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Switching insurance mid-way chemo (HMO and PPO)

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  • Switching insurance mid-way chemo (HMO and PPO)

    I have an HMO now and planning to start treatment prior to new year. Next year I have PPO plan which would consider treatment at the HMO as out-of-network. I'm paying out of pocket to meet with oncologist to preemptively try and continue my chemo at an in-network facility. Anyone have experience with this?

    I thought about purchasing double insurance (one PPO I already have bought) and buy another policy on ACA Health Exchange

    ----
    Portland, OR, USA
    31 yr , CSIa, 100% pure embryonal. 1xBEP adjuvant
    Age 31 - Portland, OR
    01NOV16- Pain in right testicle, palpable mass
    13NOV16- R I/O. Markers normal
    27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
    06DEC16 - CT scan clear
    09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
    03JAN17- Ended 1xBEP; start surveillance
    18MAR17-2nd pathology report shows 90% EC , 10% seminoma

  • #2
    If you are just getting 1xBEP, can you get it done before the end of the year? Even without switching insurance, deductibles & max out of pocket usually reset on Jan 1, so getting as much as possible out of the way before then is a plus, usually.

    Dave
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

    Comment


    • #3
      I tried to get in on time, but I will have the last Bleomyacin after the new year. Anyone have experience in changing the infusion center mid way? I am actively pursuing another doctor under a PPO plan so I can try to line up the change mid-way.
      Age 31 - Portland, OR
      01NOV16- Pain in right testicle, palpable mass
      13NOV16- R I/O. Markers normal
      27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
      06DEC16 - CT scan clear
      09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
      03JAN17- Ended 1xBEP; start surveillance
      18MAR17-2nd pathology report shows 90% EC , 10% seminoma

      Comment


      • #4
        No experience, but any center should be able to administer the bleo. It's more a logistical problem of getting that last treatment set up ahead of time so that there is no delay. Chances are you will be paying for that treatment out of pocket anyway, might be easier to just get it at the original center? The main downside is it wouldn't count towards next years deductible on the new plan.

        Dave
        Jan, 1975: Right I/O, followed by RPLND
        Dec, 2009: Left I/O, followed by 3xBEP

        Comment


        • #5
          OK. I do have insurance for next year, it's just that I would need to do it at a different place and I'd have to be put on their schedule. I'm ok with paying the deductible/OOPM, I just don't want to pay the sticker price. One thing I was thinking about is buying double insurance (one on my employer for PPO I have ) and a 2nd one via the ACA exchange for HMO.
          Age 31 - Portland, OR
          01NOV16- Pain in right testicle, palpable mass
          13NOV16- R I/O. Markers normal
          27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
          06DEC16 - CT scan clear
          09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
          03JAN17- Ended 1xBEP; start surveillance
          18MAR17-2nd pathology report shows 90% EC , 10% seminoma

          Comment


          • #6
            Any idea how much 1x bleo would cost (raw bill) ?
            Age 31 - Portland, OR
            01NOV16- Pain in right testicle, palpable mass
            13NOV16- R I/O. Markers normal
            27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
            06DEC16 - CT scan clear
            09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
            03JAN17- Ended 1xBEP; start surveillance
            18MAR17-2nd pathology report shows 90% EC , 10% seminoma

            Comment


            • #7
              I believe a single dose will cost around $500 - $600.

              You should be able to inquire at the infusion center/pharmacy for a better estimate.

              - Matt
              March 4th 2014: [AFP = 2.5; bHCG = 6; LDH = 618]
              March 13th: Left IO 100% Classic Seminoma
              6.3 x 5.1 x 3.8 cm, no invasion of anything
              LDH never fully normalized
              Stage: IS
              Watchful Waiting
              May 1st: promoted to Stage IIB with two PET active tumors in the para-aortic lymph nodes 2.5 & 2.4 cm
              May 12th: started 3xBEP
              Neupogen during Cycle 2 and 3
              July 8th: Last Bleo shot of Cycle 3 -- chemo completed !
              August 4th: Post Chemo CT/PET scan
              September 4th: Port removed
              July 8th 2017: 3 YEARS ALL CLEAR !

              Comment


              • #8
                Originally posted by mcintoda View Post
                OK. I do have insurance for next year, it's just that I would need to do it at a different place and I'd have to be put on their schedule. I'm ok with paying the deductible/OOPM, I just don't want to pay the sticker price. One thing I was thinking about is buying double insurance (one on my employer for PPO I have ) and a 2nd one via the ACA exchange for HMO.
                OK, I think you might want to jump through whatever hoops you need to then. Contact the new insurance & explain the situation. Something should be able to be worked out.

                Dave
                Jan, 1975: Right I/O, followed by RPLND
                Dec, 2009: Left I/O, followed by 3xBEP

                Comment


                • #9
                  Thanks Davepet. It seems switching infusion centers mid-way is not that big of a deal -- just need to work with them.

                  UPDATE: I switched insurance and infusion centers mid-way and it wasn't a problem.
                  Last edited by mcintoda; 02-26-17, 09:45 PM.
                  Age 31 - Portland, OR
                  01NOV16- Pain in right testicle, palpable mass
                  13NOV16- R I/O. Markers normal
                  27NOV16- Stage Ia non-seminoma, 1.3cm, 100% EC, no LVI
                  06DEC16 - CT scan clear
                  09DEC16 - Started 1xBEP. Neutropenic at day 15; Worst part for me was bleo (allergic).
                  03JAN17- Ended 1xBEP; start surveillance
                  18MAR17-2nd pathology report shows 90% EC , 10% seminoma

                  Comment

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