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Thread: What do ya do when your insurance cap is reached?? HELP

  1. #1

    What do ya do when your insurance cap is reached?? HELP

    Looking for any information on what to do once your insurance company sends a registered letter stating you are $40,000 from your life time limit. My sister lives in NY state and has been fighting cancer since 1994. She just received the above letter. Her husband is with the Teamsters Union which I "thought" would have a HUGE lifetime limit. She received this letter and we thought we had time to research alternatives for medical assistance. But, over the weekend she had a "mini-stroke" and busted her foot and needs testing done to see what had happened to her. This testing will probably eat up the remaining $40,000. Any ideas on what our next move should be?? Any information will be greatly appreciated. She is ready to go for a divorce so her husband don't get stuck with her bills. Sucks that life here is the US in 2008 has to come to this. You would think they could find a cure. But, then what would they do with all the cancer centers???? How much money would they lose?????????..............Thanks!! LadyHawk57

  2. #2
    LadyHawk57, I am truly sorry about your sister's problems in getting adequate insurance. It really is a shame that one of the most advanced countries in the world is way down on the list of countries in terms of health care provided to its citizens. I wish I had an answer for her.
    Long-term cancer survivor
    1992 Astrocytoma grade 2, left motor strip
    2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
    My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
    My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
    My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029

  3. #3
    Regular User
    Join Date
    Apr 2007
    There is a special Medical Assistance Program for Breast & Cervical Cancer for patients in New York.
    Check this link. If your insurance will no longer provide coverage for you, you may be eligible to receive coverage under this program.

    Here is the link that explains the program and how to apply for it.

  4. #4

    What do ya do when your insurance cap is reached?? HELP

    I would like to thank you for the reply and the information. My thoughts and prayers are with you. I hope you are doing well.

    I would like to thank you for the information. I printed it out. I will be going to NY for a few days next week to assist both my Mom and my Sister with things needing to get done. I will give her the information. Thanks again.

    Thank you both for your replys. God bless.

  5. #5
    Contact Social Servies. What about medicade or medicare. Contact the American Cancer Society. What kind of cancer does she have? With that information I can help you more. Also tell your husband not to sign anything at the hospital. Tell him to tell them the Hill Burton Foundation will take care of the bills. Also contact your Patient Advocacy Program. They will find the help she needs. Another good place to go for help.

  6. #6
    A lot of Cancers do qualify a person for disability. The amount is based on the person's previous income but it does include Medicare coverage. Medicare does not kick in from the beginning... I think it takes 12 months... but it certainly is something to look into.
    Long-term cancer survivor
    1992 Astrocytoma grade 2, left motor strip
    2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
    My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
    My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
    My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029

  7. #7
    seen this thread come up and thought id give it a bump up and some attention. so far i have not seen any good news for the patient when it comes to health costs all around.
    april / 2013 pop passes away on mama's birthday
    march / 2013 mama has a colon resection due to benign tumor
    august / 2013 mama goes jaundice, has a stent put in bile duct, diagnosed with 2b tumor on the ampulla of vater stage 2
    september / 2013 mama has wipple procedure
    december / 2013 mama has a port put in for future chemo
    january / 2014 scans show no cancer with benign cyst on liver and kidney
    january /2014 gemzar - tarceva chemo treatment begins
    may / 2014 scans show cancer spread to liver stage 4
    may / 2014 abraxane replaces tarceva as palliative treatment
    october / 2014 xoleda replaces gemzar - abraxane treatment
    november / 2014 mama goes to heaven
    cancer sucks

  8. #8
    Administrator Top User Kermica's Avatar
    Join Date
    Jul 2009
    The post above was made over 6 years ago. Here is the update on Medical coverage in the U'S':


    Good health,

    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 67
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxan, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.
    February 2015 - Doc and I agreed to stop R maintenance as it is depressing my immune system too much.
    June 2015 - Confirm that the beast is back by physical exam, will scan in August after esophageal issues settle down so we can get a clear view.
    August 2015 - physical exam in error, PET/CT shows no evidence of disease. Remission continues well into second year!
    December 2015 - Cardiologist tells me I have plaque buildup growing at an alarming rate. Stent or bypass down the road but not yet...
    March 2016 - new tumor below the jaw so remission is over. Back to active surveillance until treatment is needed.
    June 2016 - C/T scan indicates presence of multiple lesions in iliac chain.
    August 2016 - PET/CT shows multiple areas of lymphoma as expected plus new areas of concern in bowel.
    January 2017 - C/T scan shows significant progression in cervical and inguinal lymph chains, largest tumor is impacting hearing, measures 2.1x4.6 cm. 4 to 8 cycles of R-CVP, 1x3weeks to commence 2/6/17.
    April 2017 - Mid treatment scan shows about 1/3 reduction in multiple tumors. Also shows abdominal aortic aneurysm with peripheral thrombus. Cardiologist changed meds, spoke of need for surgical repair down the road.
    September 2017 - finished 10 rounds of R-CP, V was stopped due to neuropathy in feet. No further treatment planned at this time, at least 10 tumors can be felt which seem to be growing again.
    December 2017 - Biopsy of external iliac node with SUV of 13.1 shows no transformation! However, the FL grade is now 3A instead of Gr 1-2. Will start indefinite protocol using Copanlisib, one of the new targeted therapies. I remain hopeful.
    March 2018 - Copanlisib failed, treatment stopped 3/28. New plan is to go to Dana Farber on 4/16 for case review and treatment recommendation.

    May 2018 - did not qualify for clinical trials at Dana Farber. Tumors need to get larger to be considered. On consultation w/Dr. Armand at DF and my onc, have decided to take a break from cancer treatments. Will have a biopsy of the mass in my sinus discovered in scan at DF and to get the aneurysm repaired as it has developed a potentially catastrophic penetrating ulcer. Surgery scheduled for 7/12.

    September 2018 - biopsy of mass in nose shows transformed DLBCL throughout. Assessing options for this negative development.

    October 2018 - started 6 to 8 cycles of R-CHOP. Goal is to get to full remission to open up other options.

    February/March 2019 - PET shows four hot spots following R-CHOP. referred to Dana Farber for stem cell transplant. Pre testing all good, accepted for Auto Transplant. Will begin inpatient process about April 1.

  9. #9
    Kermica, that link doesn't work (for me). Here's a summary (excerpts) from the US Dept of Health & Human Services on new rules:

    Lifetime & Annual Limits

    The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also restricts and phases out the annual dollar limits a health plan can place on most of your benefits — and does away with these limits entirely in 2014.

    What This Means for You

    Before the health care law, many health plans set an annual limit — a dollar limit on their yearly spending for your covered benefits. Many plans also set a lifetime limit — a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits.
    No annual dollar limits are allowed on most covered benefits beginning January 1, 2014.

    Some Important Details

    * Be aware that plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered “essential.”
    * If the new rules apply to your plan, they will affect you as soon as you begin a new plan year or policy year on or after September 23, 2010. (For example, if your policy has a calendar plan year, the new rules would apply to your coverage beginning January 1, 2011).
    * If you have a “grandfathered” individual health insurance policy, your health plan is not required to follow the new rules on annual limits. (A grandfathered individual health insurance policy is a plan that you bought for yourself or your family; that you did not receive through your employer; and that was issued on or before March 23, 2010.) If you’re not sure whether your plan is grandfathered, ask your insurance company.
    * The ban on lifetime dollar limits for most covered benefits applies to every health plan — whether you buy coverage for yourself or your family, or you receive coverage through your employer.
    * Some plans may be eligible for a waiver from the rules concerning annual dollar limits, if complying with the limit would mean a significant decrease in your benefits coverage or a significant increase in your premiums.
    Tarceva hints in this thread.

    Hospice - a support thread here .


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