Please Pray. Medicaid suddenly decides not to cover women with stage 4 breast cancer

[clarabelle]

So you think no one is ever terminal ever?

No matter how much pain it puts her through
No matter how much it costs
No matter how her children have to see her suffer

We should do everything possible?

 

[my3sonsagn]

So you think no one is ever terminal ever?

No matter how much pain it puts her through
No matter how much it costs
No matter how her children have to see her suffer

We should do everything possible?

I think she isn't a dog and thus all of the above should be her decision (along with her doctors) to make.

I have no advice for your friend, OP, but I wish her the best, and I think no one's life should be shortened on a beaurocratic technicality!

 

[rie'smom]

So you think no one is ever terminal ever?

No matter how much pain it puts her through
No matter how much it costs
No matter how her children have to see her suffer

We should do everything possible?

I think it should be a decision made by Connie, her family, and her doctors.

Do you have children? I don't personally know of any woman who has had cancer and doesn't want to fight. It's because they want to be around to see their children grow up.

If you (general you) gets to Stage IV cancer and don't want to fight, fine. That would be your decision.

I can't believe anyone would care what a treatment costs if it can help save a life.

No one is terminal until they stop breathing. I've heard of about a dozen cases locally where doctors have given someone under a year to live-terminal, in other words- yet they live completely normal life spans.

 

[clarabelle]

Yes I have children

I am very sorry for this woman and I hope she gets what she wants

I was a nurse -I saw things done to people sometimes by choice and sometimes not by choice that did little more than prolong their suffering and line the doctors pockets with money (and no I am not anti -doctor -I married one)

What I am trying to say is that the best choice for someone -(not necessarily her just speaking in general terms) may be end of life care, a good quality of life for her end of days instead of endless rounds of chemo and being too sick to spend time with her children.

I don't think of her as a dog that needs to be put down. I think I just have a different attitude about death and how we treat death in this country.


I am sorry OP -truly.

 

[chloelovesdisney]

Yes I have children

I am very sorry for this woman and I hope she gets what she wants

I was a nurse -I saw things done to people sometimes by choice and sometimes not by choice that did little more than prolong their suffering and line the doctors pockets with money (and no I am not anti -doctor -I married one)

What I am trying to say is that the best choice for someone -(not necessarily her just speaking in general terms) may be end of life care, a good quality of life for her end of days instead of endless rounds of chemo and being too sick to spend time with her children.

I don't think of her as a dog that needs to be put down. I think I just have a different attitude about death and how we treat death in this country.


I am sorry OP -truly.

I completely agree with you.

 

[jjarman]

My first reaction to this situation was horror. How dare a bureacrat dictate your medical treatment. By the way, Medicaid is government healthcare for anyone interested.

Then I read a little more. Saw she had stage IV cancer. I am sorry but if that was my mother or my sister I would say it is time to make you comfortable. I know there are those instances where people beat stage IV cancer but how many really do?

I know it sounds cold but Medicaid has to watch their money as well. There comes a point where you can't continue to pay out money for something that is not working. Not all cancer is curable or even treatable, whatever that means.

 

[Bluestars]

If she is terminal, then yes. People go into hospice care every day with terminal illnesses. Of course, if her cancer can still be treated then she should be provided treatment. We are not her doctors. We don't know.

It does seem like there was a SNAFU between Medicare and Medicaid. I hope that it gets worked out very soon!

The thing is, you never really know if it is terminal if the person doesn't get the treatment. My coworker's best friend has a daughter who was diagnosed with stage IV cancer. She was within a couple of weeks of death. She received intensive treatment and is in complete remission. She has been healthy for several years now.

Who gets to decide if a person's life is worth it? It treatment is available, the sick person should get it. Anything less than that is inhumane.

 

[ead79]

So you think no one is ever terminal ever?

No matter how much pain it puts her through
No matter how much it costs
No matter how her children have to see her suffer

We should do everything possible?

I think that decision should be left up to the patient, her doctors, and her family. I don't think it should be left up to a government agency. I have a BIG problem with stuff like this. I don't want a government agency making decisions about my access to healthcare treatments. I have private insurance, but it's easy for me to put myself in someone else's shoes. I wouldn't want someone else deciding that issue for me.

Now if the patient decides that it's time to stop fighting, then I am all for palliative care. But that shouldn't be forced on her.

 

[golfgal]

Ok, this isn't something that was "suddenly stopped" it was that user did not fully understanding the system. There are two different insurance plans in place here Medicare and Medicaid. Medicare is for elderly and disabled and Medicaid is for low income individuals/families. Since she went on Medicare, she was no longer eligible for Medicaid.

 

[HeatherH]

My first reaction to this situation was horror. How dare a bureacrat dictate your medical treatment. By the way, Medicaid is government healthcare for anyone interested.

Then I read a little more. Saw she had stage IV cancer. I am sorry but if that was my mother or my sister I would say it is time to make you comfortable. I know there are those instances where people beat stage IV cancer but how many really do?

I know it sounds cold but Medicaid has to watch their money as well. There comes a point where you can't continue to pay out money for something that is not working. Not all cancer is curable or even treatable, whatever that means.

But see, here is the problem...Medicaid only STOPPED paying because she applied for SSI and now has the two-year waiting period for Medicare.

They would STILL be paying for her treatments, otherwise. It has nothing to do with them "saving their money". It is up to the patient and her doctors to determine when treatments no longer would improve her quality of life and/or lengthen it.

As a mother of young children, of COURSE she wants to do everything humanly possible before facing the inevitable. Those memories she makes with those precious babies are priceless. I'm sure she is cherishing every moment with them.

Just because the inevitable is that she will die from this disease does NOT mean she does not have the right to FIGHT and prolong her life as long as possible.

 

[Judy from Boise]

I think it is ludicrous to truely believe that as a society we can afford to do everything for everybody! Healthcare is but one service the government provides, if we spend money for treatment that has statistically not been proven beneficial(and I do mean statistically not the antedotal stories that have been reported)......will you in turn put up with no roads, 50 kids in a class, and 60 minute 911 response times?
With limited funds I would rather cover pre-natal care for 1000 poor women that futile treatment for one.I acknowledge that if that one is your loved one this is heartbreaking.

I don't mean to be political, or hardhearted, just share what I think is the reality of the situation.

 

[Irish9697]

I am Connie's sister Cristin's friend and I am THRILLED this story made it here to the Dis! Spreading the word...more people, more power, more prayers!

Praying for Connie and all of the Andrews sisters (they have a lot on their plates right now) and I am eager to get a solution to this horrific situation!!!

Connie will kick this cancer!!

 

[arminnie]

With limited funds I would rather cover pre-natal care for 1000 poor women that futile treatment for one.I acknowledge that if that one is your loved one this is heartbreaking.

I don't mean to be political, or hardhearted, just share what I think is the reality of the situation.

I posted earlier that my mother died as a result of stage IV breast cancer.

Sometimes even I have wondered if the hundreds of thousands of dollars spent on her the last year or two of her life were really worth it. I wanted every day with her, and she wanted every day of life. But was this really the best use of all of that money?

 

[natenapril]

I posted earlier that my mother died as a result of stage IV breast cancer.

Sometimes even I have wondered if the hundreds of thousands of dollars spent on her the last year or two of her life were really worth it. I wanted every day with her, and she wanted every day of life. But was this really the best use of all of that money?

This question you posted shocks me. I will say I have never nursed someone who was dying from cancer but I did see my mother die from cancer.
How can you not want to spend every dime you have to have one extra moment with your loved one? SHE CHOSE TO LIVE. She couldn't take the money with her. You said she wanted every day of life.
I think I should back away from this thread

 

[barkley]

I think that decision should be left up to the patient, her doctors, and her family. I don't think it should be left up to a government agency. I have a BIG problem with stuff like this. I don't want a government agency making decisions about my access to healthcare treatments. I have private insurance, but it's easy for me to put myself in someone else's shoes. I wouldn't want someone else deciding that issue for me.

Now if the patient decides that it's time to stop fighting, then I am all for palliative care. But that shouldn't be forced on her.

just out of curiosity-does your private insurance cover everything you/your doctor might conceivably want to provide to you in the way of care/treatment?

if so-your policy is the exception vs. the norm. private insurance policies commonly have exclusions to coverage and items of coverage that require review and preauthorization for coverage. so it's not just government agencies that make rules about coverage, insurance companies do it routinely.

the ONLY way any individual person can make all their own decisions about what care they will receive, and then receive is if they are going the entirely cash for service pay route. a nice ideal to aspire to, but financialy out of the question for most people (and in the case of cancer treatment tremendously so-i know of a person with an 80/20 policy that did allow agressive treatment of their child's cancer-their 20% of the bill AFTER the insurance company figured in a reduction b/c of their negotiated rate with the providers, just for a period of 7 months was in excess of $60,000, i don't know many people who have a spare $600,000 or so).

 

[chloelovesdisney]

12 chemo treatments at $12,000 is $144,000. It sounds like a lot but she probably has 15 friends and/or relatives that could come up with $10,000 and she can move forward with the chemo treatments, or 30 who can come up with $5,000, or even 144 people who will donate $1000. It's possible to raise that amount of money.

 

[Pea-n-Me]

I am of the personal belief that if someone wants to keep fighting, they should be allowed to fight. If she's truly "futile", there are ways to "fight" without doing the whole gamut of treatments. Most people are reasonable about that but want to be given hope. That hope may translate into a little more time to say the things they want to say to their families, tie up some financial matters, or whatever. It's not always an all or nothing scenario - sometimes there can be a middle ground. But the bottom line, to me, is that whatever is decided it should be between the patient and the care team, not something that's decided by a numbers cruncher behind a desk somewhere. I hope the people surrounding this woman find a way to help her.

 

[Carly_Roach]

I think that decision should be left up to the patient, her doctors, and her family. I don't think it should be left up to a government agency. I have a BIG problem with stuff like this. I don't want a government agency making decisions about my access to healthcare treatments. I have private insurance, but it's easy for me to put myself in someone else's shoes. I wouldn't want someone else deciding that issue for me.

Government agency, insurance agency, same difference. If you have private insurance, then it's someone at the insurance agency who is making decisions about your access to healthcare treatments.

And their motivation is fairly callous: profit.

It's a false sense of security thinking that this can't happen to you because you have commercial insurance. Just ask all the people who's commercial insurance companies denied coverage or dropped them (and their family) completely because their expensive treatments would eat into that insurance company's profit margin and bonus plans.

 

[ead79]

Government agency, insurance agency, same difference. If you have private insurance, then it's someone at the insurance agency who is making decisions about your access to healthcare treatments.

And their motivation is fairly callous: profit.

It's a false sense of security thinking that this can't happen to you because you have commercial insurance. Just ask all the people who's commercial insurance companies denied coverage or dropped them (and their family) completely because their expensive treatments would eat into that insurance company's profit margin and bonus plans.

I absolutely don't think that this can't happen to me. That's why I mentioned that it's easy for me to put myself in her shoes even though I do have private health coverage right now. I realize that insurance companies can choose to deny claims as well. I just think these decisions should be left up to patients and doctors, not bureaucrats.

barkley, I am fortunate to have very good insurance through DH's employer. We purposely picked a higher cost plan with better coverage. Fortunately, we have never had very, very expensive treatments, so I can't completely speak to them covering literally anything. However, we did pick a plan with no lifetime max and great coverage tiers.

 

[Bluestars]

We have a great private insurance. One person on our policy is currently getting treatment and she has stage IV cancer. I am so glad that the option of possible recovery was not taken away from her.

I draw the line at denying treatment because of health condition or age. The government can cut costs anywhere else, but to let someone die because it's too expensive to keep them alive when they want to keep fighting is unethical.

We have so much abuse in social services and so much overspending. They should cut benefits for the healthy before they do it for the people who need treatment to live.