Asking for a little prayer...

[tulip]

Listen to her and let her talk. I was just visiting with a friend today who is in the late stages of cancer. She's very frustrated that she can't finish all the things she set out to do. She also talked about some regrets. And reflected on what a good life she has had and all the wonderful things she has done and all the incredible people she has met. I just let her talk and we both just held each other and cried. I told her she is so loved. That's all I could think of to say.

My heart aches for you and your sister.

[shootingstar]

I'm sorry to hear the latest news. Be there with her.

[nscrbug]

Boy oh boy...this week has been nothing but one letdown after another. My sister had decided that she wanted to seek out a 3rd opinion at the Cancer Treatment Centers of America (the place that runs commercials on tv). They have a Midwestern Regional facility a little over an hour away from us, so we all thought "she has nothing to lose" by going there and hearing what they have to offer. She called to set up the appointment and the representative she spoke with was very helpful and started initiating the process. She was actually excited and hopeful for the first time since being diagnosed. Well...she got a call back from them saying that there is some kind of out-of-network "loophole" with her Blue Cross/Blue Shield PPO plan...and her insurance will NOT cover the treatment at CTCA. Needless to say, she is devastated that her insurance won't cover being treated at this facility. So now we are back to square one again. She is going to talk with her HR department at work tomorrow (she works for the federal government in Medicare) and see if there is something that can be done. Please keep your fingers crossed for us!

Linda

[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?

[nscrbug]

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?

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.

[goldfinch]

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.

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.

[shootingstar]

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.

[goldfinch]

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?

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).