Asking for a little prayer...

I am wondering about the the "loophole." Typically, if the provider is not in your PPO plan network you pay a higher percentage of the cost of care and may also be required to pay the difference between what the health care provider charges (which is not regulated) and what the plan deems to be "reasonable and customary" for the service. So it can get extremely expensive and often unaffordable. But it is less common for a plan to out and out not cover a provider.

I don't suppose Mayo is in her network?

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Originally Posted by goldfinch

I am wondering about the the "loophole." Typically, if the provider is not in your PPO plan network you pay a higher percentage of the cost of care and may also be required to pay the difference between what the health care provider charges (which is not regulated) and what the plan deems to be "reasonable and customary" for the service. So it can get extremely expensive and often unaffordable. But it is less common for a plan to out and out not cover a provider.

I don't suppose Mayo is in her network?

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As in Mayo Clinic in MN? I really wouldn't know, she would probably have to call BC/BS and find out. It's weird though, because I just went to their (Cancer Treatment Centers of America) website to see what insurances they accept, and while they do list Blue Cross/Blue Shield...they don't specifically list Blue Cross/Blue Shield PPO. I'm kind of shocked, actually...I would have figured BC/BS to be accepted pretty much everywhere.

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Originally Posted by nscrbug

As in Mayo Clinic in MN? I really wouldn't know, she would probably have to call BC/BS and find out. It's weird though, because I just went to their (Cancer Treatment Centers of America) website to see what insurances they accept, and while they do list Blue Cross/Blue Shield...they don't specifically list Blue Cross/Blue Shield PPO. I'm kind of shocked, actually...I would have figured BC/BS to be accepted pretty much everywhere.

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A PPO (preferred provider option) is kind of a cross between traditional insurance and an HMO. The insurer has a network of physicians and other providers that are "preferred" or "in network". If the doctor or other provider isn't in your network and it isn't an emergency you end up paying a lot more. BC/BS in various states are different entities plus BC/BS often has many different types of plans available, including PPO plans, HMOs and traditional insurance.

Her employer should have a book with a list of in network providers that she can check.

Important to find out what truly would the treatment do....simply prolong her life....would it reduce the cancer?????

I understand that pancreatic cancer is a difficult cancer that can be painful..

YOu really,really need to grill the doctor specialists. Get them to tell her/you the real prognosis for her.

This is how my sister-doctor dealt on behalf for my father who has prostate cancer.

We know given his age 82, he will not get better from chemotherapy, it will only delay the cancer. It will weaken his immune system for certain and there won't be no turning back, even with chemo. Chemo will happen --the decision is his. So he has not elected this yet ...and simply functions along....looking um......normal to us.

So far we have noticed that he simply has colds more often and takes longer to recover from sniffles.

He has up to now, no respiratory problems, no cardiovascular problems. I cannot even begin to say...how inspiring this is to my family..how important to have good health starting from youth onward...because if he did have additional health problems, most likely he wouldn't be as "good" outwardly as he is now.

We know our father is livinig an illusion but we know if we get him to know acknowledge that cancer will take him down, then he will fall into a depression and that will pull down his health faster.

So we skim along....playing the little mini illusion for him..to keep his mental equilibrium.

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Originally Posted by Muirenn

Do you know why CTCA aren't covered?

In the past, it's been suggested to me that I actually ask specific doctors if they are willing to be a part of a PPO. It was suggested by my insurance company. Maybe you could call an insurance rep at CTCA? Just to try? Maybe a specific doctor would help?

Is being a part of a trial still a possibility?

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Yes, they could ask to be part of the network but that would mean that they would have to accept the insurer's fee structure. They may or may not want to.

(Just answering some of the insurance questions here and staying away from the issue of whether chasing CTCA or clinical trials is advisable).

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Originally Posted by nscrbug

I just learned this evening, that my older sister has been diagnosed with pancreatic cancer. She is 51yo...we are 7 years apart. I'm not sure how to even process this devastating news. She just had her biopsy on Tuesday, and today she was informed that there were cancer cells found in the biopsy. The next step is for her to see an oncologist to discuss how advanced it is and treatment options. I know this is an aggressive and very deadly form of cancer that progresses quickly, but that's all I really know about it. Can anyone here shed some light on this? Thanks.

Linda

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I would recommend getting advice from a Naturopath in conjunction with the Oncologist. I tried for years to get someone I loved who was diagnosed with colon cancer to do this, but they never did. I think his outcome would have been better and I would not missing him every day and thinking about him all the time. I believe it was the chemo that killed him.

Naturopaths can't cure cancer. They can't and they don't and they never have. False hope is cruel.

http://www.sciencebasedmedicine.org/...thic-oncology/

No one wants to hear the worst news, the nightmare and the fear we all want to avoid.

The news truly saddens me. There is no other way to put it or to lessen to devastating news. The most important thing from here is to try to get involved in something enjoyable and to help stop dwelling on the inevitable. Some may want to call it denial; but, I see it more as a means to a quality of life to celebrate who we are.

Sincerely,

Shawn

Well...I just spoke with my sister. She and the rep from her HR department have been on the phone most of the morning with BC/BS to see if there was some way around this "loophole". Unfortunately, she was told "no". She will not be able to switch her insurance plan from "basic" to the "standard" plan, which DOES cover a portion of out-of-network costs....as opposed to her basic plan which does not. She feels like we are "spinning our wheels" here, and doesn't want to waste anymore precious time. So...CTCA is no longer an option, and we are on to "plan B"...which is back to Northwestern for the standard line of treatment. She is calling them today to set it all up and we will go from there and hope for the best.

Linda

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Originally Posted by nscrbug

Well...I just spoke with my sister. She and the rep from her HR department have been on the phone most of the morning with BC/BS to see if there was some way around this "loophole". Unfortunately, she was told "no". She will not be able to switch her insurance plan from "basic" to the "standard" plan, which DOES cover a portion of out-of-network costs....as opposed to her basic plan which does not. She feels like we are "spinning our wheels" here, and doesn't want to waste anymore precious time. So...CTCA is no longer an option, and we are on to "plan B"...which is back to Northwestern for the standard line of treatment. She is calling them today to set it all up and we will go from there and hope for the best.

Linda

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We're all hoping for the best, too, Linda. We're here for you no matter what.

I haven't been on the forum much and am late to this thread. I wish you and your sister strength and peace through all of this.

I just realized that it's been a while since I posted an update to this thread, so here goes. The last time I posted, my sister's insurance had been rejected by Cancer Treatment Centers of America and we were moving on to Plan B - back to Northwestern for standard line of treatment, which consisted of a fairly new but extremely aggressive 3 chemo "cocktail" called Folfirinox. It required a chest port to be implanted so that the "fanny pack" pump she would have to wear for 46 hours could easily be attached for the treatments. Well...right before she was to have the chest port implanted (last Thursday), she decided that she didn't want to go through with the Folfirinox treatment. This regimen is considered very tough and only offered to the healthiest of patients due to the very harsh side effects. She basically had decided that she didn't want to spend her last few months here in misery and agony from the effects of the chemo...so she declined. But before we left the hospital, our NP called us back in to talk about another option. That option would be the old, conventional chemo treatment - gemcitabine. It's not as effective as the Folfirinox regimen, but it is much better tolerated by most patients. This is the treatment that Patrick Swayze underwent initially after he was diagnosed back in 2008. After taking the weekend to think it over, my sister has decided to give the gemcitabine treatment a try. She is tentatively scheduled for her first treatment on July 7th, but they are trying to get that date moved up sooner. She has been feeling nauseous and not eating much lately and is working with a nutritionist at the hospital. Naturally, they want her to maintain her weight as much as possible, so they are encouraging her to eat small, frequent high-protein, high-fat snacks/meals. Hopefully, she will have a positive response to the gemcitabine chemo and be willing to stay on it long enough to see if it helps.

That's all I have for now. Thanks for all the thoughts and prayers...it is very much appreciated.

Linda

Thanks for the update. Your sister sounds like an admirable woman. Still wishing the best for all of you.

Pam

Be with her.

Stay healthy yourself, meaning don't get a cold and expose it to her. Her immune system will break down with that chemo treatment.

I feel for you.

Keeping you both in my prayers.