What Can My Friend Do -- Healthcare Costs?

[momtosam]

My friend recently had a cancerous tumor removed. It was very involved and the treatment is going to be very aggressive. She is to start chemo on Monday and just found out the the chemo doctor she is seeing is considered out of network and will only be reimbursed 70%. There are no other doctors locally who can treat her because of the rarity of her case. If she goes to another hospital she starts from square one and her much needed treatment is delayed. So what on earth can she do about the medical bills. She is looking at $1000's of dollars. Thank you for any advice!

 

[minnie1928]

My father had a similar situation...he went into a rehab facility and the insurance said it was out of network and didn't want to cover the costs 100%. When I called them they said the facility wasn't in network. I pointed out that this facility is really, the only facility nearby that he could go to. They re-submitted the charge because after researching it they discovered that there was a mileage clause stating that if there were no "in-network" facilities within 20 miles that they would cover out of network facilities at the same in-network coverage rate.

Perhaps there is a similar clause for your friend?

 

[Leajess99]

If the PP's suggestion does not work (call your insurance company as they may find it in network because it is the only one available for the specific treatment) apply for Medicaid under the disability portion. They may be able to have approval but if not they again can possibly lead you in the right direction.

 

[angierae]

If the PP's suggestion does not work (call your insurance company as they may find it in network because it is the only one available for the specific treatment) apply for Medicaid under the disability portion. They may be able to have approval but if not they again can possibly lead you in the right direction.

This. There should be a social worker in the hospital that can help, too.

 

[momtosam]

Thank you for the suggestions so far. I will give my friend any advice anyone has!

 

[hambirg]

First. . .I'm sorry. Prayers and hugs for you and your friend. If she has no luck with her insurance maybe she can go to the insurance commissioner in your state. Also, if all else fails, try a benefit auction. Nobody should have to worry about money when they are fighting for their life.


Oh yeah, it doesn't hurt to get the media involved.

 

[RNMOM]

Yes, each state has a department that oversees insurance issues. My understanding here in Ohio is if there is no one is in network within 50 miles of your home they are required to cover the situation at in network costs. Remember also that once the deductable and out of pocket costs are met they should be covering at 100%. For example, we have a deductable of 500 and an out of pocket per family of 3000. Our insurance is to cover all costs above that at full. We did reach that one year. Of course it was at the end of the year so only a few prescriptions were covered in full.