Hello and thank you for looking at my post,
I was recently diagnosed with stage 3 multiple myeloma and am now on Revlimid 25 mg, 21 days on with 7 days off. Also dexamethasone 40 mg once per week.
My question that I hope someone can help me with is a hospital / insurance type question.
I wanted to go to City Of Hope due to my wife's experience there about 6 years ago with lung cancer. They were extremely nice and the whole process was made easy due to the staff. Now I am on a different insurance and it is contracted with USC for out of area and my stem cell transplant. My insurance company said that I would have to show some type of just cause or hardship for them to even bring my case to their board for review to go to City of Hope.
City of Hope told me that if my oncologist could convince my insurance that there was a need for me to go there, that they would work with the insurance company on the whole coverage process. I really don't think think it will work, but i am going to try anyway.
Has anyone had any success getting their insurance to consider a different hospital when there's a contract with another hospital?
God Bless, George
Forums
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Getting insurance approval for a transplant center
Ask your doctor or nurse advocate to call insurance. They will persuade them the right way. Don't hesitate when time comes for SCT. I had 2 in 2010, right now all is well.
Stay strong.
Stay strong.
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Gil
Re: Getting insurance approval for a transplant center
I switched hospitals to a non-network hospital when I had a surgery done (completely unrelated to multiple myeloma). As Gil said, just have your doc or their insurance person contact your insurance. It was my doc's preference to use this other hospital and it was painless and easy from my perspective....and it was covered as if it were in-network. Just make sure you have something in writing, since your financial exposure is going to be enormous with an SCT.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Getting insurance approval for a transplant center
Gil and MountainGuy,
Thank you for your input. I have contacted the insurance, which is with my wife's work. They told me at first that they were contracted with USC for these services. A second call to them (same person) with a different answer. Now they say that my oncologist will have to write a referral to see if I can go to USC. Even a first visit consultation could be expensive if I had to pay out of pocket.
I also asked if the insurance covered bone marrow harvest and storage for future use. He didn't know, but said to look at my insurance coverage brochure. The brochure only shows the typical costs for hospital co-pay and emergency room co-pay type of details. nothing other than that.
I feel that i have gotten the ole run around. You would think that the insurance representative is there to help. It was like he was afraid to give me a clear answer. Also felt like I was wasting his time during the second call.
I think that both of you are leading me in the right direction. I am not an insurance specialist, so I should probably let the billing staff at my oncologists office help out.
Thank you both,
George
Thank you for your input. I have contacted the insurance, which is with my wife's work. They told me at first that they were contracted with USC for these services. A second call to them (same person) with a different answer. Now they say that my oncologist will have to write a referral to see if I can go to USC. Even a first visit consultation could be expensive if I had to pay out of pocket.
I also asked if the insurance covered bone marrow harvest and storage for future use. He didn't know, but said to look at my insurance coverage brochure. The brochure only shows the typical costs for hospital co-pay and emergency room co-pay type of details. nothing other than that.
I feel that i have gotten the ole run around. You would think that the insurance representative is there to help. It was like he was afraid to give me a clear answer. Also felt like I was wasting his time during the second call.
I think that both of you are leading me in the right direction. I am not an insurance specialist, so I should probably let the billing staff at my oncologists office help out.
Thank you both,
George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Getting insurance approval for a transplant center
George,
When I had my stem cell transplant, I was assigned an advocate from the insurance company as well as one from the transplant team. I would recommend that you call your insurance carrier again an ask for a breakdown of your policy's coverage. They are supposed to be transparent in this day and age. Then you will have the ammo you need to continue.
But in the same note, USC may have the myeloma specialist that City of Hope does not! Myeloma is an insidious cancer that requires a lot of fine research and a specialist in that type of cancer is a better choice. Check out which has a myeloma doctor and go from there! I have two oncologists, one is the hemotology doctor I see on a regular visit (I am in a remission waiting and watching phase right now), and the myeloma doctor is on "call" if I relapse.
I hope this helps.
Be strong!
Mary
When I had my stem cell transplant, I was assigned an advocate from the insurance company as well as one from the transplant team. I would recommend that you call your insurance carrier again an ask for a breakdown of your policy's coverage. They are supposed to be transparent in this day and age. Then you will have the ammo you need to continue.
But in the same note, USC may have the myeloma specialist that City of Hope does not! Myeloma is an insidious cancer that requires a lot of fine research and a specialist in that type of cancer is a better choice. Check out which has a myeloma doctor and go from there! I have two oncologists, one is the hemotology doctor I see on a regular visit (I am in a remission waiting and watching phase right now), and the myeloma doctor is on "call" if I relapse.
I hope this helps.
Be strong!
Mary
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Mary Degenkolb - Name: Mary Degenkolb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2011
- Age at diagnosis: 54
Re: Getting insurance approval for a transplant center
Mary Dee,
Thank you so much for the info. My oncologist is pretty strong on USC over City Of Hope. I live in a small costal town near Pismo Beach, which about 200 miles away from USC. My oncologist is really something special. He treated my wife after lung cancer surgery and we have had several friends and neighbors that went to him for different types of cancer. He always stresses to get a second opinion if I want one, and he is willing to work with other hospitals for treatment.
I will do more research as you recommended. Have you had any experience with USC or City Of Hope? I wish nothing but the best for you!
Stay positive, God Bless
George
Thank you so much for the info. My oncologist is pretty strong on USC over City Of Hope. I live in a small costal town near Pismo Beach, which about 200 miles away from USC. My oncologist is really something special. He treated my wife after lung cancer surgery and we have had several friends and neighbors that went to him for different types of cancer. He always stresses to get a second opinion if I want one, and he is willing to work with other hospitals for treatment.
I will do more research as you recommended. Have you had any experience with USC or City Of Hope? I wish nothing but the best for you!
Stay positive, God Bless
George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Getting insurance approval for a transplant center
I have HealthNet PPO (not an exchange policy) and City of Hope will not work with me. They said if I use my out of network benefits I will be balance billed to the full charge for the transplant, which is $600,000! I attempted to switch to a Blue Shield policy and City of Hope said they only take that if the employer has over 150 people. I employ 68 so that doesn't work either. I have not fought it too hard yet.
I am going to Fred Hutchinson next week for a second opinion/consult. If the financial picture is better there (appears that they will work with my insurance) I will just travel to Seattle when I get my transplant this fall. I have not found City of Hope to be cooperative.
I am going to Fred Hutchinson next week for a second opinion/consult. If the financial picture is better there (appears that they will work with my insurance) I will just travel to Seattle when I get my transplant this fall. I have not found City of Hope to be cooperative.
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Cragsdale
7 posts
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