Insurance Issues

Posted by danab @danab, Wed, Aug 21 1:39pm

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.

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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@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

@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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