ACA stopping my daughter's chemo-therapy...why?

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Posted 10/2/2012 by pleidesexpress in NSBR Board
 

pleidesexpress
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Posted: 10/2/2012 11:02:00 AM
My daughter has been receiving chemo treatments for 35 months. Now her doctor tells her Obama Care will no longer allow him and the hospital to treat her without she and husband pay cash.

scorPEAo
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Posted: 10/2/2012 11:18:36 AM
I have a hard time believing this.



GIPfunny

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Posted: 10/2/2012 11:23:47 AM
Interesting first post. What brought you to two peas?






IPeaFreely
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Posted: 10/2/2012 11:37:26 AM
Confusing. How are you paying now?

JenAllyson
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Posted: 10/2/2012 11:42:32 AM
35 months of chemo?! maybe they stopped because they didn't want to poison her to death.


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Posted: 10/2/2012 11:43:14 AM
1 month shy of THREE YEARS of chemo? That sounds a bit excessive.



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Posted: 10/2/2012 11:44:53 AM
Yeah, not buying it one bit.

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Posted: 10/2/2012 11:44:58 AM
ACA or no ACA, 35 months seems excessive.

I think it spells TROLL


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Posted: 10/2/2012 11:45:12 AM
this being your first post and the bad grammar makes me think you're a spammer/troll




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Posted: 10/2/2012 11:46:33 AM
Hm. Did the doctor say which part of the ACA requires your daughter to pay cash for her treatment?



**Angie**
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Posted: 10/2/2012 11:57:00 AM
Per the Pea rules:


pleidesexpress
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Posted: 10/2/2012 12:02:00 PM
--------------------------------------------------------------------------------







gale w
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Posted: 10/2/2012 11:58:46 AM
you left out the actual post


pleidesexpress
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Posted: 10/2/2012 12:02:00 PM
My daughter has been receiving chemo treatments for 35 months. Now her doctor tells her Obama Care will no longer allow him and the hospital to treat her without she and husband pay cash.


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Posted: 10/2/2012 11:58:50 AM
Three years of straight chemo? Yeah, right.




lovetodigi
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Posted: 10/2/2012 11:59:44 AM
Edited to remove ugly roll eyes

Sorry




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Posted: 10/2/2012 12:00:27 PM

My daughter has been receiving chemo treatments for 35 months. Now her doctor tells her Obama Care will no longer allow him and the hospital to treat her without she and husband pay cash.


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Posted: 10/2/2012 12:02:08 PM
But it's not Thrusday!!!





flanz
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Posted: 10/2/2012 12:21:23 PM
I call B.S. on this!

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Posted: 10/2/2012 12:29:51 PM
This Republican Romney / Ryan fan says, "TROLL!" And quit muddying a perfectly good election with crap.

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Posted: 10/2/2012 12:34:06 PM
Hey pleidesexpress...

1. How is Rosewell this time of year?
2. You might be too invested into politics.
3. You might be too invested into American Idol.
4. Did Video professor ever refund your money?
5. It's not Thrusday.


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Posted: 10/2/2012 12:56:38 PM

Three years of straight chemo? Yeah, right.




Actually, pediatric and adult ALL receive chemotherapy for 3 years. They get about 6-8 months of intensive chemotherapy, followed by another 25-30 months of maintenance chemotherapy, which consists of low-dose oral chemotherapy. However, my BS indicators are still going off just in regards to the other information given. But wanted to clarify that there is in fact regimens that can go up to 3 years.


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Dazeepetals
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Posted: 10/2/2012 12:59:42 PM

Three years of straight chemo? Yeah, right.




Actually, pediatric and adult ALL receive chemotherapy for 3 years. They get about 6-8 months of intensive chemotherapy, followed by another 25-30 months of maintenance chemotherapy, which consists of low-dose oral chemotherapy. However, my BS indicators are still going off just in regards to the other information given. But wanted to clarify that there is in fact regimens that can go up to 3 years.


One Doctor of Pharmacy trying to Make Cancer History



pleidesexpress
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Posted: 10/2/2012 1:10:47 PM
I assure the poster who called me a scanner and the poster who called me a Troll they couldn't be any more wrong with their cynicism. As for my so-called bad grammar, that poster should get a life.

I discovered this web site by searching on Google for reasons why the doctor told my daughter she would have to pay for any further treatment.

I refuse to believe it myself but I have been challenged by Jeannie to find some factual source that could refute her doctor.

I believe the ACA is a good thing and would never post anything negative about this Act if I wasn't sure with my information.

My wife and I just need some kind of concrete proof that this doctor is wrong. He has to be. My understanding about the ACA is there have only been three(3) changes implemented thus far in health insurance as mandated by the ACA.

a. Pre-existing conditions can't be denied by any insurance company.

b. Children still living with the parent(s) and 26 and under can be carried by the parent's insurance.

c. Wellness Care (physicals, mammagrams et al) cannot be denied.

Jeannie has Stage 3 breast cancer. She has had a double mastectomy and 10 subsequent surgeries. She has chemo weekly (today, Tuesday).

To the poster who asked "how are you paying now"...my daughter's husband's insurance armed with a cancer Rider, (cancer is wide spread in her mother's family...thus the Rider),has paid all medical expenses until this chemo treatment today

I would like to have some positive comments...please

MNshotz
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Posted: 10/2/2012 1:26:43 PM

I discovered this web site by searching on Google for reasons why the doctor told my daughter she would have to pay for any further treatment.



My advice to you, if you are truly just a new pea who found this board from a google search, is to go to find a site where you can get some good advice. You have found a non scrappbooking board on a scrapbooking website. The board is filled with a whole lot of women and a few men who have extremely varied life experiences, and a whole lot of opinions. In fact, some of the members here are extremely informed and wise. But if you are looking for more replies from people who are going through what you are experiencing, I'd suggest refining your google search.


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crimsoncat05
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Posted: 10/2/2012 1:31:20 PM
as a cancer survivor myself, who knows many people that have had breast cancer, I am sorry to hear what your daughter is going through. That being said, this may not be the best place to get answers to your questions. I know you said this site came up as a result of your Google search, but I would think you would get better information concerning your daughter's specific situation from her doctors, her insurance company, or perhaps a search on the Susan G. Komen site, or another breast cancer-specific charitable site.




"Accepting anything without question is the antithesis of critical thinking and education. ~wren*walk, 8/20/12"


KristenFNJ
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Posted: 10/2/2012 1:33:27 PM
ummm... I don't know what about "Live Life. Scrapbook it." and a banner of pretty paper screams "ACA EXPERTS HERE," but if you are really seeking expert advice on how the ACA will effect your daughter's care, I really urge you to go somewhere other than a scrapbooking site.

Perhaps call the American Academy of Pediatrics, they are heavily involved in this policy and could help provide professional interpretation.

Hope your daughter is able to continue treatment and enjoys a long and healthy life...

lovetodigi
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Posted: 10/2/2012 1:40:42 PM
Does your daughters insurance plan have a lifetime limit on amount paid out? I know a family that years ago had a child with cancer. They were cut off from the insurance company after they had reached the cap in pay outs. Maybe that is what is going on. I don't think that it has anything to do with ACA. It has to be some other reason.




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pleidesexpress
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Posted: 10/2/2012 1:40:43 PM
@Crimsoncat05

Thank you for the helpful comment. I've been searching for any information to aid me in my search.

I saw and read a poster's question on this forum concerning the cancer in her life and I thought I would try as well to get an answer.

I got a 50/50 response from the members on this forum...half nice/positive and half mean spirited and negative.

Again, I thank you for your advice and I will move on. The Susan foundation has not answered my query as yet.

God bless.

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Posted: 10/2/2012 1:45:31 PM
You need to have your daughter call and clarify with her doctor. This isn't making any sense at all. I was under the impression that doctors couldn't just stop treatment for failure to pay. Perhaps I am mistaken about that. Have her ask specifically what parts of Obamacare mandate that her treatments stop. Like, paragraph and page and section numbers and all that. That way she can read it for herself.

The only other thing I can think of is that there is a lifetime cap on her insurance and rider policies that has been met.



crimsoncat05
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Posted: 10/2/2012 1:46:03 PM
pleidesexpress, please don't take it personally. There have been instances of people signing up just to 'troll' the board, just to cause trouble. It's hard to tell when someone posts 'out of the blue' as it were, so sometimes we jump to that conclusion straightaway.

This link: Charity Navigator List is a list of over 20 of the top breast cancer charities; you may be able to find another organization that can give you the type of assistance or information that you're seeking.



"Accepting anything without question is the antithesis of critical thinking and education. ~wren*walk, 8/20/12"


crimsoncat05
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Posted: 10/2/2012 1:46:37 PM
double post- oops!



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Posted: 10/2/2012 1:58:28 PM

I got a 50/50 response from the members on this forum...half nice/positive and half mean spirited and negative.


I was one of the negative ones, so let me just clarify why. We've had numerous instances of people coming to troll the board. It is usually a charged statement designed to elicit a heated response, it often deals with social and political issue. Then there are people trying to sell something and spamming the board and those have bad grammar 99% of the time due to likely not being from the United States. You came on here, didn't introduce yourself, and made a charged post with sort of improper grammar. Our experience here in pea-land indicated that it is likely a troll post. Apparently it was not....I guess even the peas can be wrong sometimes *gasp* =P
Please don't think we were being negative and mean-spirited, hopefully my explanation tells you why we reacted the way we did.




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Posted: 10/2/2012 2:40:48 PM
But, but, I swear I copied the whole post! Weird. lol





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Posted: 10/2/2012 3:18:03 PM

pediatric and adult ALL receive chemotherapy for 3 years.

I would have thought that extreme also.


OP - sorry to hear about your dd. Hope it all goes well for her from now on and you find the answers you need.

You probably won't find them here - and yes, there are a lot of nasty posters on here. I'm sure they thought you were attacking their idol - BO. On top of all the other bad news today regarding the BO admin - well, I'm sure they didn't wanna read anything bad about BOcare. It's out there in the news but they ignore it.




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Posted: 10/2/2012 3:32:29 PM
I have no idea how to answer your question on cutting of chemo, but I did want to correct one statement about the provisions that have kicked in. There is one that actually kicked in this week regarding penalties for hospital that readmit Medicare patients for complications. Perhaps something else kicked in that is related to chemo treatment??????? Or perhaps she completely misunderstood her doctor.

ETA I found this nifty website that lists all of the implementations by year - it's interesting (I still don't have a clue what could have changed that would be impacting your daughter's chemo) Is it possible that the specific drug she's being treated with has been disallowed by her insurance?

ACA Timeline

lucyg819
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Posted: 10/2/2012 3:48:52 PM

Actually, pediatric and adult ALL receive chemotherapy for 3 years. They get about 6-8 months of intensive chemotherapy, followed by another 25-30 months of maintenance chemotherapy, which consists of low-dose oral chemotherapy. However, my BS indicators are still going off just in regards to the other information given. But wanted to clarify that there is in fact regimens that can go up to 3 years.

This was not my experience. After two surgeries, six months of chemotherapy plus six weeks of radiation therapy for breast cancer, I had no further treatment and no further medication, not even tamoxifen.


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Posted: 10/2/2012 3:56:03 PM

Actually, pediatric and adult ALL receive chemotherapy for 3 years. They get about 6-8 months of intensive chemotherapy, followed by another 25-30 months of maintenance chemotherapy, which consists of low-dose oral chemotherapy. However, my BS indicators are still going off just in regards to the other information given. But wanted to clarify that there is in fact regimens that can go up to 3 years.

This was not my experience. After two surgeries, six months of chemotherapy plus six weeks of radiation therapy for breast cancer, I had no further treatment and no further medication, not even tamoxifen.


ALL in this case = Acute Lymphoblasic leukemia


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luvmythree
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Posted: 10/2/2012 3:58:31 PM
I'm confused is it your daughter or your wife as you've said both. If it is your wife call the # on the insurance card. Good luck


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Posted: 10/2/2012 4:19:49 PM
I'm the one who called you a troll. I am so sorry, but most people don't come to a message board and not introduce themselves before posting the kind of message you posted.

I pray you find the answers you need to help your daughter. I pray she will beat the cancer and live a long life.

Suggestion. Anytime you go to a new board...give them a little bit about yourself and why you came to the board, then ask your question. Message boards get a lot of people who just want to stir up trouble and this board has a good number of highly political, debating peas. ACA is a touchy issue. I wish you all the best.


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Posted: 10/2/2012 4:42:01 PM
ACA allows some companies to choose to be "grandfathered" where certain of the new law doesn't apply yet if they keep the same payment ratios, etc.

Under ACA, "Plans may not establish lifetime limits (LTL) on the dollar value of essential benefits. Plans may only establish restricted limits prior to January 1, 2014 on essential benefits as determined by the Secretary of HHS." http://www.naic.org/documents/committees_b_Immediate_Improvements.pdf So it could be that some essential benefits may still have limits until plan year 2014.

I suspect the plan has a lifetime limit (LTL) on benefits and honestly if the LTL is $1M, that is only $27K per month and I have known some chemos to be much more than that. Especially if you add in surgeries/hospital stays/dr bills, etc.

If anything (and I am no supporter of ACA), ACA in the future doesn't allow for LTL which may be a positive thing for those with these types of issues.

lucyg819
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Posted: 10/2/2012 4:50:56 PM

On top of all the other bad news today regarding the BO admin - well, I'm sure they didn't wanna read anything bad about BOcare. It's out there in the news but they ignore it.

Wait, skybar, I thought you said that Obama controls the media and they don't print anything he doesn't want them to. So then it would NOT be in the news, would it?


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lucyg819
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Posted: 10/2/2012 4:51:46 PM

On top of all the other bad news today regarding the BO admin - well, I'm sure they didn't wanna read anything bad about BOcare. It's out there in the news but they ignore it.

Thank you. I completely misunderstood. I thought we were talking about breast cancer.


LUCYG
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Gsquaredmom

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Posted: 10/2/2012 5:15:18 PM
Call the American Cancer Society. They are there to help.



zinnia05
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Posted: 10/2/2012 6:43:57 PM
My insurance company stopped paying for my son's chemo treatment after 2years. They found a loophole and called it experimental and not approved for under age16 by the FDA. My son takes takes his infusions for juvenile arthritis every 5 weeks, at least until may. I am still fighting for them to pay for the last 2. To the posters who do not believe people can be on chemo for a long period of time they can.He has been on methotrexate every week for 6 years. Chemo is what is used to treat juvenile arthritis and it is used low dose long term, and it does have very high risks. Now we need to find a new drug because my son once again can not walk. My insurance company was considered a good one too


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scoobers

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Posted: 10/2/2012 7:59:48 PM

They found a loophole and called it experimental and not approved for under age16 by the FDA.


The insurance didn't "find" a loophole. 99.99999999999% of insurance policies exclude experimental treatment and every drug that is approved by the FDA is approved specifically for adult or pediatric use. There are different standards for pediatric approval.

My best for your son.



Me GOP
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Posted: 10/2/2012 8:03:23 PM

The insurance didn't "find" a loophole. 99.99999999999% of insurance policies exclude experimental treatment and every drug that is approved by the FDA is approved specifically for adult or pediatric use. There are different standards for pediatric approval.


This isn't going to be different under ACA. The protocols will still have to have non experimental status.

I'm so sorry for what you are going through.


Tracey

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Posted: 10/2/2012 8:15:09 PM
I don't understand why you would pick a scrapbooking web site to ask a cancer question?


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