Talk Cancer

Question:

I logged on to our health insurers site to look for an approved local opthalmologist where, to my amazement, a pop-up informed me that the hospital at which my wife is being treated for bc will cease to be part of their network effective November 1, 2003!  In practice this means that if we continue to go there our deductible goes from $2500 to $5000, and payments after that would be reduced from 100% to 75%.   The hospital is one of only two in the state to make it into Best Hospitals in America.  Now I understand that commercial arrangements change from time to time, but surely there should be more than a months warning.  Bad enough having to contend with the disease and with all the squabbling over who pays for what without being faced with this half-way through a course of chemo.  Suggestions anyone?

Response:

<<  Now I understand that commercial arrangements change from time to time, but surely there should be more than a months warning.   Yikes.  I wonder if you have some recourse since your wife is in the middle of her treatments.  Perhaps there would be a special exemption since she already started with them and because of that might be able to stay under there care. I don’t know too much about how one goes about it, but I think you can appeal. I also think that each state has a commissioner of insurance.  Hope that this can be positively resolved.  Take care.

Response:

Hope that this can be positively resolved.  Take care.

Thanks.  As a first step I’ve asked the hospital, who presumably have a strong interest in keeping my wife as a patient.  Even if the answer is "no" we’ll probably stick with them until the end of this course of chemo and pay up the difference.  There’s quite enough anxiety in all this without having to change horses at this stage!

Response:

I logged on to our health insurers site to look for an approved local opthalmologist where, to my amazement, a pop-up informed me that the hospital at which my wife is being treated for bc will cease to be part of their network effective November 1, 2003!   …. Suggestions anyone?

If your health insurance is provided through an employer that is a large one (large enough to have some clout with the insurer), it may be worth seeing if they can/will apply any pressure either to change the situation, or get an exception in your case. Also, though it sounds ridiculous to say this, it may be too early to go into full-bore panic.  In my state, Blue Cross has gone into showdown mode with a couple of hospitals I know of (and maybe more that I don’t).   The hospital associated with my cancer center was one of them.   First, they were going to drop the hospital as an in-network provider effective (I think it was) 12/31/02, with *much* press-release sniping on both sides about whose fault it was . . . then at literally the 11th hour, they negotiated a temporary agreement running until around June, 2003.  Before that expired, they managed to come to terms and have settled down to Play Nice for the time being.  Here’s hoping you’re equally lucky! Ann T.

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