One question and a ranting

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War-eagle
Regular Member


Date Joined Sep 2007
Total Posts : 219
   Posted 10/26/2007 5:15 AM (GMT -7)   
Good morning to all,
I need to see if anyone else has experienced this. Over the past few days I have had pain in my left heal. Like a stone bruise. I hurts the worst in the morning after a good nights sleep. Also after riding in the car for soom time. I will discuss with my Oncologist in 11 days but just wanted to know if any of you with bone mets have had this.
Well that was the question and now the rant!
We just found out that our insurance plan will change Jan.1. The insurance provider is not doing this, it is the health care provider/employer. They said that the "premium" plan was too expensive, so they are dropping it. Now all doctors must be "in plan" and use the providers facilities. This means that if I don't want to pay a $4K yearly deductable, $40 co-pays, and 20% of the cost for HT, Zometa infusions, CT & Bone scans, etc. that I must change ALL my doctors and the Cancer Center that I go to. What about continuation of care? Doctor/Patient relationships? Future care programs such as chemo trials? I guess the all mighty dollar determines care today and the patient is last on the list.
 
I feel better now! I had to get that off my chest. Maybe God has a plan for me to meet some new doctors and look at some different options. I am praying that this is HIS will and the company is HIS servant. Time will tell.
 
I love you all and still fighting the war.
WAR EAGLE!!!!!!!!!!
 
Walt
Age: 54
PSA 43 7/2005
Biopsy 12/14 Gleason 7 & 9
Divinci 9/2005 - spread to bladder
HT - 10/2005 (Eligard every 6 months)
RT - 10/2005 (38 treatments)
PSA 0.12 to 1.9 2/2007
Bone Scan and CT 4/2007
Casodex 4/2007
Spread to Spine (L4 & T5), rib, and pelvis
Zometa infusions 4/2007
PSA 4.8 8/2007
PSA 4.9 9/2007
PSA 5.4 10/07
 
"I will persist without exception - I will find a way where there is no way"


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 10/26/2007 9:40 AM (GMT -7)   
Walt-Eagle,

With your involved medical care, if there is any kind of continuation clause with your insurer, they should cut you some slack - just to avoid all the visits required just to get your new physicians up to speed.

My employer is "self-insured" and just uses (currently) Blue Cross as an administrative function.  Whenever the rules don't make sense and the (current) insurer won't budge, I have gone to my employer and explained the extra cost or risk or whatever and suddenly the insurer found (that is, was authorized by the underwriter, my employer) a loophole....
If your employer is not "self-insured," this idea may not be feasible.

I've had similar changes in "plan" before and it is never good when an accountant is making medical decisions for 100s of people.  (My employer has 60,000+ employees.)  The "In Network versus Out of Network" business strategy to keep costs competitive is just as scary to those of us with subtle variations of medical care - as the price increases we are witnessing in medical care and prescription drugs.  [The price of Viagra ($15) vs. alldaychemist's Sildenafil Citrate (47 cents plus shipping) is an example of the argument for the "Network pressure" being put on our medical providers.] 
The skyrocketing costs can become survival issues for some employers.
The reduction in benefit can also cause a loss of the employees critical to survival, too.

Many blessings to you if you have to meet and greet new doctors.  Many blessings, anyways!

As for the pain in the heel, I don't know anything about bone mets but:  I find I get this whenever I am overweight (most of the time these days....) and I try to run or jump rope or such.  So, I do my cardio exercises on a rowing machine or swimming and the pain goes away.
Podiatrists will try to talk you into surgery.
I am not a big fan of this procedure. 
If this "stone bruise" is what you have, low impact exercise and dieting are cheaper and more reliable.

You might just have to spread your wings and take flight.....

CCedar
ICTHUS!

Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 10/26/2007 9:52 AM (GMT -7)   
A heel spur or faceitis is more likely the culprit. Does like a spur but could be either. Go see the foot Doc if it doesn't get better wearing a good supportive shoe. Shoe inserts are wonderful.

Take care,
Swim
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 10/26/2007 9:57 AM (GMT -7)   
A heel spur or faceitis is more likely the culprit. Does sound like a spur but, could be either. Go see the foot Doc if it doesn't get better wearing a good supportive shoe. Shoe inserts are wonderful.

Plantar is also a possibility which in that case, would require a bit of treatment.

Hard to see the bottom of one's own foot. Been known to stick a foot in my mouth on occasion but still didn't see that coming....sorry, couldn't resist a TGIF :>)

Take care,
Swim
 


War-eagle
Regular Member


Date Joined Sep 2007
Total Posts : 219
   Posted 10/26/2007 12:05 PM (GMT -7)   

Thanks guys.

Cedar, you are a storehouse of all kinds of knowledge. I talked with the wife and we will appeal. She knows several others that are doing the same. I know where to go with the tough questions, now. I don't know if my wings are large enough to lift the 215. I would have to have a wing span of 20 feet.

Swim, I have the same problem with foot-in-mouth disease. I'll get some inserts and see how that goes. You know how it is, every new ache and pain brings thoughts of something bad. I gotta work on that.

You guys are great.

War Eagle, baby

Walt

 


Age: 54
PSA 43 7/2005
Biopsy 12/14 Gleason 7 & 9
Divinci 9/2005 - spread to bladder
HT - 10/2005 (Eligard every 6 months)
RT - 10/2005 (38 treatments)
PSA 0.12 to 1.9 2/2007
Bone Scan and CT 4/2007
Casodex 4/2007
Spread to Spine (L4 & T5), rib, and pelvis
Zometa infusions 4/2007
PSA 4.8 8/2007
PSA 4.9 9/2007
PSA 5.4 10/07
 
"I will persist without exception - I will find a way where there is no way"


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 10/26/2007 6:10 PM (GMT -7)   
Hi War Eagle. I feel for you with the insurance companies. It is just not fair the way they treat people, expecially with the meds. I have suffered from gout for several years and I have some searing pain from it mostly in my big toes on either foot but have had what can only be gout in my left heel. You may have it too. Trust me, my PC surgery and recovery was never as painful as gout. See your regular Dr. and see if the your uric acid in your blood is high which may mean you have it. Hope you don't.

Take care

Mika

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/26/2007 8:47 PM (GMT -7)   

War Eagle Walt-

My first thought is to send them a copy of that new Michael Moore film...Sicko..I think it is called.  My second piece of advice comes from my husband who is a FP doctor.  He said that often times he has patients whose insurance companies change and he has written a letter on behalf of the patient stating why the patient needs to remain in his care.  Perhaps that is part of the appeal process that Cedar mentioned, I'm not sure, but he said it has worked in a number of cases, but definitely reccomends getting a letter from your dr.  I know for drug coverage, a prior authorization filled out by the dr can often get a drug approved that is not on the "formulary", hopefully this is the case with medical coverage too. 

Third, no advice about the foot, but here is to hoping that it is just sore from kicking cancer's ass!  Wishing you the best always!!!! 

 

Doting


Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
In process of determining follow up therapy
 
 


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 10/27/2007 11:00 AM (GMT -7)   
Walt,

My recommendation is not just an appeal within the system.
It is rather an appeal to your employer after the appeal within the system fails.

An example:  I once got Shigalla from brushing my teeth carelessly in Belize.
The test run to determine what was causing my problem (green diahrea....)
was sent to a specialist to be read.  Charge $100.
The insurance company was not going to pay $100 for a person to read a computer printout that already cost $100 - essentailly making me a $100 political football.
While they argue, I pay.

I wrote my employer that hired the insurance company (Then Healthcare International) to administer both the policy and the appeals... and told them that as their insurance company refused my appeal I was going to go to a state agency and complain about the double billing they "so wisely" avoided.  I didn't want to pay either.
   Not such a big deal but my dilemma:
Did they want such a fuss about one of their employees with this bug in the news for $100?

They paid the bill very quickly.

My suggestion is that if you (and as Doting wisely suggests) and your physicians can explain the long-term costs: financial, emotional, etc. of the changeover versus the savings they seek, they might override their own policy and appeals process to make your life easier.
Perhaps as you suggested at least give you a little more time.

Our owner has been known on many occasions to just step in and pay an entire catastrophic health bill of an employee.  Aside from the fact that about 50,000 people will describe him as a saint....   His paying out of his own pocket avoids the precedents for other insured not-so-catastrophic patients and pre-empts complaints from the  new provider about their exclusivity clause...
So, keeping your request a quiet and polite one might pay dividends, too.

With your Spirit Walt,
I'm sure we will see an amazing dive from heavenly heights for a large fish, soon!

CCedar
ICTHUS!

Post Edited (Cedar Chopper) : 10/27/2007 12:04:55 PM (GMT-6)


uncledan
Regular Member


Date Joined Aug 2007
Total Posts : 120
   Posted 10/27/2007 9:19 PM (GMT -7)   
War-Eagle, I had a problem with my foot once (about 22 years ago ) and it was a torn tendon that attached to the muscle in the bottom of the foot. To help me get around I put something under the arch of my foot to keep the weight off the heel. I was able to continue work and it finally cured itself in about 5 weeks. Hope yours doesn't take that long. Good Luck and God Bless, Uncle Dan
Age 67
No symptoms, DRE negative, 10 - 06 PSA 5.44, 01 - 07 PSA 6.47
5 - 07 CT and Bone scans negative, 05 - 07 Biopsies, 2 of 6 positive
Gleason Score (3+4) 7 Stage T1c
08 - 14 Dr. Dasari - Baptist Hospital, Nashville da Vinci RAP, five hours surgery
Some right nerve and all left nerve removed,
Hospital discharged 8 - 16
Pathology report Negative margins, Encapsulated, 50% left side
Lymph nodes 2 R & 1 L - Negative, R & L seminal vesicles - Negative
Gleason changed (4+3) 7 closer to 8 than 6
9 - 26 Great PSA 0.000, 9 - 27 Starting on meds for ED
10 15 Dry most of the time, occasional leak (dribble )
Viagra no help yet, will try Lavitra ?


War-eagle
Regular Member


Date Joined Sep 2007
Total Posts : 219
   Posted 10/29/2007 1:52 PM (GMT -7)   

Cedar,

Great advise. Our appeal will go to the employer (a Hospital Network). BCBS just admins the coverage. We will try to do what is right in hopes that they do what is right. Still one question if we decide to stay with our doctors after an appeal in denied (hope this doesn't happen), what cost would be incured? The standard charges or the negotiated prices? The difference is huge. CT & Bone scan care a standard price of $12,000 while the negotiated price is almost 50% less. Zometa infusions are the same. I guess we will find out and pass on the info for all to know.

I got some inserts for the heel problem, they helped alittle. Will keep pushing through.

 

Wae Eagle

 

Walt


Age: 54
PSA 43 7/2005
Biopsy 12/14 Gleason 7 & 9
Divinci 9/2005 - spread to bladder
HT - 10/2005 (Eligard every 6 months)
RT - 10/2005 (38 treatments)
PSA 0.12 to 1.9 2/2007
Bone Scan and CT 4/2007
Casodex 4/2007
Spread to Spine (L4 & T5), rib, and pelvis
Zometa infusions 4/2007
PSA 4.8 8/2007
PSA 4.9 9/2007
PSA 5.4 10/07
 
"I will persist without exception - I will find a way where there is no way"

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