MBC and Going on Medicare soon, any advice.

Vicsmit,
First, I want to say that I am sorry to hear about your diagnosis.
When my wife first went on Verzenio, she had no drug coverage, but Lilly has something called the Lilly Cares Foundation, she applied and was approved, we paid $0 for Verzenio until she obtained proper drug coverage. I don't know what it takes to qualify, but it might be worth looking into, they also help those that are underinsured (it is possible that things could have changed in the two years since she went on it). Since you are on Ibrance at this point, this may not be an option for you, but maybe someone else will be able to benefit from the information.

Thank you, very helpful info!

Good luck. I trust and appreciate my knowledgeable Oncology team, but I ask many questions. They have been patient and thorough. I understand that the treatments you are considering are good ones. In 2018 I was diagnosed with MBC, and due to some testing challenges, my Doctor recommended a Chemo called Capecitabine. I have been on it for 4 1/2 years, and my PET scans done every 5 months show no return of Cancer. When it does return, they will change my treatment. I feel like I am buying time for the better treatments in research today.

Jackie....thank you for your reply. You have a very positive mindset regarding buying time for better treatments. There has been a lot of cancer in my family and am amazed at the progress being made in treatment. Wishing you the best!

Although my ex-employee offered great incentive to switch to Medicare Advantage, I decided not to. Very glad since several of my doctors do not take it and I go very often. Therefore, since they take Medicare, you're required to pay upfront until they get paid by the Advantage plan and that quickly add up since I'm seeing someone every week. They do this because Advantage tries to deny the treatment or takes forever or asks for referrals for specialist. The US government is now suing many of the plans so unless you are very healthy, be very careful about signing up for an advantage plan.

What company and state were you dealing with? I have had zero issues. No need for referrals. All hospital and health care systems take my plan. I need to find out if I need to stay in this state 🙂

I have Medicare Health Insurance and have never had a problem with their insurance. When there was a rare question, I called them on my insurance card from them, and they explained very clearly.

Hi all, am scheduled to have a double mastectomy without reconstruction in two weeks. As it is very expensive to have this done at a well-known cancer center, I asked for a cost estimate so that I can check with my insurance company and understand my financial responsibility. The insurance company said some of the billing codes in the estimate were invalid so I went back to the hospital and asked for the correct billing codes. It has been nearly 10 days and no one can get me the correct codes. I was stuck between the billing department, the cost estimate team and the patient access coordinator and made many calls and sent many messages. Everyone said that it is not its job. It is very frustrating and disappointing that I have to deal with this. I wanted to check in advance so there is no surprise after the surgery. Is this not reasonable? I would like to check if you have run into similar problems and whether the associated expenses and costs are covered by insurance after deductible and the annual maximum out of pocket? Are there any expenses that are not covered? It is so stressful. Thanks so much!

Hi, to follow up on the above, there is one thing in particular I wanted to check with this group - there is a hospital tax charge in NY. Do any of you have seen this? Is this covered by insurance? Many thanks!

Have you checked to see what your insurance plan covers then work with all concerned based on what you've been able to determine your insurance covers that might be helpful? Working backwards might provide some guidance on what medical/surgical codes are needed to make sure it is covered by your insurance.

I was still working when I was dx with TNBC BRCA 2+ and was extremely fortunate - the only amount I had to pay was about $150 as my hospital co-pay. All other treatment (chemo, surgical and radiation) except specialist co-pays, were covered by my insurance. Since I knew I was going to retire in the near future after my dx I wanted all my treatments to be covered by the same medical plan. Then when I switched to Medicare I had help in finding a Medicare plan that I knew would cover those procedures I was going to have going forward (routine CT scans and regular lab work). So far those have been covered so again I only have been paying for the specialist co-pay visit which occurs about twice a year.

I fully understand wanting to know your financial responsibility for procedures. I kept setting aside money in anticipation of possible charges; but my surgery was about 18 months ago and I've not received any bills. I'm still worried they'll decide they didn't bill me and send me a late invoice for treatment. I wonder if there is a statute on how far in the past they can invoice for services rendered.