ESRD, Kidney Cancer + Cardiac Arrhythmia

[somarco]

A guy I have known almost all my life has been fighting kidney cancer for about 2 years. Currently on dialysis at home, 4x per week, waiting on a call from the transplant team.

Nov 2022 kidney removed, started dialysis

Two weeks later visited transplant center for evaluation to determine if he would be a transplant candidate. Approved and put on a list.

August 2023, still waiting on the call . . . now diagnosed with low BP, clots and an arrhythmia. He also passes out without warning. Doc wants to implant a pacemaker. Files prior authorization with MA carrier.

Sept 24, 2023 scheduled by doc for pacemaker the next week.

Oct 12, 2023 pacemaker postponed because MA has not yet approved the procedure.



And yet, some would say look at all the money he has saved by not paying Medigap premiums . . .

 

[mmike160]

A guy I have known almost all my life has been fighting kidney cancer for about 2 years. Currently on dialysis at home, 4x per week, waiting on a call from the transplant team.

Nov 2022 kidney removed, started dialysis

Two weeks later visited transplant center for evaluation to determine if he would be a transplant candidate. Approved and put on a list.

August 2023, still waiting on the call . . . now diagnosed with low BP, clots and an arrhythmia. He also passes out without warning. Doc wants to implant a pacemaker. Files prior authorization with MA carrier.

Sept 24, 2023 scheduled by doc for pacemaker the next week.

Oct 12, 2023 pacemaker postponed because MA has not yet approved the procedure.



And yet, some would say look at all the money he has saved by not paying Medigap premiums . . .

Sorry to hear this is happening to your friend. I'm sure this scenario is more common than many would image.

 

[somarco]

Sorry to hear this is happening to your friend. I'm sure this scenario is more common than many would image.

Thank you!

Gary is getting a lot of support from friends and family. He is a good man and is putting faith in God to pull him through

 

[StephanieCJ]

Sorry your friend is going through this. If he had a decent agent, they could call the carrier and see why the PA is taking so long (with the better carriers, it is usually a 24 hour process from what I've seen and they can be obtained retroactively). He can also call and see what is missing for the PA to get done. Who is the carrier?

 

[somarco]

Sorry your friend is going through this. If he had a decent agent, they could call the carrier and see why the PA is taking so long (with the better carriers, it is usually a 24 hour process from what I've seen and they can be obtained retroactively). He can also call and see what is missing for the PA to get done. Who is the carrier?

He lives in another state . . . plan is from his former employer (no agent) . . . don't know the carrier. Essentially a DIY plan.

 

[DonP]

A guy I have known almost all my life has been fighting kidney cancer for about 2 years. Currently on dialysis at home, 4x per week, waiting on a call from the transplant team.

Nov 2022 kidney removed, started dialysis

Two weeks later visited transplant center for evaluation to determine if he would be a transplant candidate. Approved and put on a list.

August 2023, still waiting on the call . . . now diagnosed with low BP, clots and an arrhythmia. He also passes out without warning. Doc wants to implant a pacemaker. Files prior authorization with MA carrier.

Sept 24, 2023 scheduled by doc for pacemaker the next week.

Oct 12, 2023 pacemaker postponed because MA has not yet approved the procedure.



And yet, some would say look at all the money he has saved by not paying Medigap premiums . . .

The question I have is if he’s a guy you’ve known almost your whole life why isn’t he on a med sup with you ?

 

[T Sparks]

Oh man... if only he would have had OM and medigap he would have had a new kidney by now right?

 

[somarco]

70% of the working age population are covered by EARNED benefits including EGH. Often, those EARNED benefits carry over into retirement. This represents a different class of people who have not spent their life looking for taxpayer handouts. Nor do they waste money buying lottery tickets and hoping for a windfall.

For most of their life they have come to rely on a paternalistic employer who pays a steady wage that is earned based on their contribution to the employer. They work hard, they plan and save for retirement and look forward to health insurance benefits they have EARNED. They don't protest outside the work place demanding a LIVING WAGE which is a term used by socialists.

Many of these plans are much richer than taxpayer funded coverage that is handed out without merit.

My friend Gary has two advanced degrees and worked for the same employer from college until he had to retire at age 72 due to his health.

The plan he EARNED is a managed care plan and is available to him without paying a premium. His situation is not unique except for the fact that his employer is one of the few that provides a retiree health insurance plan.

I don't hunt for prospective clients, they find me. I don't have to persuade them to consider OM benefits they have EARNED and PAID INTO for 40 years or longer, but if they are interested in learning about something better than health care managed by bean counters in an insurance company, I explain the difference and let them CHOOSE.

Gary did like a lot of people and just ASSUMED the coverage he had was good since he had never really used the plan while he was working. Like many people our age, he had no idea how hard it is to have access to care until he got sick. As much as he would like to get away from managed care he is stuck in a plan that does not serve his needs.

I realize this type of situation is difficult to understand when your policyholders are merely looking for the next handout while hoping the lottery will lift their standard of living at least for a few months until they have blown the winnings on foolish toys since they have no money management skills. All they know is "My name is Jimmy and I take all you gimme"

 

[kgmom219]

He lives in another state . . . plan is from his former employer (no agent) . . . don't know the carrier. Essentially a DIY plan.

What state?

Don't get me started on the Employer Retiree MAPD plans. Just don't.

 

[somarco]

Don't get me started on the Employer Retiree MAPD plans. Just don't.

I won't.

We probably share similar views. Discussed this with a neighbor yesterday. Wife retired from school system and both of them are now on her self funded group MAPD plan.

Look up "cheap" and you will see his picture. Does (almost) anything to avoid paying for things. Wife has been retired 3 years, had multiple surgeries (different things). Going thru 3 months of PT/OT and he complains about having a copay for every session.

But at the same time says he is glad they are not paying a premium like his mother and father do.

I didn't say a word . . .