Tag Archives: Health Insurance

Us Health Care Costs

If you’ve read much of my blog you will know that I am from England where health care is free at the point of delivery, it is not free, people pay a tax so that when they really need health care they don’t have to decide whether or not to see a doctor and lose their house in fees or to accept that they will die earlier than they would if they could afford medical care. You will also know that when I got diagnosed with Hodgkin’s Lymphoma I was completely baffled by the US health insurance system with people talking about co-pays, deductibles, in-scheme and all sorts of other words and phrases I’d just never come across. Without my wife doing everything for me I couldn’t have navigated my way through the maze because, along the way I discovered that there were several billing mistakes which had to be rectified, and, wouldn’t you just know it, none of them were in our favor.

This week I got another shock from the industry known as U.S. medicine and health care. I saw my surgeon for a pre-op meeting so that he could ask how long I’d had my port in my body, prod it a couple of times, speak to the two trainee doctors who trailed around after him and then shake my hand. At the maximum he spent 8 minutes with me; his receptionist somewhat less and I’d already seen the guy who arranged the surgical appointment. I’d payed my co-pay when I was in his office and then, this week, I received an invoice for $485.00, the remainder of his fee after deduction of my $50.00 co-pay. The letter did threaten that “If this matter is not resolved in a timely manner, serious collection activity may be initiated:. Naturally I spoke to my insurance company but I ended up passing the phone to my wife as I couldn’t make head nor tale of what the insurance company wanted to know let alone what it had done simply because none of the figures they were giving matched with the ones I knew of. It turned out that the reason none of the figures matched was because the deal between my insurance company and my surgeon means that instead of receiving $485.00 from me he actually received just $90.00 from my insurer, that’s right, a reduction of $395.00!!! I find that amazing. Either he’s now working for next to nothing or his office has bloated the fee to a standard which is acceptable here in the U.S. To some extent it doesn’t affect me as I have insurance, but, if I didn’t have that insurance, I’d now owe nearly $500.00 when the physician group would have settled for less than $100.00. It seems reasonably obvious that one of the two main groups which don’t have medical insurance are the poor and unemployed and yet it would seem that they are likely to get hit with a bill almost 500% larger than the bill paid by an insurer. Yes, the U.S. clearly wants to take care of the poor and impoverished who have turned up on its shores.

I read and hear a lot about Obama care, and while I think it is better than nothing, it doesn’t go far enough. The U.S. needs to stop worrying about socialism in medicine, about government interference in making people take out medical insurance, it should, in my opinion, and I realize that I am only a guest here, move towards a system such as that in the UK, where people are taxed to pay for health care, surely the government can’t object to taxing its citizens can it?


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Filed under Cancer, Health Insurance

The US Health Insurance Arrangements Suck

Those of you who read my previous blog will know that by now I should have had my chemotherapy port removed. Those of you who are astute readers may now be inferring that I still have it firmly in place and that this is so because of health insurance. My astute readers, you are correct.

From coming to the US the entire health insurance set up has been as clear to me as London smog. Co-pays, deductibles and so on were notions which were so alien to me coming from England with the NHS to which we all contribute and which is free at point of service. I always thought that to be a great scheme and think it an even better one now that I have experienced the US system. Since arriving in the US I have been on my wife’s health insurance, for which she pays a small fortune because, obviously, if I claim under it she is still working so the health policy won’t lapse, whereas if she claims under it for anything serious there is every chance that she might not be able to continue working and the policy would lapse thereby meaning that the insurance company’s responsibilities would be terminated and liability limited. In September I completed application forms for insurance through my employer and subsequently discovered that my insurance had been backdated which meant that we were not able to cancel the insurance I had under my wife’s policy as they require 3 months notice to cancel or some such. This has meant that I have had double insurance.

When I went to the outpatient center for my port removing this became a problem as the Center told us that they couldn’t accept the insurance under my wife because that wasn’t my primary insurance and we couldn’t use my own insurance because the doctor wasn’t on my insurance. The consequence is that the surgery was cancelled, I still have my port and now we are concerned in case this revelation means that the insurance we had used will now be cancelled retrospectively and we will be billed for the cost of things such as my CT scan.

American health care is good, the NHS is good, the difference is that people in the UK don’t have to sorry about how they will pay for health care when they are ill, neither do they have to spend hours worrying about which policy to select by trying to predict a year in advance just what health care they might need in order to find a policy which will cover them if that happens without having to pay out a large proportion of their income to cover events which they consider to be unlikely.

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“I don’t think it’s the cancer I’m feeling.”

Those were the words of my oncologist Dr Taché yesterday before the start of my third cycle of chemotherapy. The suggestion is that, perhaps, what Dr Taché was able to feel, is the healing of the incision from my biopsy. It’s difficult not to get excited about the possibility that maybe, just maybe, the Hodgkin’s Lymphoma has been killed but the reality is we don’t know, and as Dr Taché was quick to point out we need scans to know what is going on. I suppose the lymphoma could have shrunk and be hiding beneath, or perhaps even within the biopsy healing, so at the moment I’m working hard at containing my excitement as I would prefer continuing darkness to a false dawn at this stage.

In the run up to yesterday’s appointment I’d been experiencing both daytime cold sweats and night sweats for the previous four or five nights, both of which I associate with the onset of the cancer and its development from Stage 2 to Stage 2B. In addition I’ve had sore throats and tightness in my chest, coughing when breathing deeply or encountering cooler/moist air. I’ve also been feeling shaky several times a day, and from time I’ve been getting hand tremors: it’s this last which I’ve had most difficulty in accepting with any degree of calmness. So to find that maybe, just maybe, the lymphoma has gone may be a great relief, but only if it actually has. Anyway Dr Taché’s office is now involved in the usual discussions with our health insurance provider to get approval for the scans, and so there’s the tension of will they approve them or won’t they? Clearly time is of the essence as I need to have these scans done and the results evaluated and back with Dr Tache within a fortnight and I know that the last time we went through this it was touch and go. Of the scans the most important is probably the one which will reveal any damage to my lungs from the bleomycin as there is the possibility that the cough etc are the result of damage from that drug. If there is excessive damage then the bleomycin will be dropped from any future treatment – hence the need to get the results before the next infusion. It won’t be replaced by any other drug. The protocol says to just carry on with whatever other drugs are being used so that will be AVD instead of ABVD.

How do I feel about all this? On one level I’m trying very hard not to feel anything in case it turns out that although the lymphoma has shrunk it is still there in hiding, or that the sweats indicate that it has metastasized and we should be looking somewhere else, in which case the treatment may not be working and we might have to change treatment which I think would be a huge blow to my moral. On another level I am desperate for good news. I know that the infusion before this one has caused me to react more strongly than any of the previous ones and I therefore want to believe that it is kicking the lymphoma as hard as it possibly can, but, another part of me thinks that maybe, just maybe, the lymphoma is fighting back and causing the effects rather than them being side-effects of the chemo. I don’t know what to think really. Maybe I’m like a young child on Christmas Eve, knowing I’ve been good all year and hoping that I’ll get that brand new shiny bike from Father Christmas but aware that it costs a lot of money and that not all little boys can get everything they really, really, really want just because it is Christmas.

Fingers crossed!


Filed under ABVD, Cancer, cancer staging, chemo, chemotherapy, Dr Jason Tache, Health Insurance, Hodgkins Lymphoma

NHS V Private Health Care

I’m English so I’ve been able to rely on the NHS, which, much to the surprise of many Americans I have spoken to is “free at point of service”. This doesn’t mean we get it for nothing, oh no, no, no. We pay a National Insurance contribution from our wages which means that when we need a doctor we go and see one or alternatively the doctor comes to us. It means that when we need a hospital we go to one. It means our medication and drugs and scans and tests and a whole battery of other things are paid for already because of our National Insurance contribution. It also means the unemployed are covered to the same level as everyone else

Over here, in the US, it is different. If you work for a good employer you may have an excellent health insurance package. A less good employer and a less good package and so on, but many people have no medical insurance at all and this causes fear. Even people with insurance policies are terrified of losing their home because of the size of the bills which very rapidly mount up. If you are too ill to work then you’ll lose your insurance through your employer just when you need it.

In England the parties are coming together to fight the proposed changes to the NHS, and with good cause too I think. For those of my friends in the UK who are in any doubt whether the NHS should be kept or privatised please read this blog by the wife of a cancer patient who, with colleagues, left his job as a matter of principal. For those of you who may not read it I’ve copied the horrifying bit below:

“He’s going to die from this, all because he quit his job almost 5 years ago. If he hadn’t walked out, he’d have insurance. He could have seen a doctor when he noticed something wrong. He wouldn’t be going to die.”

Please read the comment from nadeaucaron which explains just why her husband finds himself in this position.


Filed under Cancer, Health Insurance, NHS

If this had been happening a year ago.

Something made me think, last night, about how different this entire cancer experience would have been had it happened twelve months ago.

A year ago I was living in England with my mother who was, and still is, suffering from both Alzheimer’s Disease and Dementia while sustaining a very long distance relationship with my fiancee in Florida. A year ago the process had been started for assessments to be made of Mum which would, ultimately, lead to her being placed in full-time residential care. I was working at a job which I didn’t find particularly satisfying, which, in winter, meant leaving the house before dawn and returning after dark. The pay was poor (though in line with other companies) and I did the job basically because it was undemanding, as I had little energy left to do anything after long sequences of broken nights and energy sapping arguments with Mum, who was clearly slipping into the other world of dementia.

Had the cancer been identified at that point in my life then I would have found myself having to deal with it in a very different way to the way I can now. Now, I can rely upon my wife, had I been living with Mum then she, my mum, would have been relying on me and there would have been no way of getting her to understand and remember anything about the cancer. Perhaps the situation would have speeded up the reporting and evaluation process needed for Mum to go into care but these things seem to have a life-cycle all of their own, and I can’t say that I have any belief that things would have progressed more quickly on that front.

From what I understand, the treatment for Hodgkin’s Lymphoma is pretty standard, which, I presume, means I would have been prescribed the same course of drugs and infusions in the UK as in the US. One of the instructions which goes with that treatment is that I shouldn’t mix with groups of people, e.g. in a theatre, as the chemotherapy drugs will suppress my immune system. So, it’s very doubtful that I would have been able to continue working, particularly as my journey to work involved a peak time commuter train in both directions as well as a tram ride. Then there would have been the difficulties of working with groups of people, shift rotations of staff and an appreciable number of visitors to the site as well. It seems pretty obvious that I would have had to leave the job as being, physically, not capable of doing it. This would have left me without an income. Mum going into full time care would have left me without a home, so I would have had neither home nor job. Not a great prospect!

I am sure my daughters would have given me all the support, both physically and emotionally, which they could, but they each have their own lives to lead and family commitments to meet, as well as working themselves.

Instead of all the above problems I’m being looked after by my wife who is the one who goes to work and is making no real demands upon me other than that I put my energies into recovering as quickly as I can.

The only downside is that in the UK my treatment would have been free under the NHS, whereas here, in the US, we have to pay for every visit and every treatment.

It may seem strange to say it, but, I think I am a very lucky man for a number of reasons:

  • I have Hodgkin’s Lymphoma which, statistically, is unlikely to kill me;
  • I have a home and the love of a really good woman;
  • I have the love and support of my daughters;
  • I have the support of friends;
  • My wife’s job includes health care which minimises the costs borne by us though they are still substantial.

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Filed under Alzheimers, Alzheimers Disease, Cancer, chemo, chemotherapy, Dementia, Health Insurance, Hodgkins Lymphoma, NHS

Another change in diagnosis!!

Well the results of the second opinion by Dr Jaffe of NIH Maryland were back with my oncologist Dr Jason Tache today when my wife and I arrived for my first chemotherapy infusion. Dr Jaffe’s opinion is that the cells previously identified as +20 are actually -20, which meant that my oncologist, Dr Jason Tache, decided not to include the Rituxan in my personalised cocktail of chemotherapy drugs aimed at killing this cancer as quickly as possible. The diagnosis is now Lymphocite Rich Calssic Hodgkins Lymphoma, so I’ve gone from having a rare cancer to having the second most common – I suppose that’s good news – well probably. The less good news is that I’m now classed as stage 2B lymphoma rather than 2A. From what I’ve read and been told this isn’t really likely to make any difference to my treatment or recovery. The significance of the change of diagnosis to Lymphocite Rich Classic Hodgkins is that Rituxan wouldn’t make a proven improvement to the chemo cocktail but would have side effects, so, the logic goes, why impose potential side effects when there is unlikely to be any gain? This position means that Dr Tache could not, in conscience, use the insurer’s approval for eight treatments at a cost of around $8,000, and presumably thought that if he were to do the professional thing and notify the insurer of the change of diagnosis, then the insurer would cancel the authorisation. Do I trust Dr Tache’s diagnosis? Yes, absolutely, he strikes me as a very knowledgable and professional man. That level of trust was supported by the comment of one of the nurses that the doctors at this particular centre are world class. That’s certainly good enough for me!!

So, the chemotherapy itself went well. The nurse who worked with me was Lisa Doyle-Frank and I cannot commend her enough. She was friendly, supportive, professional, available and informative. Lisa was there the second that I showed any sign of needing her and very willing to leave paperwork to come and support me. Lisa was also really good at giving my wife information. Not to leave out the other nurses in the chemo room, I just don’t know their names – they were all very friendly to me and the other patients who pass through the room on their way to good health. There is a feeling of professional enthusiasm and good humour in the room which was tangible from the moment I walked in, and believe me, that atmosphere feels very good and is very, very reassuring. The relationships between patients and nursing staff were obviously excellent and I felt very secure.

Lisa approved of the quality of work performed by Dr Todd Schwartz, the interventional radiologist who implanted my “port” that comment was also very reassuring! After watching Not as I Pictured: Lymphoma and hearing the comments of John Kaplan about how painful the hook was as it was pushed through his skin and into his port, I was expecting the worst, but it wasn’t at all bad. Yes, I felt Lisa push it in, but I have to say I’ve had more discomfort from IVs pushed into a vein. Lisa started off by giving me a sedative just to relax me and boy did it work! All I wanted to do was sit back, close my eyes, and bring on the rest of the treatment! I wasn’t out of it by any means and I was able to join in the conversation when I wanted to, but I was very, very, very relaxed. After that came a test sample of bleomycin, just to make sure that there was no reaction. After the rest of the drugs were administered through the drip into port there had been no evident reaction and so Lisa gave me the rest of the bleomycin dose. After that we were done, a quick chat with Dr Tache to let him know that my wife had spoken with the insurer today and they had confirmed approval of the Rituxan should he at any time change his mind and decide it should be incorporated, and we were done. The advice from Dr Tache was to eat soup just in case I should suffer nausea. The advice of my wife’s pediatrican friend Henry, who has survived cancer himself, was that I should avoid eating my favourite soup! No, I don’t want to explain why he gave that particular advice!!! Anyway we decided that, before my immune system gets suppressed, we would have one last meal out so it was soup for me at Denny’s, and very enjoyable it was. During the “meal” I wasn’t sure whether or not I felt nauseous because of the chemo or because my stomach was empty after not having eaten for around 10 hours. Happily it turned out to be the latter and, so far, I’ve not been nauseous. Lisa thinks there is a good chance that I will not be nauseous at all and I want to believe Lisa is correct! Actually Lisa did say that it is often the second day after treatment that nausea hits but another lady in the chemo room said that it’s usually Saturday when she feels nauseous after a Tuesday infusion, so, I guess, it’s just a case of wait and see and hope the anti-nausea pills I have for the next three days will work and I won’t need to start using the back-up pills for the week afterwards.

Anyway it’s been a long day and midnight has just slid past while I write this, so I really ought to take the first of my pills, which may make me drowsy, and take myself of to bed – to dream perhaps!

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Filed under anti-nausea, Cancer, cancer stage, cancer staging, chemo, chemotherapy, Dr Elaine Jaffe, Dr Jason Tache, Dr Todd Schwartz, Dreams, Health Insurance, Hodgkins Lymphoma, John Kaplan, Lisa Doyle-Frank, Not as I pictured

I Will Get Rituxan

Today’s task was to track down the person who would be making a decision about whether or not I am to receive rituxan. It sounds a simple task doesn’t it? Mmmm I thought it would be too but, I’ve been wrong before and I’m sure I will be again. My first problem was in navigating the menu with Cygna. It seems my ID doesn’t include the last two digits, but, of course I didn’t know that so it took several attempts to get through to a real person. Eventually I was put through to one lady who clearly failed to grasp what I was telling her – a request for an off-list drug, rituxan has been made by my oncologist, it won’t show on your system because the request is, or at least was, being evaluated, so can you transfer me to the people who will be making that decision please? No, that’s no good apparently. It seems that the system works if I have a battery of numbers which the doctor’s office provides to Cygna and without which the lady to whom I was speaking couldn’t help me, though she did tell me she would try to connect me with someone who could and then put me on hold. When she hadn’t come back to me after around 20 minutes I did the obvious thing and rang off, after all, she had my phone number so she could call me back, right? Wrong! No return phone call. I then phoned the doctor’s office where Sheena was able to tell me that they still hadn’t had approval and the request was still with “clinical review”. These two words were clearly magical and could convey in an instant the department to which I needed to speak – eternal optimist me!

So, armed with the phrase, “clinical review”, I called Cygna back but this time took a different menu option and spoke with Tammy (Tammi?) who was really helpful, understood what I was saying, what I wanted, and set out to put me through to the person I needed. Really helpfully, Tammy kept coming back to me to let me know that she was still there and still trying to help. (The downside is that the beeps I kept hearing on the phone and which I thought were Tammy trying other phones turned out to be my stepdaughter calling, but I didn’t find that out for a few hours!) Eventually Tammy was able to transfer me to Brandy who grasped things really quickly, knew that she wasn’t the correct person for me to speak to as I needed the “injectible department” (I kid you not), and transferred me to Angelina who was the correct person to talk to and who was able to resolve things for me very quickly by liaising with someone and asking me a couple of simple questions i.e. is this a new treatment or a continuation and is the treatment at a hospital or the doctor’s office? Such simple questions that you might have thought the paperwork would have covered them, but, clearly not. Anyway, armed with my two answers, Angelina was able to complete the liaison and came back after only a few minutes to tell me that the request had been approved for eight treatments and confirmation would be faxed to my doctor for me for Monday. Like my wife, I can’t help but wonder whether this would have happened had I not phoned. Anyway, thank you, Tammy, Brandy and Angelina – you really were very friendly and helpful.

That apart things seem to be going ok. I’ve had a couple of nights of good sleep without the night sweats and I feel much less tired which is great.

Last night my wife and I watched a documentary “Not as I Pictured: Lymphoma” a film by John Kaplan who is an award winning photographer. The film tells the story of John’s own journey and is very, very involving. There were quite a few things in it which struck home to me, but one of them jumped out today when I accidentally touched “my triangular lump” which John said he was reluctant to do. I think I can understand why – it just doesn’t feel natural! Well, obviously, you might think, but the skin just doesn’t feel natural over it either. The other things he said about the port were that although the doctor gives some cream to numb it there is still pain when what he described as “a meat hook” is pushed through the skin and into the port. Mmmm, now there’s something for me to look forward to on Tuesday!

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Filed under Cancer, chemotherapy, Health Insurance, Hodgkins Lymphoma, John Kaplan, Not as I pictured