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Kim in CA · 08-17-2012, 04:15 PM

Just an update on my PET scan and return to Herceptin.

First of all, big relief.....PET scan didn't show anything abnormal!

Now, spoiler alert, I'm gonna rant a bit!

After my Onc got the scheduling dept. to move my first Herceptin infusion to Aug. 6th, I had more hoops to jump through.

When I arrived at my appt. I was told they couldn't give me the infusion because they didn't have authorization from my insurance yet.

Now, I have been told by my insurance (Blue Shield) that no authorization is required for metastatic Her2 positive breast cancer. I have told this to the scheduling & authorizations dept. many times, but they insist that they still have to request it, and then wait for the letter that says I don't need authorization. Blue shield has told me that all the doctor's authorization person has to do is call the Blue Shield Medical Management Dept, and they can get authorization over the phone, but this wasn't good enough for them I guess, cause they just weren't cooperating. They said if you will just come back in a few days, we should have authorization by then.

I ended up telling them I would "self pay" just so I could get my Herceptin! Thank goodness my Visa card wasn't maxed out!

I'm still fuming at the the whole scenario! Anyway, all I can say is that I'm glad to be back on Herceptin, as my CA15-3 had gone from 49.3 on July 23rd to 76 on August 6th, and my Her2 Serum had gone from 26.8 to 49! That's a bigger jump than it made back in 2001 right before it spread like wildfire.

I just hate to get so mad (cause it's so not me) but our medical system is so dysfunctional. My husband and I pay a King's ransome ( over $30,0000 a year and one of the reasons we're selling our home) to have good medical insurance, and then we still have to go through garbage like this.

OK.....feel better now to have let off steam, thanks for listening!

08-17-2012, 04:15 PM	#14
Kim in CA Senior Member Join Date: Sep 2001 Location: California's Gold Country Posts: 404	Re: Oh PooP...Herceptin Holiday Over! Just an update on my PET scan and return to Herceptin. First of all, big relief.....PET scan didn't show anything abnormal! Now, spoiler alert, I'm gonna rant a bit! After my Onc got the scheduling dept. to move my first Herceptin infusion to Aug. 6th, I had more hoops to jump through. When I arrived at my appt. I was told they couldn't give me the infusion because they didn't have authorization from my insurance yet. Now, I have been told by my insurance (Blue Shield) that no authorization is required for metastatic Her2 positive breast cancer. I have told this to the scheduling & authorizations dept. many times, but they insist that they still have to request it, and then wait for the letter that says I don't need authorization. Blue shield has told me that all the doctor's authorization person has to do is call the Blue Shield Medical Management Dept, and they can get authorization over the phone, but this wasn't good enough for them I guess, cause they just weren't cooperating. They said if you will just come back in a few days, we should have authorization by then. I ended up telling them I would "self pay" just so I could get my Herceptin! Thank goodness my Visa card wasn't maxed out! I'm still fuming at the the whole scenario! Anyway, all I can say is that I'm glad to be back on Herceptin, as my CA15-3 had gone from 49.3 on July 23rd to 76 on August 6th, and my Her2 Serum had gone from 26.8 to 49! That's a bigger jump than it made back in 2001 right before it spread like wildfire. I just hate to get so mad (cause it's so not me) but our medical system is so dysfunctional. My husband and I pay a King's ransome ( over $30,0000 a year and one of the reasons we're selling our home) to have good medical insurance, and then we still have to go through garbage like this. OK.....feel better now to have let off steam, thanks for listening! __________________ Diag. Feb 1997 4.5cm IDC <10%ER+, PR-. 5 out of 36 nodes +. Mastectomy followed by 3 rounds Adriamycin/Cytoxin. 5/1997 Hi Dose Chemo w/ Stem cell rescue. Spent 4 weeks in isolation ward. Then 6 weeks radiation. 9/2001 widespread mets to liver. 8 mos Taxotere/Herceptin brought me almost to NED. Stop Taxotere & add Femara . 11/2002 liver resection to remove spot that turned out to be necrosis. Officially NED! 7/2003 Tumor markers rising add Xeloda Disastrous reaction, 8 days hospital, but tumor markers came back to normal! June -Dec 2004 UW Vaccine Trial. 7/2005 MRI single 11mm brain met 8/2005 Gamma Knife. Brain MRI @3 months NED! 2006-2011 brain/body still NED 8/04/11 Taking Herceptin break, will monitor with tumor markers. 6/20/12 Tumor markers begin to rise. CA15-3 is 31.3 and Her2 Serum is at 17.1 Decide to repeat in one month. 7/23/12 CA15-3 now 49.3 Her2 Serum 26.8 8/6/12 Back on Herceptin CA15-3 now 76 Her2 Serum now 49 11/7/12 Add weekly Taxotere for 4 cycles 2/2013 Stopped Taxotere added Perjeta. MRI shows approx. 50% reduction liver mets. CA15-3 still elevated @ 55. Will continue on just Herceptin & Perjeta. November 2014 Continuing on Herceptin, Perjeta, and Femara indefinitely. Guess I'm NED again, but watching those tumor markers carefully! Dec. 2015 PET scan reveals mass in perirectal area of abdomen.biopsy confirms. Still Her2+, but no longer ER+. Bye bye Femara Jan 2016 Begin Kadcyla March 2016 PET scan shows tumor now barely visible, still NED everywhere else. 2016/2017 continue Kadcyla November 2017 brain MRI reveals small focus of T2 hyperintensity with possible 4mm enhancing nodule. Short term follow up MRI suggested. Stay tuned...