Cancer Treatment

[lelapin]

A friend has just explained the difficult situation his wife finds herself in: -

 

She had an operation 1 month ago to remove a, malignant tumor from her stomach.

Subsequent biopsy showed that they had removed the tumor and there was no cancer in the surrounding lymph nodes.

Last week they met the oncologist at Bangkok Pattaya hospital and she recommended a 12-treatment regime of chemotherapy over 24 weeks. They said that she would be infused and needed to stay in hospital for 2 nights each time. The cost per treatment was 150,000 THB or 1.8m THB.

On Saturday they visited again and they recommended she should have a pod on her chest to do the infusion, a 1-hour operation which would cost 120-150,000 THB.

They then got a call from the hospital saying the insurance had only given O.K for 1 night stay, and we had to pay the second night.

He asked the oncologist why she needed chemo if her results were clear. She said that there was a 70% chance of it returning within 5 years, but with chemo it was 30% chance.

She also had a PET scan in BKK and nothing was found outside of her stomach area, that was before the operation.

Questions

1. Is a 2 night stay necessary for an infusion?

2. Should she do the chemotherapy?

 

Can Sheryl or any other knowledgeable forum member give any useful advice for me to pass on to him.

[dj230]

If it is indeed true that chemotherapy would decrease chances of the cancer returning, I would 1000% do the chemotherapy. I know with thyroid cancer they have the patient do radioactive iodine treatment to kill all traces of cancer even after removing the thyroid glands.

 

Cancer isn't something like a migraine where you can go the whole natural route with very little consequences, it's a very serious disease, if not treated, will result in death.

 

It is a shame that insurance isn't covering it all though, but you don't keep any money when you die either. 

 

Edited June 20, 2022 by dj230

[FriendlyFarang]

19 minutes ago, lelapin said:

A friend has just explained the difficult situation his wife finds herself in: -

Is his wife Thai?

[grain]

21 minutes ago, FriendlyFarang said:

Is his wife Thai?

If the wife isn't Thai then get her home pronto.

[Sheryl]

Absolutely she should do the chemo. Gastric cancer, by the time it is symptomatic,  has a poor prognosis so requires aggressive treatment. What they have been told is correct.

 

The "pod" you refer to (a port) does not require a real operation. It is a simple procedure done under local anesthesia as an outpatient (or should be). There is no medical reason to be admitted or stay overnight for this. And the cost mentioned seems excessive.

 

There is  no medical reason to be admitted at all, let alone stay 2 nights, for the infusions. Normally this is a day procedure. Most insurance, even if  hospitalization-only, will cover outpatient chemotherapy.

 

Is this woman Thai? Because if so she can get free treatment through the government health system. There is a government cancer hospital in Chonburi town which can do this.

 

If she is foreign, she could also  use the government cancer hospital (won't be free, but will cost much less than private hospitals) but: there will be  very long waits and crowds, language barriers,  less comfortable environment. Additional problem is that it won't be possible to arrange to direct insurance payment to government hospital and may be difficult even to get reimbursement as government hospitals are not good at completing the required documentation.  Since they have insurance this is probably not worth pursuing.

 

Other options would be:

 

1- continue to use BPH but insist on having the post inserted as a day surgery, and the infusions also done as day treatment. Be firm, tell them this is all your insurance will pay for.

 

2 - Use a less expensive hospital. In the Pattaya area options would include:

- Phyathai Sri Racha hospital - contact Gavin Waddell in their marketing dept, he is an expat and very helpful in helping foreigners find the best doctors etc.  [email protected]  tel Tel: 089 7500293  or 03 831 7333

- Pattaya International Hospital (not 10% sure they can do this, but can ask)

- Pattaya Memorial Hospital (not so much English speraking there)

 

If it were me, given that she has started at BPH and other than the cost aspect what they have done sounds appropriate, I would try #1 first. If they make it clear they will otherwise go elsewhere, I think BPH will accommodate them and do all thus as day procedures without admission.

 

But if not, then I would then try Phyathai Sri Racha.

 

 

 

 

[Sheryl]

31 minutes ago, dj230 said:

If it is indeed true that chemotherapy would decrease chances of the cancer returning, I would 1000% do the chemotherapy. I know with thyroid cancer they have the patient do radioactive iodine treatment to kill all traces of cancer even after removing the thyroid glands.

 

Cancer isn't something like a migraine where you can go the whole natural route with very little consequences, it's a very serious disease, if not treated, will result in death.

 

It is a shame that insurance isn't covering it all though, but you don't keep any money when you die either. 

 

 No insurance will pay for medically unnecessary charges, there are provisions to that effect in all policies - treatment must be medically necessary and charges "necessary and usual".  While chemo is certainly medically necessary in her case, what the hospital is proposing (overnight admission just too place a port under the skin in a 30 minute procedure; 2 night admissions for chemo infusions) is neither "necessary" nor "usual". Hence their problem.

 

In fact it sounds like their insurance is more generous than most if it would pay for 1 night admission for each infusion.

 

They need to be firm with the hospital.  Aside from the cost/insurance aspect, most people find it unpleasant and inconvenient to have to spend unnecessary time in a hospital. Especially when going through chemo,  which inevitably means a lot of time in hospital, one wants to maximum time with family at home, not spend excessive and unnecessary time at the hospital.

[dj230]

13 minutes ago, Sheryl said:

 No insurance will pay for medically unnecessary charges, there are provisions to that effect in all policies - treatment must be medically necessary and charges "necessary and usual".  While chemo is certainly medically necessary in her case, what the hospital is proposing (overnight admission just too place a port under the skin in a 30 minute procedure; 2 night admissions for chemo infusions) is neither "necessary" nor "usual". Hence their problem.

 

In fact it sounds like their insurance is more generous than most if it would pay for 1 night admission for each infusion.

 

They need to be firm with the hospital.  Aside from the cost/insurance aspect, most people find it unpleasant and inconvenient to have to spend unnecessary time in a hospital. Especially when going through chemo,  which inevitably means a lot of time in hospital, one wants to maximum time with family at home, not spend excessive and unnecessary time at the hospital.

Bangkok Hospital has been pretty fair with me whenever I went so I think they would be fine with doing the outpatient treatment like you suggested if it is indeed just a short chemotherapy infusion. I am not a chemotherapy specialist, and have no clue the procedures for the OP's Wife's cancer, but some chemotherapy infusions can take several days, I am assuming this is what Bangkok Hospital is recommending. 

 

Although this isn't that relevant to the topic, I have to say, I personally would rather spend more time in the hospital than at home with family. It's actually quite comfortable at the hospital, have nurses to take care of you etc. and there is a certain emotion you have, of not wanting to be sick or suffering in front of friends/family and having them watch you. This is a personal preference though. I guess there is the aspect of wanting to spend more time with your friends/family, albeit in the OP's Wife's case she is doing the chemotherapy as post-treatment after having the cancer removed so she doesn't currently have cancer and would have a longer life expectancy than someone who has cancer that is un-treatable and is prolonging death through chemotherapy. Once again, all a personal preference. 

 

Edited June 20, 2022 by dj230

[underjoh]

Thanks to the very informative replies. It is my wife ( Thai) who is to have the chemotherapy. It is clear that the recommendation is to have the treatment, but to question the hospitals reasons for the 2 night stay. As someone pointed out it may be that the infusion time is longer than normal in her case. We are now armed with information to challenge the hospital. We would prefer to stay with BPH as the surgeon and oncologist have both been good to my wife .It seems it's the insurance and payment dept. that is trying to maximise revenue. Many thanks again for your helpful comments.

[Sheryl]

6 minutes ago, underjoh said:

Thanks to the very informative replies. It is my wife ( Thai) who is to have the chemotherapy. It is clear that the recommendation is to have the treatment, but to question the hospitals reasons for the 2 night stay. As someone pointed out it may be that the infusion time is longer than normal in her case. We are now armed with information to challenge the hospital. We would prefer to stay with BPH as the surgeon and oncologist have both been good to my wife .It seems it's the insurance and payment dept. that is trying to maximise revenue. Many thanks again for your helpful comments.

 

There are a number of different chemo protocols that can be used but none that, to my knowledge, would require 2 night admission per infusion.

 

The fact that they also want an admission just to place the chemo port is also an indication of trying to maximize revenue.

 

Insurers are used to this sort of thing and can spot it a mile away.

 

Just hold firm and tell them they have to stay within what your insurer approves. Do NOT pay any hospital charges yourself - you need to conserve your resources as this will be a long haul and further down the line there may be things that you legitimately need to pay for.

[Sheryl]

I would add that, aside from trying to maximize revenue, sometimes  the issue is just a staff person in the third party payment office of the hospital trying to avoid work.

 

What happens is that the hospital has to submit detailed estimated costs to the insurer; once approved, the insurer issues a "Guarantee of Payment".  It is quite common that the insurer does not accept the first version submitted by the hospital, and sometimes rather than  going ahead and revising it for re-submission the hospital staff will try to get the patient to pay the difference.

 

This can happen even when total cost is not the issue. For example, I had surgery last year, there was a package price which was fine but  when the hospital submitted the estimated cost  to the insurer they failed to break out the room charge adequately (my policy limits reimbursement for private rooms to equivalent of US $75, but for room only, excluding meals and nursing). Rather than just break it out so as to show the allowable amount for room and list meals, nursing etc separately - still within the same total cost --  they called me first to see if I would just pay for the room myself and this save them the work of having to revise the paperwork to the insurer.

 

Easy question to answer: NO.  I told them to sort it out with the insurer.

 

Magically the problem went away and the insurer paid the cost in full.

 

I have also heard many cases of hospitals trying to pressure people into paying first and getting reimbursed later, again just to save them the paperwork. (Ironically this pressure comes from staff hired specifically to submit insurance claims, i.e. their job would not exist if everyone did as they asked).  Needless to say anyone how makes the mistake of agreeing to that, will then find it very difficult to interest the hospital in providing them with the needed documentation to get reimbursed.

 

 

[lemonjelly]

I went through this with a Thai girl. We took her to the cancer center in Chonburi. The chemo was administered through an IV drip. Whole process took a couple of hours and quite affordable.

[underjoh]

Thanks Sheryl and others. I am pleased to say that you were correct, and a deal was struck between the hospital, ourselves and the insurers WR life, who have been great all through this.

The hospital offered day infusion with a pill, almost the same price, but potentially more debilitating according to them. They still insisted that the infusion took 2 days, it was an American programme. As one of the correspondents said, she preferred to be in hospital rather than at home. So a deal was struck with the insurer, for which I am not privie to the details. So. all good, and thanks again for all your comments.