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Old 07-27-2017, 07:28 PM   #5
Kkmom
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Join Date: Jan 2013
Location: 'Burbs of Atlanta, GA
Posts: 172
Re: Insurance Frustrations

Tracy,
I am sorry you are having to deal with this stupid game the insurance companies like to play. I work in a doctor's office. This is what you do - Contact your doctor's office and find out if they have received the same documentation you have for the coverage denial. If so, in the documentation, the may direct your doctor to do a prior authorization for the prejeta and herceptin. Otherwise, they may ask for a peer to peer consult - between your doctor and a doctor on staff at Aetna (which when you think about it, is a total insult). Then the next step is the total appeal process. Whatever you have to do, keep pushing them - in my experience the wheel that squeaks the loudest gets the grease. Don't stop till you get what is rightfully your right to health coverage. Sorry if I sound too militant.
Pam P. S. - If I remember correctly there is plenty of assistance to reduce the cost for herceptin and perjeta - and it doesn't matter what your household income is - At your doctor's office, they may have a social worker on staff and I found they could be very helpful and informative.
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[FONT=Tahoma]Dx 12/14/2012, IDC, 2cm, Stage II, Grade 2, 4/5 nodes, ER+/PR+, HER2+[SIZE=2][COLOR=Blue]
Surgery 12/28/2012 Lumpectomy (Right); Lymph Node Removal: Axillary Lymph Node Dissection (Right)
Chemotherapy 02/06/2013
Herceptin, Carboplatin, Taxotere Started 6 rounds on 02/06/2013 Herceptin
Finished chemo - May 22, 2013
Radiation Therapy 06/12/2013 - 36X External
TM Marker - 13 October, 2013
TM Marker - 15 November, 2013
Annual Mammagram - 3D - Both Breast - CLEAR!!!
Colonscopy - 1st-Clear - November 18, 2013
CT Scan-Results-Clear - November 27, 2013
BC Diagnosis-1 Year - December 14, 2013
TM - holding steady at 15 - December 24, 2014
TM - 24.2 - January 12
Herceptin Treatment - Last One-February 4, 2014!!!
TM - 3.7 - February 4, 2014
MRI & CT - February 21, 2014 - All Clear
NED - and my doctor said - "well, it looks like you are NED - your MRI and CT are clear - Febuary 25, 2014
TM - 18.2 - February 21, 2014
Port Removed - Scheduled for Wed, March 19, 2014
Port Removed - Yeah!!! I feel lighter already!!!
TM - 15.3 - March 25, 2014
Diagnostic 3D Mammogram - Rt Breast - All Clear!!! - Tuesday, May 13, 2014
TM-15.5 - June 25, 2014
Diagnostic 3D Mammogram - Nov. 2014 All Clear!!!
Diagnostic 3D Mammogram-Rt Only-May,2015-All Clear!!!
Diagnostic 3D Mammo-Annual-Nov 2015-Right Clear!!! - Left Breast-found 5 mm CYST. Aspirated - all clear!!
TM - Nov 2015 - 18.2
NED-December, 2015 - 3 Years NED!!!
TM-Feb 2016 - 13.7
TM-June 2016 - 13.3
TM-Oct 2016-10.0
Annual 3D Mammo-Nov, 2016-All Clear!!!

Annual Mammogram - November 2017 - ALL CLEAR. i AM 5 (YES) YEARS OUT!!!

NED - 10 Years Out!! - December, 2022
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