Two questions.. Insurance.... and Amiloride clinical trial..

JennifersHope

New member
I have two questions...

First is anyone doing the amiloride study...I was told it is in clincal trial 1.. Patient saftey just established It is for ppl with Mild forms of CF..... My CF nurse was telling me about it... but then I was disqualifed for the study because I have a cardiac history........I am bummed.. I keep getting bumped out of all these studies... IF you are doing it.. I was wondering how it was going????

Second

UGGGGGGGGGGGG

I just got a letter from my insurance company telling me that they will only pay for 80 PERCENT OF MY home infusions plus I Have a THREE THOUSAND dollar deductable....They said they only will pay one hundered percent if I am in the hospital..... and that if I want to go home and I still need IVS I have to go to their outpatient infusion center for the infusion....

In Septemeber when I was on home IVS I did an IV infusion every three hours for over two weeks... This last time, I did one every eight hours.. for two weeks... I can't afford the three thousand dollars.. or the 20 percent.. I don't have to tell you how expensive even twenty percent of Vanco or Fortaz is.. much less paying for the nurse to come to the house.. I am in debt.,. PLus I am at least a good hour away from the hospital to begin with..by the time I got home I would have to turn around and come back.. to get another infusion

My question is, I am a health care worker and my insurance is considered one of the best or so I thought, I have blue cross blue shield PPO, How do you guys afford HOME IVS????

I think He LL will literally have froze over before I can spend two full weeks in the hospital every few months.. They will have to put me in coma, with a drip of the stongest sedative they can find before I could do it... EVen going in for one week every few months is a lot for me to take.. forget going in with no hope of Parole...

So what do you guys do..

Thanks so much..

Jennifer
 

JennifersHope

New member
I have two questions...

First is anyone doing the amiloride study...I was told it is in clincal trial 1.. Patient saftey just established It is for ppl with Mild forms of CF..... My CF nurse was telling me about it... but then I was disqualifed for the study because I have a cardiac history........I am bummed.. I keep getting bumped out of all these studies... IF you are doing it.. I was wondering how it was going????

Second

UGGGGGGGGGGGG

I just got a letter from my insurance company telling me that they will only pay for 80 PERCENT OF MY home infusions plus I Have a THREE THOUSAND dollar deductable....They said they only will pay one hundered percent if I am in the hospital..... and that if I want to go home and I still need IVS I have to go to their outpatient infusion center for the infusion....

In Septemeber when I was on home IVS I did an IV infusion every three hours for over two weeks... This last time, I did one every eight hours.. for two weeks... I can't afford the three thousand dollars.. or the 20 percent.. I don't have to tell you how expensive even twenty percent of Vanco or Fortaz is.. much less paying for the nurse to come to the house.. I am in debt.,. PLus I am at least a good hour away from the hospital to begin with..by the time I got home I would have to turn around and come back.. to get another infusion

My question is, I am a health care worker and my insurance is considered one of the best or so I thought, I have blue cross blue shield PPO, How do you guys afford HOME IVS????

I think He LL will literally have froze over before I can spend two full weeks in the hospital every few months.. They will have to put me in coma, with a drip of the stongest sedative they can find before I could do it... EVen going in for one week every few months is a lot for me to take.. forget going in with no hope of Parole...

So what do you guys do..

Thanks so much..

Jennifer
 

shinkdew

New member
My insurance company pays 100% of IVs at home. I have Cigna Open Access, I actually think they prefer me to do them at home, it's a lot cheaper for them. That sucks you have to pay that much. You should try calling them and telling them it's much cheaper for them if you do them at home.
 

shinkdew

New member
My insurance company pays 100% of IVs at home. I have Cigna Open Access, I actually think they prefer me to do them at home, it's a lot cheaper for them. That sucks you have to pay that much. You should try calling them and telling them it's much cheaper for them if you do them at home.
 

anonymous

New member
The only time my insurance questioned paying for the home IVs my doctor simply picked up the phone and asked them whether they wanted to pay for the IVs in the hospital or at home, and diplomatically pointed out that it would be much cheaper for them to opt for the at home choice. He made it very clear that denying hospitalization was NOT an option if they refused to pay for home health, and he would go to the top to ensure that my care was paid for. Within five minutes the home health option was approved. It is so important to have a doctor who will fight tooth and nail for you and is not intimidated by the insurers. It is a no-brainer that it is cheaper to do it at home. For a two week course of antibiotics, I get a PICC, and the home health nurse only comes out once at the beginning, a week later to change the dressing, and to pull the PICC. I do all the infusions myself. It is incredibly simple.
 

anonymous

New member
The only time my insurance questioned paying for the home IVs my doctor simply picked up the phone and asked them whether they wanted to pay for the IVs in the hospital or at home, and diplomatically pointed out that it would be much cheaper for them to opt for the at home choice. He made it very clear that denying hospitalization was NOT an option if they refused to pay for home health, and he would go to the top to ensure that my care was paid for. Within five minutes the home health option was approved. It is so important to have a doctor who will fight tooth and nail for you and is not intimidated by the insurers. It is a no-brainer that it is cheaper to do it at home. For a two week course of antibiotics, I get a PICC, and the home health nurse only comes out once at the beginning, a week later to change the dressing, and to pull the PICC. I do all the infusions myself. It is incredibly simple.
 

julie

New member
Jen, way out there thought but my life is forcing me to think out of the box lately... What about another nursing student coming and starting your IV's? Some people afford it because they have family members do their IV's. Have you considered those options (not even sure if they woudl work for you)???

Is there any way that you can qualify for medicaid based on income and health? I know you are a student, but that should not disqualify you. At least they could potentially pick up that deductible.
 

julie

New member
Jen, way out there thought but my life is forcing me to think out of the box lately... What about another nursing student coming and starting your IV's? Some people afford it because they have family members do their IV's. Have you considered those options (not even sure if they woudl work for you)???

Is there any way that you can qualify for medicaid based on income and health? I know you are a student, but that should not disqualify you. At least they could potentially pick up that deductible.
 

JennifersHope

New member
Hi

I do all my own Infusions.. Always.. I get up and do them myself....and set the alarm.. but the policy of the home service I use is the nurse comes out the night I get out they do an evaluation... because of the MRSA history... everything I get I end up keeping.. IV poles... Blood pressure stuff etc.. and they send new stuff each time.. The policy is the nurse comes out for subsequent visits as well.. Sometimes I have litteraly raced home from school to meet the nurse..

This past time, My work has done my dressing changes.. I tried and didn't do so well with one hand...My boss really takes care of me.. or one of the other nurses.. I just go there and they do whatever.. I am really blessed....(though without a doubt my next job will not know about my CF it does have its benefits)

But I still get charged... for all the supplies.. gloves, flushes, meds, saline, needles etc, I get charged two hundred dollars for a sharp container I don't even use...

Anyway.......my Cf team would without a doubt go to the end of the world for me.. and fight tooth and nail..I am going to have to try really hard to figure something out.. work out a deal with them.. beg them.. appeal what ever..but right now I can't.. I am conserving all my energy .. I am very close to being burnt out.. and I have to remove stress.. My blood pressure is very high right now, and also with Addison's stress is the worst thing.. Today someone asked me who my teacher was for nursing three, which was just last semester, and I couldn't remember who my teacher was or where my clinical was.. and it was at my OWN WORK...I am told this is a side effect of the steroids that will go away.. but really quite frustrating right now...

Anyway, all that to say, I will start the battle with my insurance company in a few days....I will at least get copies of the policy, and start the appeals process...


Thanks
Jennifer
 

JennifersHope

New member
Hi

I do all my own Infusions.. Always.. I get up and do them myself....and set the alarm.. but the policy of the home service I use is the nurse comes out the night I get out they do an evaluation... because of the MRSA history... everything I get I end up keeping.. IV poles... Blood pressure stuff etc.. and they send new stuff each time.. The policy is the nurse comes out for subsequent visits as well.. Sometimes I have litteraly raced home from school to meet the nurse..

This past time, My work has done my dressing changes.. I tried and didn't do so well with one hand...My boss really takes care of me.. or one of the other nurses.. I just go there and they do whatever.. I am really blessed....(though without a doubt my next job will not know about my CF it does have its benefits)

But I still get charged... for all the supplies.. gloves, flushes, meds, saline, needles etc, I get charged two hundred dollars for a sharp container I don't even use...

Anyway.......my Cf team would without a doubt go to the end of the world for me.. and fight tooth and nail..I am going to have to try really hard to figure something out.. work out a deal with them.. beg them.. appeal what ever..but right now I can't.. I am conserving all my energy .. I am very close to being burnt out.. and I have to remove stress.. My blood pressure is very high right now, and also with Addison's stress is the worst thing.. Today someone asked me who my teacher was for nursing three, which was just last semester, and I couldn't remember who my teacher was or where my clinical was.. and it was at my OWN WORK...I am told this is a side effect of the steroids that will go away.. but really quite frustrating right now...

Anyway, all that to say, I will start the battle with my insurance company in a few days....I will at least get copies of the policy, and start the appeals process...


Thanks
Jennifer
 

ReneeP

New member
Jennifer,

I'm sorry you're having so much trouble with your insurance company. I know first hand they can be a pain. I don't know if I can be of help to you, but I would certainly be willing to try. I worked for Blue Cross Blue Shield of MN for several years and did learn a great deal about loopholes and what can and cannot be negotiated. The thing is that BY FAR THE MAJORITY of plans are actually written by the employer you have rather than Blue Cross Blue Shield, therefore 10 people with BCBS insurance will have 10 totally different policies...however, there are ways of getting around certain things. One thing that strikes me with your story is the $3000.00 deductible. I won't say it's unheard of, but it's awfully high. It sounds like an "out of network" deductible to me. It's very unusual to have an in network deductible be that high. If that's the case, there are ways around that. Anyway, if you would like me to try to help you, feel free to e-mail me. I have many friends who still work at BCBS and can maybe give me some advice if there are things I have forgotten. I'd certainly be willing to try for you. I have had enough problems with insurance companies myself in dealing with my daughters. I know how frustrating they are and I thank God for my years at BCBS and the learning experience it was for me in caring for my them.

My e-mail address is lindareneelyons@hotmail.com if you want to e-mail me.

Best of luck to you.
 

ReneeP

New member
Jennifer,

I'm sorry you're having so much trouble with your insurance company. I know first hand they can be a pain. I don't know if I can be of help to you, but I would certainly be willing to try. I worked for Blue Cross Blue Shield of MN for several years and did learn a great deal about loopholes and what can and cannot be negotiated. The thing is that BY FAR THE MAJORITY of plans are actually written by the employer you have rather than Blue Cross Blue Shield, therefore 10 people with BCBS insurance will have 10 totally different policies...however, there are ways of getting around certain things. One thing that strikes me with your story is the $3000.00 deductible. I won't say it's unheard of, but it's awfully high. It sounds like an "out of network" deductible to me. It's very unusual to have an in network deductible be that high. If that's the case, there are ways around that. Anyway, if you would like me to try to help you, feel free to e-mail me. I have many friends who still work at BCBS and can maybe give me some advice if there are things I have forgotten. I'd certainly be willing to try for you. I have had enough problems with insurance companies myself in dealing with my daughters. I know how frustrating they are and I thank God for my years at BCBS and the learning experience it was for me in caring for my them.

My e-mail address is lindareneelyons@hotmail.com if you want to e-mail me.

Best of luck to you.
 

JennifersHope

New member
Thanks I will email you.. I am not out of network totally .. It is a new thing.. a Tier 2.. out or Tier 1-3.. ?? What ever that means..


THANK YOU SO MUCH FOR BEING WILLING TO HELP ME... I WILL EMAIL YOU TOMORROW..


Jennifer
 

JennifersHope

New member
Thanks I will email you.. I am not out of network totally .. It is a new thing.. a Tier 2.. out or Tier 1-3.. ?? What ever that means..


THANK YOU SO MUCH FOR BEING WILLING TO HELP ME... I WILL EMAIL YOU TOMORROW..


Jennifer
 
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