$2600.Med. test or WDW?Warning,long and rambling

[Maray]

I'm not sure what to do. Now normally I would always choose my health first, of course.

But, $2600. !

I am trying to plan a trip to WDW for my Grandson's 1st trip and I need that Money, LOL, ya know?

My DH's health is not that good either, and I want to take Ryan soon, just in case,ya know?

We play WDW CandyLand Game ,and he talks about going to the Castle with Gramma,Pop-Pop,&

Mommy and Daddy all the time.

He carries a little globe around and calls it "My Disney World", LOL

I think he thinks this from seeing pics of Epcots"Globe"

He only knows 4 states, PA. where we live, N.J. where rest of family lives,Cal.,

and "Florida, where Mickey's house is, Gramma!"

Yes, the child has been brainwashed from birth-His nursery room was all Baby Mickey & Minnie,etc.

He has been going to sleep every nite to "Disney Lullabyes" since birth.

Money is much tighter these days,since I had to give up my job almost 3yrs.ago

due to increasing problems with Fibromyalgia progression.



This is my situation. My Oncologist scheduled me for a "Breast Coil" MRI Study with Dye tomorrow

at an Advanced MRI Center.

My problem is the cost is $2600.! I have very good Health Insurance,

but This study "May' be considered experimental and may not be covered.

The Center called me and said I would have to sign paperwork

saying I am responsible for the full amount if it is denied.

They spoke to someone at BC/BS and were told they would only cover $800. of it. Still $1800. on me.

I saw My Oncologist last wed.,had a Mammogram and chest x-ray on Fri.

I spoke to someone on Thurs at BC/BS and was told they don't do pricing, only percentages.

It's either covered or it's not.

But, then couldn't give me an answer to whether it would be covered????

I asked if anyone else,a supervisor perhaps could help me and was told no.

I tried to explain about my past history of very aggressive Breast Cancer history,chemo,radiation,

and that My oncologist feels I should have this done,

But It was obvious I was talking to a robot and wasn't going to get any additional help here.

I called The MRI Center again today to let them know what I was told.

They explained more about the test and gave me a procedure code to give to BC.

So, I called back and a very nice woman,took the info, and said she needed to see if the MRI Center is in or out of network 1st?

She would get back to me by end of the day.

I'm only hesitating because I think I may just be a good candidate for this "Study".

I'd gladly have it done to help myself and other women ,as I have no fears of the test itself, but not at that cost.

Like for years I have been paying $348. for a specific Cancer Antigen Blood test that the Dr.s swore would find cancer spread 6 - 12 months before any other signs were noticeable.But,on This visit to my Onc. Dr., when I asked whether he was going to do Bloodwork, He said "Oh, we found it 's really not that helpful."

I am wondering whether to just postpone the test until I can get a definitive answer.

I am now waiting for a return call from my Oncologist's office on whether we should wait until he at least reviews my mammogram films which I have here and then decide whether he feels this Special MRI is needed.( They look the same as last years to me

I know this seems silly, but with my history of Fibromyalgia, I get many aches, pain, tenderness in weird places all the time,

so I think perhaps that could be the problem.

Oh, I'm sorry, I am not usually this scatter -brained.

I forgot to tell you the only symptoms are some dull pain, tenderness ,occasional burning sensation,

but no palpable lumps of any kind.

Well, again, I'm sorry so long and TMI, but just writing this all down, has clarified this better for me

( Probably not for anyone reading it tho, LOL)

I think I will postpone the test, bring Mammo films to Onc. , see what he thinks and then go from there.


If, Blue Cross gets back to me today and test is covered, I will then keep the appt. for tomorrow.

If anyone took the time to read all this rambling and has any experience or advice, thank you.

Otherwise as Gilda always said "NeverMind"

Marilyn

 

[tassie42]

I think your health comes first! I know you love your Grandson but I think you should take care of yourself!

 

[shatzjsl]

This is just my opinion but if you have a history of breast cancer I don't see how you could be having a problem with this decision.

I understand that your grandson wants to go to WDW with you but I am sure that he would rather have you around as he grows up than just have memories of a trip.

So, I think you should have the test and put the trip on hold.

 

[HauntedMansionGeek]

Oh I'm soooooo bad! I wonder if you can't do BOTH.

I wouldn't NOT have the test but I know the clinics/hospitals in our area take payments after a test is done. Can you do that AND still save for a trip to DWorld with your grandson?

After having seen DisneyWorld from the eyes of a young child AND that child having been my grandchild, I'm not sure that's something you want to pass up either.

Keep in mind everyone here would have some great budget ideas for you if you decide to take a trip. LOL

Good luck deciding.....maybe it's all a moot point anyway and the insurance will cover most of the test costs anyway. I hope that's the case!!

 

[my3kids]

This is your health! Isn't it better to have a long and healthy life with your grandson than this trip to WDW? You have a history of aggressive breast cancer and you aren't sure whether to follow your oncologist's recommendations or go to Disney World???

 

[Toby'sFriend]

I think that if your Oncologist feels you need the test, then you probably are going to have to get the test. I'm sure your Grandson wants you healthy more than he wants a vacation.

Other than that -- just the usual advice. You are probably more experienced than I am in dealing with Medical bills....

but if the Insurance Company denies make sure you appeal at least once and if you pay make sure you ONLY pay the "reasonable and customary" amount BC/BS would pay if they did cover it and not the ridiculous cash price.

Good Luck.

 

[meandtheguys]

Before you jump someone, maybe it would help if you understood that doctors often schedule unecessary tests, etc. I don't think it is ridiculous to get the facts before she makes a decision that might cost her a great deal of money with little in return.

Maray, I hope that all works out well, and that you do get to take your trip with your grandson. Best wishes and prayers,

Michelle

 

[Cindy'sCastle]

Maybe they will let you pay a little each month. That's what I'm doing for 3 separate medical facilities that I owe. I send them each $10 a month and told them that's all I can afford to pay right now. So far I've not had any problems with them. I didn't let them know this in advance either. I just wrote a note when I got my bill and sent them a check for $10 and am still doing it. I hope this helps. Sure would like to see you do both.

Cindy

 

[Maray]

Sorry,I'm not really as dumb as my post sounded.
Thank you for being polite with your responses.

I do believe in being proactive when it comes to one's health.
I have had many tests and false positives, shadows that turned out to be nothing etc. over the last ten yrs.,
so that's where my hesitation comes into play.
I think I was just trying to make light of my own concerns and fears.
The what ifs, fears, never really go away once you've been thru a serious bout of Cancer.

Our WDW trip is only in beginning stages, nothing booked yet, thinking of Feb,with time to save money yet.
I definitely want to be around at least another twenty years to see my Grandsons grow up!
(Tho, I do have to admit, my first thought when I was told the cost was"That's money that could be used for WDW!")

I would never choose ONE WDW trip over many stay-at home moments with Ryan - not one precious, wonderful moment!

As far as the MRI, Blue Cross has not gotten back to me,
The MRI Center said I could let them know in the morning and they are " in Network".
My Oncologist said he would have no problem with putting a hold on the MRI,
until he sees my Mammogram films first.

I would rather just get the test done tomorrow and over with,and then see my Onc. on my scheduled
June 1st appt. for all the results
but I would have to put the $2600. on a charge card as I don't have that money now
if it turns out NOT to be covered.

Right now, I think I will try to reach Blue cross early in the morning,take films to ONC.
and see if I can still make the 1:15 appt. or reschedule it later this week depending on what my Dr. says.

Thank you again for taking the time to read my post and for caring enough to Yell at me.

Hugs, Marilyn

 

[Dan Murphy]

Marilyn, Marilyn, Marilyn. What am I going to do with you?! Health is #1, WDW is close, but still, #2, at best. Hey, wait, Ray is #2, WDW is #3. See how fast we can get our priorities straight.

Marie just had the breast MRI done a few weeks ago, we have BC/BS. It was done at an 'in network' facility, Lutheran General Hospital, no problems. She is now waiting for a regular biopsy to be scheduled, but her MRI was covered, in network. If it was out of network, -0- benefit. If your doctor wants you to go to a certain facility, out of network, tell him to find one that is in network.

Maybe I'll call ya later.

 

[Micca]

If it helps at all, I think it's best to take children at least 7 or 8 yrs. old to WDW. I don't think you mentioned his age, but maybe you could have the test, and save for a trip in a few years. Good luck on your decision

 

[Mskanga]

Marilyn I live in the same area you live ( poconos ) and I also have BCBS. My MRI last year done at Pocono Medical Center was covered by BCBS , Pocono Medical is in their network.
In any case, even if it's not a covered procedure, if the place is in network, they can only charge you the fee according to their contract, in other words, their regular fee could be $2600 but the fee that they can charge a BCBS patient may be much lower than that.
The facility also should know if they participate with BCBS , plus BCBS has a website that you can probably look it up.

 

[Maray]

and ready to face the cold hard reality of how fleeting life can be and how vulnerable we all are. Tho, it's depressing to be back.
But, that's exactly why I don't want to wait too much longer to take Ryan to WDW.
Micca- Thank you for your reply
Ryan will be four in Oct. almost 4 1/2 in Feb.
and then I'd like to go back when he's 7 or 8 & my new grandson, Tyler is four if possible.
Cindy- thanks for your suggestion-They made it sound as if I had to pay it now,but That is unusual & I'll find out for sure tomorrow.
I would hate charging it!
Tobysfriend - thanks for reminding me of the Appeal process, if necessary.
my3kids,shatzjsl,tassie42-Thank you for caring enough to reply-I know what I OP probably did seem like I was actually choosing WDW.I did need those reminders.
Hey Geek - I intend to do my darnest to do both LOL
meandtheguys( Michelle)-
Thank you so very much for reading thru all of my long, rambling post and understanding why I was hesitating.

And Dan the Man- The order is Health, my grandsons, my sons, THEN Ray, family, then WDW.
It depends, some days Ray would be waaay down on the list LOL
I'm so sorry Marie is going thru all this again too.
Keep me updated and give her my love.

Thank you all again for your concern, prayers, and wishes for good luck- I'll gladly take them.
I'll let you know what happens.
Hugs to All,
Marilyn

 

[parmstrong]

Well, I didn't read the other posts, so I don't know what they said, but here is my opinion. My son, an only child and 10 years old, is closer to his Grandma than anyone. When I think back on the all the wonderful things they have done together over the years, it is priceless. We went to WDW when he was 3 1/2 and 51/2 and he doesn't remember much of either, but he does remember Grandma Dolly every Christmas, sends her mail regularly and calls her all the time. I would always put my health and more time with family over any trips. The truth is, no matter how much fun it is to take the little ones to WDW, they don't remember much of it as time passes. I think, in the long run, you would rather be around to be you grandson's "best bud" when he is 10, than have one trip to WDW when he is 4, that he won't remember when he is a teenager.

 

[Maray]

Hi, again,
This MRI is a Special Breast Coil MRI.
Pocono Medical Center does not have the equipment or training to do this kind.

My Oncologist runs the Hughes Cancer Center across from Pocono Hospital.
He is sending me to Valley Advanced MRI in Easton, PA.
(About 40 min-1 hr. away from me)
When I talked to Valley again this aftnoon, they said they were in Network, I don't know why they didn't give me this info first, and they never mentioned accepting what BC/BS would pay. Just the $2600. quote and then the $1800. if covered.
What's up with that??
I'm glad some of you reminded me that I don't always have to pay that face value.
My DH is a Supervisor w/ N.J. Transit and we have Horizon Blue Cross/ Blue Shield of N.J. PPO.
Thank you, I didn't know about the website.
One of these days we will have to plan to get together.

edited to add: Be careful w/PMC, if you have any serious health issues, go to St. Lukes in Bethelhem or Lehigh Valley Hospital in Allentown.
PMC were the ones who misdiagnosed my 1st Cancer.(And any serious illness or accidents always get airlifted to these other hospitals.) Just a FYI

 

[kpgclark]

Let me add something too. Going to DisneyWorld is not some "guaranteed by birth" right. It is a vacation. That's it. Many, many people never go in their whole lives and live very normal happy lives. Your health is much more important as is just spending time with your children. Not going to WDW is not a big deal in the grand scheme of life. There are many more important things to be sure you have money to fund such as any health related items, college funds, retirement accounts etc.

Additionally this April we were supposed to go on our second Disney cruise and we cancelled it because several months earlier my husband's dad died. We just weren't feeling the magic and didn't think we'd enjoy ourselves. Well, we almost immediately regretted cancelling and tried to rebook but it was sold out. We ended up spending that week with my parents who live about 6.5 hours from our house. On the way home from a rather uneventful trip to Vermont (in April where it is mud season and there is nothing to do) I asked the children if they were sad we didn't go on the cruise. Do you know what they said? We'd much rather visit with Grandma and Grandpa! Mind you that my kids like the cruise much better than WDW. Family is what is important. Yes it is nice to vacation in great places if you have the money (and your health). Please take care of yourself first. That is what really matters.

Lastly, over the past few years I've had three friends (ages 38, 37, and 42) and an aunt die from breast cancer. Don't take it lightly. Do whatever it takes to get an accurate diagnosis and treatment.

 

[TinkBoo&ElliesMum]

Going to WDW is your choice, so I'll leave that to you!

But in my pre-two kids life I was the medical billing specialist for four docs. So I've gotten REALLY good at dealing with ins. companies! Which has proven helpful when dealing with my own insurance company!

If the doctor is in network and the testing is needed to further treat your case there shouldn't be a problem.

How long have you been with BC/BS? Obviously they're aware of your medical history and breast cancer status, I have yet to see them deny a claim when medical history backs up the testing. (Our ins. paid for "experimental" testing on both DH and I to the tune of $2,500 per person! My medical history was enough for them to cover it.)

BC/BS may only cover $1,800 of it but that doesn't tell you what their network negotiated rate is. I had $15,800 in medical bills from a recent hospital stay, the negotiated rate ended up being $1,600 with -0- out of pocket. You need to find out what your % is if any.

Good luck!!

 

[Pembo]

Maray - I just wanted to say I hope you get things worked out with your insurance company. Why do they have to be so difficult?! Best of luck to you!

 

[Mskanga]

Marilyn , check your pm's.

 

[momof2inPA]

Does the Transit Co. have an insurance rep. in their HR dept. who is assigned to help the employees with insurance claims?

I feel for you. BC/BS is supposed to be such good insurance and the company probably pays an arm and a leg for it, but you still have to go through he** to get a definitive answer from them.

I have had some success with just annoying their people on the phone so much they put a manager on the phone, and then annoying and laying the guilt trip on the customer service manager so much they actually solved the problem. You might want to try that route, if you can stand it emotionally.

Good luck with your tests; after all the worry it feels like a whole new lease on life to get a clean bill of health.