multiple myeloma, bone marrow transplants, hospital procedure, and an insurance question

[trovia]

Setting: Massachusetts, within the last five years.

I'm working on a fic about a doctor who befriends a cancer patient. Since I'm neither a doctor, nor do I have any experience with cancer (and I don't live in America), I'd really appreciate some help to get my facts straight. Cutting for length:

1.

Comments

[anonymous]

My partner has multiple myeloma and received treatment in Massachusetts at Baystate Medical Center in Springfield (chemo/radiation) and Brigham and Women's Hospital in Boston (autologous stem cell transplant). I'm not a medical expert but I can answer questions based on personal experience

[trovia]

Thank you so very much. All that was extremely helpful. I hope your partner is doing as well as is possible under the circumstances.

When they start knocking down a person's immune system for the transplant...

They do this on purpose? I saw a reference to that somewhere, but I was unclear on whether this is intentional or a side effect of treatment. Can you tell me more about that, if you wouldn't mind?

Is the story set before or after Obamacare?

Uh, it doesn't quite matter to the story either way - it's vaguely contemporary. I guess after Obamacare would locate it more firmly in the presence, so I'd go with that. I understand from another reply further down that there would be plenty of bills left to pay for the father-in-law even if she had insurance.

2. I don't know under what circumstances an eighteen-year-old would be referred for an allogenic transplant. That's a last resort after an autologous transplant has failed, and it would take a year or two (I think) to know whether the myeloma had come back after the autologous

[anonymous]

He is doing well, actually. He was diagnosed with Stage 3B in 2007, had the transplant in 2008, and has only needed to do chemo and maintenance meds since then

[trovia]

First of all, really glad to hear that your partner is doing that well. Ugh, that sounds like it must have been pretty awful when he got to the ER. Doctors can get so stuck on the "probable" diagnosis.

Honestly I might be turned off of the story by an eighteen-year-old getting an allogenic transplant for MM, but I would defer to the oncologist.

I've found Google results indicating that it's happened. However, I will make sure to point out how this is rare - I imagine it's a thing that the hospital is gossiping about, "have you heard about that patient on the third floor? They've scheduled her for a transplant, it's crazy." Knowing that it's possible, however, won't help me any if I have readers reacting to it the way you do, so thank you for pointing it out to me specifically.

Thank you for the explanation in layman's words and again, for all the other replies. :)

[whswhs]

On 8, you're not right any more. The Affordable Care Act makes it illegal for health insurance companies to ask you questions about your medical condition before signing you up. So if she was admitted after January 1, 2014, she should be covered. Of course, at that age, she'd likely be covered on her parents' insurance anyway.

Though it appears that insurance signups fell short of including the entire uninsured population by some probably substantial margin, so you'd have to look at that.

[trovia]

Thank you! I understand that even if she has got insurance, there'd still be plenty bills left to pay for the father-in-law - which is relevant to the story - so fortunately this works out for me either way. I wasn't even thinking of Obamacare, although it did get covered on our news.

[tafkarfanfic]

It really depends on the insurance company. The amount they pay varies WIDELY - my company just switched from one provider to another and the new company is paying about 3x more of my bills with no increase in fees for me. My father had cancer twice and his insurance paid for EVERYTHING. This was in Massachusetts

[trovia]

Thank you for all the information! It's extremely useful to know. Fortunately, this is a fairly minor point of the story - since it's a story about the doctor, not the patient. I just wanted to cover all my bases and make sure I don't imply the wrong thing at any point. Health insurance is a huge mine field if you write American characters but aren't an American yourself. So thanks for all the wonderful help, I think I'm set. :) I do like the rich future father-in-law paying some bills, although I don't think it's wise for me to mention specific insurance companies if I haven't got any personal experiences with them. There's a theme running through the story of supportive vs. non-supportive families; the loaded father-in-law paying all the bills serves as, sort of, an ultimate example of how family can be awesome.

[alisanne]

So I just happen to be an oncologist who treats patients with MM

[trovia]

So I just happen to be an oncologist who treats patients with MM. :)

God I love the internet. :))

Thank you so very much for all your answers, it's all extremely helpful and exactly what I need. This story just became half as difficult to write as it was two hours ago.

My geriatrician will be able to handle her patient by herself then. It'll make her look competent, which might compensate for how the rest of her life is so screwed up. :D

3) Not only can she have visitors, but they can even stay with her

By that do you mean, she can stay for how long? Or through the night?

(I hope that's enough). :)

Totally, thank you. :)

A 4/10 match would be a very dangerous transplant. I assume you're going for a MUD? (Matched, unrelated donor?) The dangers of a fully matched MUD are pretty big as is. I think if you want to make it really hairy you could do a one allele mismatch and have her be really sick. Yes, a MUD. The story is actually going to end before the transplant happens. The whole donor/transplant thing is a plot device to get

[alisanne]

You are welcome! Glad I could help.

A competent geriatrician could totally manage this patient as long as you don't expect her to give the chemo or do the transplant herself. *nods*

Yes, people can stay with transplant patients throughout the night and they often do.

do you bring down the immune system on purpose before the transplant, or is this a side effect of a treatment?It's both, actually. The problem with MM is that your immune system is not working, so chemo is really to kill the bad cells in order to hopefully have the good cells repopulate the bone marrow

[trovia]

Thank you! Both for the good-luck-wishes and the answers! You and the others have given me such great answers, I can't believe that I'm all set already.

[maeveth]

Medical reimbursement student and former insurance agent hat on

[trovia]

Medical reimbursement student and former insurance agent hat on.

The internet is so awesome. :) (heh, your reply seriously strained my English abilities, but I think I made it through intact!)

She doesn't have insurance because she ran away from home a couple years ago. Lived on the street, met the right people, got off the street, got a contract as a musician and enough income to pay for rent and food. And a rich girlfriend. ;) So yeah, she's an emancipated minor by now.

All that said, even with insurance cancer is a verrrrrrrrrrrrrrrrrry expensive disease to treat. She could have insurance and still be out of pocket for hundreds of thousands of dollars in deductibles, copayments, and non-covered services, especially if she's on a fairly inexpensive health insurance plan. I hope fiance's rich daddy is SERIOUSLY loaded.That is very good for me actually (not so good for real people with cancer obviously! :( ) because I need the dad to be spending a considerable amount of money on this for her. He's just a really great dad. And yes

[maeveth]

Any time. (Although I had no IDEA you weren't a native English speaker, so if you need clarification on something please tell me!)

You can have her have insurance and still have a lot of bills if she has cheap insurance (in the US, all insurance is most definitely not created equal). A lot of young people who signed up/are signing up for insurance via the ACA are signing up for what's called a catastrophic plan; it's basically only there to pay for preventative care and you're gambling that nothing seriously bad is going to happen to you. That way, while the costs of treatment will be blunted somewhat, fiancee's daddy is still shelling out a lot of money.

[trovia]

Thank you. :) Is "catastrophic plan" a term used by insurance people, or does everybody call it that? (or, when the patient herself talks about her insurance, would she say "I'm on a catastrophic plan"?)

I knew American health insurance is tricky, but... geez.

(Although I had no IDEA you weren't a native English speaker, so if you need clarification on something please tell me!)

Thank you. :) I'm usually fluent, but insurance language is a little outside of my usual expertise. American girlfriend helped me clarify, though.