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5 Things I Love About My Very Expensive Health Insurance

5 Things I Love About My Very Expensive Health Insurance

Living with Triple-Negative Breast Cancer
(#11 in a series)

Cranial Prosthesis. Prosthetic Brassiere. Prosthetic Breast. Affordable Care Act. All important words if you have breast cancer.

After a diagnosis of triple-negative breast cancer, I braced myself for health insurance hell. After all, I’d had years of experience in that hell. But there were a few surprises in store for me:

1. My individual health insurance plan was grandfathered into the new health care law. Because of the Affordable Care Act, my insurer informed me that “As of January 1, 2011, I would face “no lifetime dollar limits or maximums.”

2. My chemotherapy would be covered at 100 percent.

3. A doctor’s prescription containing the words “cranial prosthesis” meant that the purchase of a wig would go toward my deductible, or be paid if I had already met the deductible.

4. A prescription for a “prosthetic bra,” or “prosthetic breast,” meant that these costs would go toward my deductible, or be paid in full after I’d reached my deductible. I didn’t buy any, but a prescription for the post-mastectomy camisole would be covered as well.

5. To date, there have been no issues with denials of payment to providers!

As a person with a very expensive individual health insurance policy, last October’s breast cancer diagnosis was enough to choke me with fear.

I’ve had multiple sclerosis (MS) for years, and I’ve had almost nothing good to say about my health insurance. With 30-35 percent annual increases, my policy has an annual deductible of $5,000 (not for a family plan — just for me). I have a 40 percent co-pay on regular prescriptions, plus a separate $10,000 annual deductible on MS medications, in addition to doctor visit co-pays.

The $5,000 annual deductible is the highest my insurer will allow, and the only reason we have, thus far, been able to keep the monthly premium for my policy under $1,000. It is very likely that by next year, we’ll hit that $1,000 per month mark. My husband also has an individual policy. He’s fairly healthy, but in order to keep his premium under $500 a month, he also has a $5,000 deductible. All told, that’s a mountain of out-of-pocket expenses every year before benefits kick in.

When dealing with general health and multiple sclerosis, we did our best to avoid visiting doctors or having tests, but the financial burden was a great.

When that cancerous lump made its appearance, I was more afraid of my insurance company than I was of the cancer. The surprising news is that, so far at least, things between me and my insurer are fairly stress-free when it comes to cancer-related treatment.

Don’t get me wrong … I’m still scared. Next year’s rates won’t be pretty, and the Affordable Care Act is not going to offer me much help in that department. I still think it’s likely I will become uninsured at some point. I’ll have to remain uninsured for a long six months before becoming eligible for the new federal high-risk pools put in place to bridge the gap to 2014, when full reforms kick in.

For a cancer survivor, that is a very, very bad scenario. Health care reform is still a very real issue for tens of millions of uninsured and under-insured Americans.

Meanwhile, I’m keeping track of cancer-related expenses. I’m tallying the total cost charged by providers, our out-of-pocket expenses, and what the insurer actually pays after discounts. It’s a real eye-opener, and I’ll report on that in a future post.

Living with Triple-Negative Breast Cancer Series
#1 The Lump in my Breast: Meeting the Enemy
#2 Most Breast Lumps are Non-Cancerous: Would mine be?
#3 The Mammogram, the Ultrasound, and ‘the Look’
#4 The Biopsy and Breast Cancer Confirmation
#5 A New Twist: It’s Triple-Negative Breast Cancer
#6 Before the Mastectomy: Planning for the Future
#7 Mastectomy Day: What it’s like to lose a breast
#8 After the Mastectomy: Unveiling and Staging
#9 10 Odd Things to Say to Someone with Breast Cancer
#10 Cancer Battle Plan Phase 2: Chemotherapy,

Access the up-to-date Living with Triple-Negative Breast Cancer Series

Breast Cancer in the News
Aggressive Breast Cancer Linked to Low Levels of Vitamin D

Take Action! Sign the petition: We can end breast cancer by 2020

Author’s Note: This is article is part of a series chronicling my first-hand patient perspective of life with Triple-Negative Breast Cancer. Without being overly self-indulgent, I hope to convey the raw emotion that comes with such a diagnosis … and the process of living with and beyond it. Entries will appear in Care2 Causes and in Care2 Healthy & Green Living. Follow on Twitter @AnnPietrangelo

For More Information:
Triple Negative Breast Cancer Foundation
American Cancer Society
BreastCancer.org

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Image: iStockPhoto.com


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31 comments

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5:46AM PDT on May 1, 2014

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1:12AM PDT on Apr 9, 2014

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11:10PM PST on Jan 19, 2014

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8:41AM PDT on May 21, 2011

Your insurance is outrageous and so is the deductible. People who has disease are treated horrible. Insurnce companies should not be getting away with charging you like that and that deductible. It is the rich taken away from the poor and will continue with the new health reform. The new health reform is a scam for the insurance companies. Nobody should be forced to by insurance when our congress etc get free insurance. Nobody should be paying for medical care, we all should have it free! We pay too much in taxes to be taken for a ride by our president! They can take that reform and stick it where the sun don't shine. what you read about in the papers about it will be the totally opp when it comes down to it.

We all should have free insurance for medical, dential etc. We pay taxes out the ass why should we make them billionaires.

7:58AM PDT on May 21, 2011

The health care system in the United States needs to be completely overhauled. Until the patient's health becomes a priority, insurance and pharmaceutical companies will continue to bleed us dry. No pun intended...

7:29PM PDT on May 18, 2011

The health care system is never affordable, and rarely is it fair.

3:34PM PDT on May 18, 2011

Glad for you! But there are so many people who would not be as fortunate as you have been to even afford the type of insurance that you have!

2:13AM PDT on May 12, 2011

From another Canadian - you are right, Brian P. My mother went through 4 types of cancer in BC and my brother once in Manitoba. The only complaint I had is that home care for the palliative in BC is not covered for the length of time it should be. Recommend you don't smoke whatever country you live in, however!

6:13PM PDT on May 11, 2011

My health insurance sucks, but it's expensive too!

1:46PM PDT on May 11, 2011

What's ridiculous is what the hospital or doctor' charges in comparison to what the insurance actually pays and it's considered paid in full. Usually (good) insurance pays ~10% of the actual charge and it's considered paid. So if the hospital bill is $40,000 the insurance pays $3,200, you pay your 20% (in this case) of $800 and the bill is considered paid in full. Why wasn't the charge only $4,000 in the first place? But if you don’t have insurance you are billed $40,000, it’s a racket.

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