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BCHusband · 11-06-2005, 05:49 PM

CLTann,

My wife had a lumpectomy in July05 for Stage 2 (Lymphnode Negative HER2+++) that was followed by 4 treatments of AC. ONC is recommending Taxall w/ Herceptin for 12 weeks followed by 40 more weeks of Herceptin (about $80k), but we're not sure our insurance will cover the Herceptin. Right now, our insurance provider (the largest in D.C. area and what we thought was a premium PPO Individual Plan for the self-employed) is reviewing my wife's case and will hopefully let us know before the Herceptin begins in two weeks. We're not optimistic, however, as our ONC tells us that our insurance company has recently denied coverage of Herceptin for other early stage patients with characteristics similar to those of my wife. We don't know what we'll do if Insurance is denied-- we're thinking about waiting a few months as we keep hearing Genentech is working to get Herceptin approved by FDA for early stage indications.

Did you or your ONC have to do anything special to get U.S. Insurance Provider to cover the cost of Herceptin for early stage?

11-06-2005, 05:49 PM	#4
BCHusband Junior Member Join Date: Nov 2005 Location: DC area Posts: 4	Insurance coverage of Herceptin for early stage CLTann, My wife had a lumpectomy in July05 for Stage 2 (Lymphnode Negative HER2+++) that was followed by 4 treatments of AC. ONC is recommending Taxall w/ Herceptin for 12 weeks followed by 40 more weeks of Herceptin (about $80k), but we're not sure our insurance will cover the Herceptin. Right now, our insurance provider (the largest in D.C. area and what we thought was a premium PPO Individual Plan for the self-employed) is reviewing my wife's case and will hopefully let us know before the Herceptin begins in two weeks. We're not optimistic, however, as our ONC tells us that our insurance company has recently denied coverage of Herceptin for other early stage patients with characteristics similar to those of my wife. We don't know what we'll do if Insurance is denied-- we're thinking about waiting a few months as we keep hearing Genentech is working to get Herceptin approved by FDA for early stage indications. Did you or your ONC have to do anything special to get U.S. Insurance Provider to cover the cost of Herceptin for early stage?