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Insurance Issues

Posted by Dana, Volunteer Mentor @danab, Aug 21, 2019

Im not sure the best place to put this thread so ill start here. I had my Heart transplant Jan 2018. I am very pleased with the outcome and except for some ongoing Hemotology and Virus issues i doing well. My question is i had my transplant in Arizona at Mayo with Federal Blue Cross Blue Shield. They paid pretty good for the transplant and the first year of post care. I figure the first year cost them about 700,000 and my out of pocket was about 10,000. So my concern now is now BCBS is considered out of network and they don't pay so well. I've had a couple of hospital stayes and one week in Mar cost me over 4000 alone. Luckily i turned 60 this year and im a vet so im getting Tricare Prime as a secondary insurance. I just recently stayed in the hosp the whole month of jun plus a few days in july. Im seeing the Bills start to roll in but not much help from Mayo on what to expect. So based on what im seeing from BCBS im looking at a lot of out of pocket. So my next decision i have to make is in November. Then ill be eligible for Medicare and Tricare for life. So far ive heard great things about this combination. So what advice im looking for is do i drop the BCBS which is not cheap either and don't really help a whole lot with Mayo. And go with Medicare/tricare. So if your someone in my shoes with Medicare and Tricare i would love to hear how well things are going. Thanks in advance.

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Debbra Williams, Alumna Mentor | @debbraw | Aug 21, 2019

Wish I could help. I know nothing about Tricare. But I bet you'll get help from others. Best of luck to you.

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Becky, Volunteer Mentor | @becsbuddy | Aug 22, 2019

@danab Hi and welcome to MayoClinicConnect. I have Medicare and Tricare for Life and it has been wonderful! Together they have paid for everything. In one year, the bills added up to 300k and I think I’ve only paid $1000. Medicare would not pay for the IV drug I’m getting because it’s not yet approved for my autoimmune disease. But, the doctor’s office convinced the drug manufacturer to cover costs (or I wouldn’t be alive!) Cost being 28k per dose.😥 You might want to get lots of Tricare for Life info to study before you make any changes—just so you don’t get any surprises! Let us know how it goes. When you’re sick, insurance should be the least of your problems. I’ve got my fingers crossed!

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Dana, Volunteer Mentor | @danab | Aug 23, 2019
In reply to @becsbuddy "@danab Hi and welcome to MayoClinicConnect. I have Medicare and Tricare for Life and it has..." + (show)
@becsbuddy

@danab Hi and welcome to MayoClinicConnect. I have Medicare and Tricare for Life and it has been wonderful! Together they have paid for everything. In one year, the bills added up to 300k and I think I’ve only paid $1000. Medicare would not pay for the IV drug I’m getting because it’s not yet approved for my autoimmune disease. But, the doctor’s office convinced the drug manufacturer to cover costs (or I wouldn’t be alive!) Cost being 28k per dose.😥 You might want to get lots of Tricare for Life info to study before you make any changes—just so you don’t get any surprises! Let us know how it goes. When you’re sick, insurance should be the least of your problems. I’ve got my fingers crossed!

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@becsbuddy thank you your experience helps. Luckly i can do a trial run. I can suspend the BCBS and reinstate it if things don't work out but i have to wait to open season. Lord willing ive done good so far. I will say that Mayo has been great about getting alteratives to pay for prescription drugs.

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iyaeinschpeck | @iyaeinschpeck | Feb 3, 2023

Hello and I am very glad t see you are doing well. Now my question is being from Canada, are there any thoughts on how my best friends heart medications slash treatments can be covered or partially covered through medical insurance. We have recently found out he has congenital heart failure and are new to all of this. The doctors in our little town gave him approximately 1 year to live and I am not convinced that this is acceptable. Especially with all of the new technology and medical advances even in the recent years, I believe there is more that can be done with our situation. If someone could please help and point us in the right direction, it would be much appreciated. Time is not on our side however, our will to keep on surviving is. Thank you for your time.

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mindfulintentions | @mindfulintentions | Feb 5, 2023

I would definitely look into more vet programs as sscondary claim submission hubs my friend.

Champva , or even reach out to the vet foundations to pick up some of the cost if possible. Grants and funding is widely available for vets and you can even call the VA and they can give you a list of organizations based on your personal surgeries/ conditions. I figure id post , I helped a buddy of mine get all costs covered and lodging with a meal per diem! Best of luck -fellow vet

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John, Volunteer Mentor | @johnbishop | Feb 5, 2023
In reply to @iyaeinschpeck "Hello and I am very glad t see you are doing well. Now my question is..." + (show)
@iyaeinschpeck

Hello and I am very glad t see you are doing well. Now my question is being from Canada, are there any thoughts on how my best friends heart medications slash treatments can be covered or partially covered through medical insurance. We have recently found out he has congenital heart failure and are new to all of this. The doctors in our little town gave him approximately 1 year to live and I am not convinced that this is acceptable. Especially with all of the new technology and medical advances even in the recent years, I believe there is more that can be done with our situation. If someone could please help and point us in the right direction, it would be much appreciated. Time is not on our side however, our will to keep on surviving is. Thank you for your time.

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Welcome @iyaeinschpeck, You will notice that we removed your email address. Connect is a public forum. We recommend sharing personal contact information using the secure private message function. For information on how to send a private message and using other Connect features, click on the Help Center link at the top right of any Connect page. Here's the link - https://connect.mayoclinic.org/help-center/.

I'm not sure if you have seen this site but thought it may provide some answers:
-- Drug coverage - Heart and Stroke Foundation of Canada: https://www.heartandstroke.ca/services-and-resources/drug-coverage.

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ce1b | @ce1b | Feb 6, 2023
In reply to @mindfulintentions "I would definitely look into more vet programs as sscondary claim submission hubs my friend. Champva..." + (show)
@mindfulintentions

I would definitely look into more vet programs as sscondary claim submission hubs my friend.

Champva , or even reach out to the vet foundations to pick up some of the cost if possible. Grants and funding is widely available for vets and you can even call the VA and they can give you a list of organizations based on your personal surgeries/ conditions. I figure id post , I helped a buddy of mine get all costs covered and lodging with a meal per diem! Best of luck -fellow vet

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If you are in Arizona I would recommend you reach out to “Be Connected” at
Susan Lane
Be Connected
Care Navigator
866-429-8387
Be Connected Resource Network | https://beconnectedaz.org/

They are an amazing group that helps veterans

Be Blessed
CEB

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