Health Insurance

Hi Guys,

It's been a while, and I know most of you don't remember me, however, I was just laid off from my job with my health insurance.  Since I "rashed out" during treatment, I was never able to be "cured".  I have several issues and wonder if anyone knows if there is health insurance support out there for those of us who need it.

Most of my specialists tell me they do not take "self-pay" patients anymore (not that I can afford it), but there have been a few people tell me that I may be elegible for Medicaid due to the Hep C, Auto-immune dosorders and necrosis of the knees.

Any adivce is appreciated.

Thanks!

[cc4mickey]

If you were just laid off,And its a fairly sized Co.they have to offer you Cobra insurance.Its good for about 12-18 months until you find another job or insurance.Its best to not let a gap of a month go by without insurance because it may kick in pre-existing conditions.Cobra is expensive,But with the many problems liver disease can cause,among other things,It was well worth it to Me.
cc

[sfbaygirl]

I remember you! Welcome back. I am on Cobra and it is expensive but well worth the payments. I doubt anyone else would cover me. I have heard that Cobra will extend beyond 18 mos. I am hoping to do this. Good luck and let us know.

[l-horn]

A doctor that doesn't take cash ? I'm self pay and my liver doc BILLS me and never asked any questions. Of course, I pay the bills. Neither here nor there but I can tell you this little bit about cost and what sort of cash you so need to come up with if you're self pay:

Initially, when diagnosed I was given a liver biopsy. That ran about $1500 with the hospital bill, doctors and the labs. I pay that out at $175/mo. ( hospital discounted for self pay )

I've had 3 heptimaxes which my PCP ( primary care phyician ) charges $225 for. ( $475 retail at a Quest Diagnostic Lab ).

I've had 6 CBC/liver panel @ $40.00

I've had 7 visits to my liver doc @ $150 per visit.

My intron/riba and procrit I've gotten on PAP programs and have no cost there. So, to make a long story short, through week 16, my total out of pocket cost has been roughly $3465.00.

I assume I'll have 2-3 more heptimaxs, 8-10 more Dr. visits, and
10-15 more CBC/liver panels and another liver biopsy for an additional $4235.00 which makes for an out of pocket total of
$7700, give or take, for the entire course of treatment.

This cost, of course will vary, depending on what your doc, hosptial charges for various services, etc.

[sfbaygirl]

That's not bad! UND Priceless! Thanks for posting this, I was wondering if the heptimax was more than my generic type PCR. Where do you live? The biopsy sounded very reasonable. I heard like 5k. Of course I live in a high cost area.

[l-horn]

San Antonio, which is one of the least expensive areas of the country to live. Keep in mind, I believe my primary care physician is giving me my blood work at cost or pretty close to it. I had my biopsy done at Methodist Hospital, which is a charity hospital and discounted me because of not having insurance.  But yeah, the cost hasn't been bad at all which is of course, a relative thing. Now if I had to pay for my drugs, then I'd be in huge trouble.

[sfbaygirl]

My two Neulasta shots alone cost more than your whole tx scenario!

But remember UND- Priceless!

[sfbaygirl]

Hi neighbor! I am in Danville area now, grew up in Oakland. What a trip! I am going to CPMC on Monday in SF. I have spent all week faxing reams of papers to them. They even found a dr. I forgot! I am paying out of pocket on this one, as Healthnet (HMO) says I am out of my "group" althought they take Healthnet. PPO's you have MUCH more choice, while costing a bit more. Frankly, if anyone else would take me I would switch to a PPO in a heartbeat. Who did you see at CPMC? My HMO dr. finally admitted I know more about hep c than he does, I ran to the phone! I have filled out more questionaires and stuff than I EVER remembering doing for any dr.

I am really interested in MSA, same thing? For tax purposes perhaps our tax consquences could be really a lot less. Wondering if there are tax benefits in a trust?

Have you been keeping up on the studies about early txing? I am sure your dr's are. Are you planning on treating soon?

Welcome!

[koala68]

For information, there can be great variation in prices depending on where you live or where you go, so it is always good to assume it will cost more than expected.
Here in the Bay Area, the Biopsy I did one year 1/2 ago was billed $11000 to my insurance company (Blue Cross), which discounted it to $8000. My copayment ended up being about $1000 (%10 of the total).

[sfbaygirl]

Woah! 11k for a biopsy? They really gouge us if they can. Of course Blue cross didnt' pay that much. I'm in the bay area too! Good to see you here! I have Healthnet, your's is a PPO? Much better! Where in the bay area are you?

[koala68]

Hi SfBayGirl,
What is Healthnet? I have Blue Cross PPO combined with a (Un)Flexible Spending Account (IRS pre-tax account for medical expenses). It works out fairly well. All the medical expenses go to the insurance company first which pay their share and whatever is left for me is automatically paid with the FSA. The only problem with FSA is that you cannot revise the amount during the year (max $4000/year). Most of the time is is very hard to accurately estimate your expenses in advance.
It is best to underestimate expenses. If you overestimate, there will be money left on the FSA account at the end of the year, and that amount will be lost.

I live in the East Bay and am followed at the CPMC in Oakland. I highly recommend them. For the first appointment they requested to have not only all my medical files but also the slides of my biopsy transfered to them as well. Then, the doctor examined the slides and told me that in his opinion I was stage 2 fibrosis, not 1, as written in the original biopsy report a year before. I felt this was very professional for them to not only take extra time to double-check all the results but tell me that they disagreed with the original conclusions.
If I am stage 2, I rather know it right away and take appropriate action than be told everything is fine and discover later I am in serious trouble!

[l-horn]

Whoooaa...I'm with SFbaygirl...$11,000 for a liver biopsy ?  I tell you one thing, I've been hauled to the ER room via ambulance a couple of times in my life, both within a year of each other, neither time did I have insurance. Once I was taken to a private hospital, the other time to a charity hospital and the difference in cost was incredible. This was in Denver. ( Littleton Advent -vs- Swedish ). Trouble is, private hospitals don't have to work out any deal with you or discount you. Charity hospitals, by law, because they recieve charitable donations, must also GIVE charity. I've never been a big believer in private/for profit hospitals because the cost, basically, get's spread to everyone via those *huge* billings to insurance companies. It's a scam.

[l-horn]

A shot that expensive should at least cure herpes.

[koala68]

You are right, PPOs are probably the best choices.
I am not familiar with MSA but for those interested found this link on the IRS website:
http://www.irs.gov/publications/p969/ar02.html#d0e954

I enrolled in the FSA that my company offered because it was simple and convenient to use, but it sounds like they are many other options, even for self employed!

At CPMC, I met with Dr Wakil, Dr Daugherty and now Dr Cooper. All very good and knowledgeable. They ask you to do many tests and fill millions of papers but it is to get a complete picture of your situation before discussing options with you.
About treatment... I am actually 17weeks into one (Interferon+Ribavirin). I am 38yo with genotype 1b and started in August. I had a pretty high VL 6 months before treatment (2.6MIU/mL), dropped to about 1300IU at week 4, then <50IU at week 8 and undetectable with TMA at week 12. So far so good. Barely any side effects. Can't wait for my shot every friday!
I want to stress this because we only hear horror stories about Tx. I feel so much better now that before starting! Good luck for your appointment Monday.

[sfbaygirl]

Thanks for the link. That's great you are 17 weeks into 48? I know what you mean about feeling better during tx. There are some sx I no longer have since beginning tx. My skin was awful before, I have scars to prove it! now all that is gone, except the scars. I don't regret txing for a second.

Congrats on UND at 12 weeks! CPMC sure asks for lots of stuff, I wake up thinking about something I have forgotten. Now I need a copy of all that stuff. Most dr's wouldn't send files to ME, they had to send them to Gish's office. Kaiser wanted me to pay 25 cents a page to me and I had to pick them up. Dr's they fax to and it's free. What are we chopped liver?