they don't always say it flat out as they'd prefer to get the monies.
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Jay Lake
User: jaylake
Date: 2010-02-22 23:31 (UTC)
Subject: (no subject)
I am too brain melty today (first full day off the chemo pump) to deal. Will be on this tomorrow from all ends.

And thank you.
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triskelmoon
User: triskelmoon
Date: 2010-02-22 23:33 (UTC)
Subject: (no subject)
EDIT: ACK, I meant:

I *can* totally hear that.

My offer of assistance is still open. I can always call on your behalf as your "bookkeeper" as well. Please let me know if I can help in any way.
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miki garrison: jello brain
User: mikigarrison
Date: 2010-02-22 23:40 (UTC)
Subject: (no subject)
Keyword:jello brain
What she said -- unless someone explicitly tells you otherwise, they can't bill you for charges that aren't allowed and coverable by the contract between OHSU and your insurance company.

The only time I've run afoul of that was when part of the hospital was in-network and part was not -- and even then, I still prevailed, just with more phone calls and paperwork than I really had the strength to spare for at the time.

The whole write-off part of the contract is essentially how insurance companies and hospitals team up to get private pay folks and those with crappy insurance to partially subsidize the cost of care for those with good insurance or government insurance.

To me, a good part of why this is an example of health insurance in the US today sucking is that it really is this confusing, overwhelming, and scary to deal with -- even for someone like you who's approaching it with more mental clarity even in chemo fog than many people have on good days. There's no excuse for that, in my mind -- especially because I am sure that at least some of it is *intentional*.
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ygolonac
User: ygolonac
Date: 2010-02-23 01:12 (UTC)
Subject: (no subject)
Third or fourth this. The hospitals usually write off the part that the insurance carriers don't cover.
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Danny Adams
User: madwriter
Date: 2010-02-23 02:44 (UTC)
Subject: (no subject)
>>I am too brain melty today (first full day off the chemo pump) to deal. Will be on this tomorrow from all ends.<<

And I figure there's at least an even chance that when they do explain stuff, they're counting on melty brains.
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(no subject) - (Anonymous)
triskelmoon
User: triskelmoon
Date: 2010-02-22 23:47 (UTC)
Subject: (no subject)
Heh, unless the insurance says it's not allowed or applies the wrong coverage %. I've dealt with that. It's sad when I pay the 30% overhead within my premium and I still have to tell them how it should work. I shudder for people without the inside knowledge from working in the industry.
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gvdub
User: gvdub
Date: 2010-02-22 23:30 (UTC)
Subject: (no subject)
Sad but typical. The best advice I can offer is to get the company benefits person involved in the dialog. Insurance companies love to send an outrageous first bill in the hopes that you'll just pay it so they don't have to. According to today's L.A. Times, Anthem/Blue Cross here in CA is looking at some serious fines for having misrepresented coverage (among other things).
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manmela
User: manmela
Date: 2010-02-22 23:32 (UTC)
Subject: (no subject)
I moan about our NHS, but seriously... the amount of stress even people with Healthcare in the US must go through!
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Danny Adams
User: madwriter
Date: 2010-02-23 02:45 (UTC)
Subject: (no subject)
I've talked to folks in both England and Canada about the reputed long waits for certain surgeries. They agree that in some cases there are long waits, even on the order of 8 to 9 months...but add a comment along the line of "But I'll bet 8 to 9 months would still seem like a godsend if you don't have insurance, or they deny you, or they won't pay enough for you to have the procedure done."

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Kari Sperring
User: la_marquise_de_
Date: 2010-02-23 12:06 (UTC)
Subject: (no subject)
I'm British. If it's serious, you don't wait. I had a suspicious lump a few years back and it was all done and dusted from initial vague suspicion to final surgery within three months. And it was state-funded.
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Stone of stumbling and rock of offense: strike
User: wordweaverlynn
Date: 2010-02-22 23:40 (UTC)
Subject: (no subject)
Keyword:strike
They kick you when you're down. It's rough enough for you, and you are well-educated, white, middle-class, insured, and self-assured. For the poor, uneducated, and afraid, this system leads to death.
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sparta5: 8 ways
User: sparta5
Date: 2010-02-23 00:01 (UTC)
Subject: (no subject)
Keyword:8 ways
Can you appoint an Attorney in Fact with limited powers - say only for healthcare and related issues? This person would have the legal ability to negotiate, etc. on your behalf while you recover. I know it means legal fees to have things drawn up and recorded, but with 6 months of this kind of Accountants Running Healthcare crap ahead of you, the peace of mind might be worth it.

Still cheering you on,

~PJ~
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barry_king: 8.5
User: barry_king
Date: 2010-02-23 01:01 (UTC)
Subject: (no subject)
Keyword:8.5
I think Krugman's post today pretty much sums up the game you're being tossed around in.

And when I attributed teh stupidtm to the era of Reagan the other night to a conservative Canadian, he literally snorted in disbelief. I don't know how the clown became a saint, but if you want to strike at the root, I think that's where it's planted.

Clearly, there is high quality fantasy fiction being sold to every American that doesn't get termed "genre". Wish I was earning royalties from it.

But to tell the truth, if I was, I'd happily open a vein. What is it with some people?
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shaolingrrl
User: shaolingrrl
Date: 2010-02-23 06:30 (UTC)
Subject: (no subject)
This frosts my cookies. I don't care if you ultimately don't have to pay the 175k. Did you know that? Did anyone explain it to you? Is there any clear, comprehensible documentation of same?

This is mental cruelty. This is bullshit.
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russ: quo vadis
User: goulo
Date: 2010-02-23 11:40 (UTC)
Subject: (no subject)
Keyword:quo vadis
It is truly ridiculous that so many US conservatives insist that US health care is the best in the world. It is sad and frustrating that apparently they sincerely believe that, despite so much evidence to the contrary.

Man, if I ever get cancer or any other such potentially expensive disease, I'll be very glad I'm living in Poland now instead of the US. Such treatment would simply be covered by the (apparently evil) "socialized medicine" here. Anna knows several friends and relatives who've had chemotherapy here without having to go through this kind of outrageous bureaucracy and financial hardship.

(Plus there is more willingness to pay for diagnostic and preventive health care tests to catch problems before they happen or before they become too serious, as opposed to the typical US insurance company which drags its feet on a lot of preventive coverage and only starts paying when disaster has struck and it costs much more. But that's another rant.)

I really hope you can work through the bureaucratic hurdles and find a way for more of the too-high costs to be paid by your insurance carrier. Good luck. Thanks for keeping blogging about all this. It's good to read how you're doing.
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Amanda
User: cissa
Date: 2010-02-24 22:55 (UTC)
Subject: (no subject)
US healthcare is the most EXPENSIVE in the world!

And that means "best", right? (Outcomes are irrelevent!)

And thus everyone but high-level insurance company executives suffer.
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Kari Sperring
User: la_marquise_de_
Date: 2010-02-23 12:04 (UTC)
Subject: (no subject)
Your healthcare system is deeply, deeply inhumane I am so sorry. No-one should have to deal with this crap while they are ill.
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The Green Knight: aches and pains
User: green_knight
Date: 2010-02-23 13:39 (UTC)
Subject: (no subject)
Keyword:aches and pains
I second la_marquise_de. Even if it turns out that it's merely wrangling and you don't end up having to pay it after all (though someone without/with crappy health insurance would be allowed to 'choose' between death or bancruptcy) this sucks big time.

You should have no worries other than the ones inherent in your situation, which are enough for anyone.
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jilliansgarner
User: jilliansgarner
Date: 2010-03-12 18:21 (UTC)
Subject: (no subject)
Some people say that cancer is a gift, or that they have it for a reason. This sounds dreadfully punishing. I choose to find something I can learn from this. It is a big journey, only just beginning, but I have found some crystals of truth in the anguish. But I wonder if someone who have cancer can get a blue cross california?
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