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Insurance getting worse - other experiences?


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#1 LivingWellWithCML

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Posted 05 July 2013 - 08:09 PM

Hey folks - just curious what others in the USA are dealing with re: insurance.  For the first two years of my CML treatment in 2011 & 2012, my employer insurance was wonderful - $20/monthly for Gleevec 400mg, and hematologist co-pays of $50 with no out-of-pocket for FISH or PCR tests.  However, I run a small company with only a few employees and our carrier forced us to change insurance plans at the beginning of 2013.  Now?  $200/month for Gleevec, and I just got a bill for $400 for my PCR/FISH test that I had back in April.  Ouch.  With Obamacare kicking in, I just got an employer letter from our carrier basically saying that it's probably going to get even worse starting in 2014.  Nothing I can do about it ... just venting.  Are others going through this, or is this just because I'm part of a small employer group plan?

I hate to even think about leaving my firm and jumping into big-company America just to get better benefits with a large group plan ... but I'm curious how CML treatment is being handled by the larger group plans now-a-days ...

Other experiences?


Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg


#2 CML2012

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Posted 05 July 2013 - 08:55 PM

Try PSI for help with copays


Diagnosed CML December 2012
Gleevec 400 mg
PCR 53%, 41%, 1.69%, 5.63% (Mutation test negative) September 2013
Sprycel 100 mg
PCR 1.1%, 0.2%, 0.2%, 0.6%, .09%, .06%, PCRU June 2015, PCRU Sept 2015, PCRU Dec 2015, 0.042% Mar 2016, 0.122% April 2016, 0.19% June 2016, 0.176% July 2016, .052% Sept 2016, .031% Nov 2016
Diagnosed Basel Skin Cancer December 2012, October 2014 (All cancer removed)
Diagnosed Melanoma April 2015 (All cancer removed)

#3 Susan61

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Posted 06 July 2013 - 11:57 AM

Hi Dan:  Its tough getting an insurance that does not leave you broke.  I have mail-order for my prescriptions, and the cost went up in 2013.  I am paying $112.00 for a 90 day supply of Gleevec.  I know people are paying much more than I am, but it still hurts when the income is low.  Our labs have been changed.  It used to be a $30.00 co-pay no matter what test you had.  Now you are billed according to what test you get.  I have to see at the end of 2013, if that balances out.  I pay $30.00 for specialist, and $15.00 for Primary.

     My bills are high due to my husbands script and mine, plus doctors etc.  I am curious to see how my insurance is handling this year.  My husband went for 2 routine exams.  The primary just decided to listen to his Carotids at this visit, and after testing he was found to have a 100% occlusion of his left carotid artery.  The following week he went for his routine Prostate Check as he has had Prostate Cancer.  A routine urine analysis which they do at every visit showed some blood.  Now he was just told on his Birthday that he has Bladder Cancer, but in remission 10years with the Prostate Cancer.

    I think it does not matter what we are paying, as long as we can afford our insurance.  I am telling people to go for routine exams, because if something is found early enough it can be treated.  My CML was found very early due to a routine 6 month exam.  So many people feel well, so they do not go to the doctor.  My husband Gary had no symptoms of either of these problems.  So he was shocked to say the least. Venting helps release a lot of tension, so anyone who wants to vent should do so.

Susan



#4 IGotCML

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Posted 07 July 2013 - 02:31 PM

I have Aetna as health insurance through my employer, which a multi-billion, international company.  I was diagnosed with CML in December and have not had any issues with Aetna regarding my CML treatment.  Tasigna costs me $70/month after I exceed my deductible.



#5 Susan61

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Posted 07 July 2013 - 05:12 PM

I have Aetna for my regular health care, but we have Medco for the Prescriptions.  I do not have to meet a deductible for Prescriptions, but I do have a $500.00 deductible for me, and $500.00 for my  husband.

It depends on what kind of plan the employers go for.  We have been switched numerous times with my  husbands employment.

I have no real issues with Aetna, but have had problems with Medco.






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