I may have cancer, and my insurance is killing me...

So, here we are, the new year, new health insurance. I said goodbye to my HMO, and apparently, my $10.00 prescription co-pay.

I knew I had a $2600.00 deductible for the year, but how this was going to be under the prescription plan was a mystery. Until today.

After suffering a spate of health issues right at the end of 2013, I mean literally up until December 31, I was having testing, seeing several doctors, and trying to get some health issues that had seemingly come from nowhere resolved, I have suddenly found myself facing a possible diagnosis of cancer.

Right now, it's unknown, and I have been trying to get an appointment since January 5.

I already have back pain issues, and have for some years. I go to a pain clinic, and had already been given a prn, or "as needed" prescription for Fentanyl duragesic patches, 0.25 mcg, for severe pain occurences. I used them rarely. In fact, my last refill, July, 2013, of 15 patches, had lasted me until January. I paid $10.00 for the co-pay when I got this filled.

I have been experiencing severe pain due to a recent issue which may be the base cause of a lot of my pain afterall, and they discovered a tumor on my left ovary, along with a cyst that I have had since 2005, that has worsened.

So, at this point, until I can get it diagnosed, removed, and find out if it is benign or not, I have no choice but to live with this pain, and the severe difficulty in walking. That appointment is Jan 31, so that is the beginning of a whole new set of out of pocket bills and expenses.

I telephoned the pain clinic, and since my next visit is not until Feb. 11, they wrote me a refill for 15 more patches. My husband took it to be filled tonight, and he was on the phone when they checked him out.

$105.00 co-pay.

I still can find no information about my prescription plan, but, I think this was the full retail price. I knew that I would be paying all doctor bills out of pocket until I met my deductible, but had no idea prescriptions would be included. So, it looks like no true "co-pay" until the deductible is met there, as well.

To be honest, I am terrified. I don't know how I am going to refill my normal pain meds, all of my regular prescriptions, PLUS see a doctor that I MUST see.

All of this has to happen now. I might have cancer. It's not something I can wait a few months to handle. I just don't know what to do.

On top of all that, my premium for myself and my husband went from 118.00 every two weeks, to 335.00 every two weeks, so what little "disposeable" income we had is sucked up in premiums.

I am simply panicking now. I am basically going to have to cough up the full deductible in the month of January. I don't know how people are going to be expected to do this. I can foresee a lot of people going without needed medical care because of this, many with much higher premiums and deductibles than we have.

If, if, I have cancer, this isn't even touching the costs of treatment and co-pays afterwards. Even if I do not, I am still facing surgery for removal and pathology of this tumor.

And no, we won't qualify for any government assistance. We make too much, and there is no way we would qualify for anything. I have to keep my job, firstly because I love it, and secondly, because I insure both of us. I am nowhere near retirement age, and already took a loan against my retirement plan to pay medical bills. The only option I can foresee is racking up a lot of bills, and eventually filing bankruptcy, but it won't help at all with the high out of pocket pain med and prescription costs.

I am simply at a loss as to what to do, or how to handle this. I may not be able to afford cancer treatment, but I simply cannot forego the pain medication. It is the only way I can face each day, and accomplish anything. My pain is 10/10 without it, and sometimes 8/10 even with it.

I am open to any suggestions, but giving up and going on disability is not an option. I am also not fond of the group funding thing.

Sorry for your troubles, I know first hand cancer can be a bitch. I hope you get good news on that front.
Now for the pain killers sometimes I think illegal drug deals in back alleys are the way to go. I wish that was a joke.
The new insurance regs are going to bite a lot of people I'm afraid.

reply to post by Libertygal


You'll probably have a lot of people tell you a lot of things to try while you wait or try and find ways to get traditional cancer treatments so here goes:

-Go on Ketogenic diet immediately, cut out all carbohydrates and switch to a high fat, medium protein, low carb(under 30 g a day) diet.

If it is cancer take Sodium Dichloracetate with a caffeine regime.

www.thedcasite.com...

It has little side effects and works. I gave it to a family member with a cancerous tumor and it went away. It has to be taken with caffeine however.

I had both mom and dad die of cancer within year of each other and had searched a researched everything I could imagine to help them and finally did find the SDCA but it was too late.

Good luck.

reply to post by Libertygal

I work for a large International Company and due to contract issues...I pay FULL PRICE for my pain meds, arythmia meds, blood thinners, blood pressure meds, and stroke meds. I have tests I need to get, cardiac, spinal, and ortho, gastro, x-rays, EKG's, MRI's...you name it, Im due. All at full price.

I get what I can, when I can, and let the rest go. But tomorrow, Im finding no choice but to take a Family Medical Leave of at least a month to get some of the more serious issues worked out...at full price.

And with the medical leave? I get no pay for the time Im off.

Take care of yourself and try not to worry. It could be even worse!
Blessings and prayers to you for good health!!
MS

Hoosierdaddy71
Sorry for your troubles, I know first hand cancer can be a bitch. I hope you get good news on that front.
Now for the pain killers sometimes I think illegal drug deals in back alleys are the way to go. I wish that was a joke.
The new insurance regs are going to bite a lot of people I'm afraid.

I have to stay legal. I just had random drug screen at the pain clinic in December, and face those at work, as well. I cannot risk jail, either, so anything from the streets is simply off limits.

Also, I take Dilaudid and Soma, so I would not feel safe at all getting anything like that off the streets.

I appreciate the effort, but thats just bad advice, really. Just being honest. I go to a pain clinic, so no reason to do anything illegal, I just need help with financial ideas, resources that people may know of.

Since I do not have a definitive diagnosis of cancer, I can not yet go to those agencies, Like the American Cancer Society, etc. Not sure if even then, we will qualify for assistance of any type.

Thanks for the kind thoughts, I read your post, if I recall, where you just dealt with this in your family, so I know you have close personal experience with cancer.

My insurance has changed as well.
In a similar way to yours. high deductibles, high co-pays after those are met.

There are some things you can try.
It worked when my spouse was dealing with a pain clinic, and other massive medical bills.
Often the Manufacturers of some of the drugs you are talking about, will offer discount cards.
These are usually good for 3 months at a time. The pain clinic can even sign you up over the phone if there is a discount available.

Another thing, is look in the container that your medicine came in. There is often a phone number that you can call if you are having trouble paying for meds. they can offer discounts, apparently at their discretion. I think this also ends up with you having a discount card, but it's more than the promo discount that I mentioned above.

another thing, is check with your pharmacy, they also offer membership discounts..Like a script card...This one you will hae to weigh the pros and cons..Because I don't think you can combine this with Insurance..Just ask em..


But most of all...Best wishes, and good luck to you

reply to post by mysterioustranger


Ah, well. I know it could be worse, but it is what it is. Part of my premiums are short term disability that I purchased. Long term disability is given to us by the hospital I work at, so that's a good thing.

I will also qualify for FMLA, so that and both disability plans, plus I have a PTO bank for extended illness, means I will actually get two paychecks for a while. Not full ones, obviously, and I will be taxed to death for that in the end.

Not worried in the least about losing my job, my boss loves me, and even if she has to hold my job over the 72 days of FMLA, I know she will. I am gratefull for reduced/no stress in that area.

I am just wondering how to cough up all that deductible, plus my regular monthly prescriptions, at full price, all at once. Its like having to cover what, for most, is a whole years worth of medical expenses in the first month of the year. And, it was totally unexpected.

I got a company contribution debit card with $1500.00 on it, and part of my premiums is a $67.00 payment to the balance on the card every two weeks. I was planning on using the card for partial payments, to help ease the pain of meeting the deductible, along with cash, but like I said, this was sudden and unexpected, so no rationing out on the card.

Also, my husband didn't have his card tonight, so we paid that $105.00 totally out of pocket.

I don't see how you are going to go without needed care, while others can just walk in and get free care, and never have to worry about paying a dime. In the meantime, I not only have to pay all of this, but I am being taxed to death to pay others', as well.

This whole Obamacare thing has me furious. Simply furious. I liked my plan, but I wasn't allowed to keep it.

reply to post by Libertygal


I wasn't trying to give you advice... Lol. Just saying desperate people will do desperate things.
My mother was on dilaudid, that stuff is nasty powerful so I can only imagine your pain. She had a pump implanted under her skin that would constantly push meds into her lower back. That thing had a remote that allowed her to give a booster once an hour for the bad times. She fortunately was on Medicare at the time and had supplement insurance that took care of the medical costs. I would hate to face the medical bills she had without good insurance.

reply to post by OrphanApology


Already been on a ketogenic diet for a long time, and off all diabetes meds. I will check out your link for the other info, thanks, I have never been able to give up the coffee, so caffeine is a non-issue.

reply to post by Hoosierdaddy71

Ok, guess I took it the wrong way, I apologize for that.

Yep, been having to take Dilaudid 8mg for a little over a year now. It just helps, barely, with the pain. When I first started it, it was a Godsend. Now, having to take the Fentanyl with it, is very upsetting to me. I have constant muscle spasms, as well, so I take the Soma every 8 hours, around the clock.

In July, my legs started hurting so bad, I couldn't walk 10 or so yards without having to stop. My pain doctor gave me two epidural steroid enjections, and said the MRI was not showing anything in my back that was explaining my pain. He then recommended I see the gyn doctor, that it may be female issues, and here I am today. Along with all of this, they found some problems with both my kidneys, bilateral adrenal hyperplasia, and mutiple tumors on both adrenal glands.

Its been a crazy mess since. It's also a bit scary, a bit like a rollercoaster that once you are on it, you can't get off it.

Just got to take it one day at a time.

reply to post by spacedoubt

Ah, thank you! That is great advice I had not thought of. I will look into that. Right now, I am self paying for Synthroid at Target, nit with insurance, but a discount card good for 3 months like you said. The only problem is, I am self paying yes, but since it is "non-formulary", it is not considered medically necessary, so I won't get "credit" for it on my deductible.

I am thinking though, if I self pay with a discount card for a prescribed med, it has to count, yes? I mean, what is the difference, other than not paying full retail?

My doctor put me on Synthroid, name brand, because the generic was too unstable, and I was having a lot of symptoms from taking the generic, which is largely unregulated when it comes to the fillers. My main issue was fatigue and hair loss, but this still didn't qualify as medically necessary to put me on name brand.

Things have changed so much, and for the bad, IMO. It's going to make some sick folks even worse, which, in the end is going to end up costing us all even more to try to get them well again, or worse, they may die.

reply to post by Libertygal


I am so sorry for what you are going through! Reading your story just makes me want to cry.
I fear yours' is just the first of many such stories that will come to light, and there is basically nothing we can do but feel helpless.
I have you ( and your family) in my thoughts and prayers.

Selenium and Graviola have been shown to have decent anti-cancer effects.

The Hoxsey Therapy is a potential alternative treatment.

That's all I've got on the advice front. But you've got my well-wishes and prayers, and I'm really really sorry this horrid society cares more about profit than human lives.

I'm kind of in the same boat...I have to get my thyroid checked once in a while because of a genetic disease in the family, plus I take meds for depression/anxiety and soon going to be starting hormone therapy.

Recently, my mom's insurance is being iffy with her, so I have a back up with my dad's (he's union) but it's still hard to get by.

reply to post by Libertygal


if the discount card is through the manufacturer, I'm pretty sure you can also run it through your insurance as well!
This is not true with most pharmacy discount cards though...those can't be used in conjunction with insurance.

Maybe this could help... I have a friend who gets free medication from a pharmaceutical company.

Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. RxAssist offers a comprehensive database of these patient assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need. All in one place.

Medication Assistance Programs

Best of luck.

reply to post by spacedoubt


Ohmygosh, I had a long post in reply, and deleted it by accident. Ugh, I hate my PC keyboard!

Anyway, your advice helped SO MUCH!

I found this wonderful website, I did a google search for dilaudid payment assistance, and found a website that helps to pay for prescriptions. There is no fee to join. They offer manufacturer discounts, and say the average is 50% up to 93%. I got coupons for Soma, Synthroid, and Ambien, as well as dilaudid. They have a searchable database of over 50k medicines, both name brand and generic.

This is NOT designed to be used with other discounts, so if you are getting $4.00 prescriptions at Walmart, Target, etc., do not expect to be able to use this discount card in conjunction with that, or with insurance co-pays. It will be one or the other, but always check to see which will be less. You may be surprised, and find one for even less than $4.00!

I was right too, that if you have a Health Savings Plan, that this WILL count towards your deductible, although it will take you longer to get there. That is fine with me, because I can put a doctor's bill or hospital bill on a payment plan, but I cannot do that with a point of sale purchase, such as a pharmacy prescription.

This will help me, and several others that have posted in this thread about facing the same pain at the pharmacy counter, in having to pay those high out of pocket expenses. I cannot thank you enough! What seemed like such a simple answer, and I had not thought of it, your answer has ended up being the key that I needed. I would applause you if I could! Do your thing! Applause this kind soul!

Anyway, this website seems 100% legit, they have a faq that explains who and what they are.

www.helprx.info...

1. What is HelpRx.info?

HelpRx.info is a pharmacy discount program courtesy of Healthcare Alliance. Pre-activated, FREE and ready to use immediately, these coupons can help you save up to 75% on all of your prescription medications. With discounts on virtually every medication sold at every pharmacy nationwide, our drug coupons and the NPSN card save families an average of $300. There are absolutely NO FEES to use these discounts and you will never be charged for them. Also, HelpRx coupons and discounts are widely accepted and work at your pharmacy or a pharmacy near you

You can request a card, print the coupons directly from their website, have them sent to your phone, or sent to your email and print them from there. They even state that if you have a problem at the pharmacy with them accepting these coupons, to have them call, and they will settle any issues. These are discounts from drug manufacturers, not "deals" or promotions, but true discounts.

They do state to be sure that you are not giving up insurance coverage, to check with your plan, BUT, at the same time, to compare prices. If your co-pay with insurance is higher, you may be better off paying out of pocket with the discount, IF the co-payment does not count in some way towards your totals.

With a Health Savings Plan, like I have, it won't matter, as however I pay, I am paying out of pocket, be it more, or less, and it will count towards my total. My insurance will not kick in until that deductible is met, anyway. Just be sure to check your individual plans, or, if you don't have any insurance, you would be crazy not to get the benefits of these discounts.

If, in the unfortunate event I have cancer, some of my medicines for treatment may not be covered, this may also come as a Godsend, then, as well.

This is not an insurance company, there is no fee or price to get your card. When you sign up for the card, they send you a printable one in email that you can use till your cards arrive in snail mail. They send you two, one for you and one for a spouse, friend, etc. The card is already activated when you get the email, you only have to print it and present it at the pharmacy.

Here is their main website:

www.helprx.info...

Anyways, I just wanted to say thank you, more than I can ever express, because you gave me the answer I desperately needed, and relieved my panic and anxiety over how I was going to pay out of pocket for all of my meds plus all these bills. There IS light at the end of the tunnel, and thank you, thank you, thank you!

Seriously,

tinker9917
Maybe this could help... I have a friend who gets free medication from a pharmaceutical company.

Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. RxAssist offers a comprehensive database of these patient assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need. All in one place.

Medication Assistance Programs

Best of luck.

Ah thank you for the help, but, as I said, financially, we won't qualify for any assistance programs, we make too much. They will not take into account what our bills are, or how much our debt is, only what our income is and how many live in the household. That was one of the first things that I did, was to check into financial assistance, and it was clear from the start our financial assets are far too high.

Pretty much, if you are employed and live above the poverty level in the US, you will not qualify for most assistance programs. Most people that have a job, house, and car will not qualify. This is the bad part, because people are driven to sell assets to pay for medical coverage. It is actually expected.

This topic had come up in a thread at one time about Medicare and Medicaid coverage, that when a person dies that had coverage, the government actually gets dibs on their estate before the spouse or family does. Any benefits paid on behalf of that person must be repaid to the government before the estate is paid out, and this is why wills are very important.

People that apply for, and get Medicaid, are usually financially destitute to begin with, and have zero assets. If it comes down to it, obviously, we will have to start selling things, but we only have a few years left before the house is paid off. The last thing I want to do is lose the house.

This is an important topic, though, that if you do not have a will, it is very important to make sure before anything happens, that you take care of that, so you can be assured that assets go where you want them, rather than to the government.

reply to post by Libertygal


That i could be of just a tiny bit of help to you, is reward enough my dear.
Now, you take care of yourself, and get healing. You're part of our ATS family!

therealguyfawkes
Selenium and Graviola have been shown to have decent anti-cancer effects.

The Hoxsey Therapy is a potential alternative treatment.

That's all I've got on the advice front. But you've got my well-wishes and prayers, and I'm really really sorry this horrid society cares more about profit than human lives.

Thanks for the information. I will look into anything right now, even though I do not have a diagnosis. Information is always a good thing. If I am found to have cancer, I know things will move very fast from that moment onward, so it is best to be informed, forearmed, and prepared for the worst, hope for the best, and take whatever comes along.

We have been spring cleaning the house, a little early, just in case. I am trying to remain positive in thought and emotion, but I see no harm in being prepared. I am not expecting anything at this point, it is hope, because that is all I have to go on. It may answer some questions, like why the pain is so bad, and why I have some symptoms I do. It may be benign, but just pressing on nerves and blood vessels. I just don't know yet and won't for a while.

I try to not have anxiety about it, but would be lying if I said I didn't. Anxiety isn't necessarily negative though, it is just considering the "what if's". Which I honestly feel I must do. I think it would be foolish to NOT consider the possibility, but I don't *expect* it.

I admit I am a little scared, but not as much as I was at first. A lot of anxiety came from worrying about money, and I just ran across a solution to that, so the rest now is really going to be mental. Just dealing until I know, one way or the other.

Thanks so much for the positive and kind thoughts, it means a lot to me, more than I can express. I know so many on ATS have been personally touched by issues and can relate, so it means doubly more to me because of that.