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I'm wondering if anyone out there in breast cancer land has Aetna High Deductable insurance. I'm considering switching to them in Jan. because our present plan, Anthem Blue Cross, denies my Pet scans. We have already determined that my pre-existing condition won't be a problem. So if you have Aetna High deductable and haven't had a problem with our pet scans, PLEASE let me know.
Switching insurance in the middle of a medical condition needs further investigation as many insurance companies will not cover a preexisting condition. Don't know what your situation is, however, you may want to check into disability and get coverage under the federal plan. I had a friend who was working and got a medicaid card just to cover her cancer medical expenses. Good luck.
Be concerned, and look into with great detail, their definition of "high deductible" as each company has a different definition. For some, it is on a charge-by-charge basis, so for instance, they will likely approve your PET scan, BUT (and likely because) you will pay for most of it. Other companies have an overall yearly deductible (a high one).
Honestly, I view the purpose of the high-deductible health plans to be for young, healthy individuals that don't want to pay a ton of money for their health insurance as they feel they are strong and healthy and won't need it, but just in case something happens, at least they won't be in debt for millions.
Since you have StageIV cancer, I can't imagine going to a high-deductible plan. Yes it is cheaper, but your deductibles are SO high that you will pay a lot more in the end. But then again, things have changed much since I was involved in all of that and perhaps you can share with us what this is?
Maxnan, We have done our homework on this First of all, my husband is retired from a large company, and they provide us with three choices of insurance. Whichever company we choose has to cover us, and we have been assured that a pre-existing condition wil NOT be a problem. A Patiend Advocate Foundation rep told me that also...as long as you are not without insurance for sixty days or more, they have to cover your conditon.
About the high deductible plan. My husband and I would each pay for the first $2400 dollars of our care. After that Aetna would pay 100% for anything that is covered. There are no percentages involved.
For the past several years we've had Anthem Blue Cross, and our total out of pocket with them was $4250 for both of us together, plus, this year, a $186 monthly premium as compared to a $35 premium with Aetna HD.
So I think we would definitely be better off with the Aetna, especially if they will cover the Pets. If they deny them, we have to pay, and that is not included in the $2400 deductible.
Sure is complicated! I talked to someone at Aetna about the pet scans, and he said, the doctor should write a letter outlining his plans for me in regard to the scans. He tried that with Blue Cross, and I still have to appeal everyone...three so far. We have two of them paid for. But the second required two appeals.
Susan
I have Anthem Blue Cross and they pay for PET scans every time. My doctor has to call them and tell them why he needs the PET scan. They should be paying. Keep pushing them.
Shanti,
Maybe your doctor has better people skills. Mine tried hard when they denied the first one, and they wouldn't budge. They told him Pet scans weren't approved for breast cancer! We had to appeal to get that one paid. Now my oncologist doesn't seem to want to be bothered by it. I've been filing the appeals myself by sending in the orginal letter he wrote for me with a new cover letter from me explaining the reasoning for the scan. In my opinion your doctor shouldn't have to call them. They should just pay for them unless he's ordering them very often.
I have bcbs thru work and two choices. 1) PPO plan or 2) a high deductible plan. After researching it I choose the high deductible and I have been very pleased. Each year I pay the first $3000 after that they pay 100%. I have to pay for my meds and then get reimbursed, a bit of a hassle but I get my money in about 3 weeks.
I don't pay copays at all and under the regular plan that is $50 a pop. I have CT scans and not PET but nothing has been turned down but I have not been a really high user (about 25K total last year in claims for family) as I am ned.
Thanks. I don't htink BC/BS would turn down a CT scan, but they don't like Pet scans for some reason...must be more expensive. Although here in northern WV, they run only a little over $4000. Glad to hear your high deductible plan is working well. Is that a real tatoo on your head? Cool!
No, it a water on tattoo...I wore it for a formal party with a floor length black dress.
My doc said that PET scans are hard to get approved with about any insurance. He uses CT scans and if something shows up then a PET.
I worry about the radiation from the CT scans as it is. I am having a scan every 4 months at this point. It is nice to have to worry about long term effects but it would really annoy me to live for 20 years with mets and have the radiation from the scans get me....
Sorry , I disgress... : )
I don't know specifics about AHD plan.
I was in BCBS for the first 5 yrs of treatment and they would NOT pay for PET scans. My deductibles were extremely high - $5000/yr.
I'm now in a state-run high risk pool with United, and my onc wanted a PET scan this week, but do not think they will cover this either. And the deductible for my new plan is $7500/yr!
I guess what I'm thinking here is if your deductible is only $2500/yr then that's not too bad especially considering the low premium (I pay $700/mo!), and if they will cover PET scans and cover pre-exisiting conditions, then go for it!
I wish all the insurance stuff was more transparent and more affordable...
Thanks, everyone, for your input. We did go for the Aetna High Deductible. It will go into effect Jan. 1st. By the way, we got my third Pet approved by appealing BC/BS. It's a pain to do it, but it seems they pay if you appeal.
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