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Lori R · 01-07-2012, 05:51 PM

Deena,
Responding to your question about insurance denial. I recently successfully worked through this process.

First, your Dr. has to be on board with the approach. My Onc wrote a page and a half letter about my history, quoted a study and submitted it to my insurance.

It only took 2 weeks for approval...but here is the catch. (there is always one when talking paper, paper more paper)

I HAD to be involved every single day. I followed up with the insurance to make sure I had the right FAX (we didn't), I called insurance to make sure they showed evidence of receiving the FAX (they hadn't).

My insurance has an emergency review process. So make sure that you are in that process to expedite the decision.

I was approved for Herceptin + Tykerb (darn diarrea causer...I hate it) + Abraxane.

We all know that this is one of the toughest moments in this jouruney. The uncertainty is very stressful.

Hang in there!! You can be successful with an appeal to insurance. And it may not take a month.

Lori

01-07-2012, 05:51 PM	#17
Lori R Senior Member Join Date: Jan 2008 Location: Evergreen, Colorado Posts: 454	Re: I could really use some input Deena, Responding to your question about insurance denial. I recently successfully worked through this process. First, your Dr. has to be on board with the approach. My Onc wrote a page and a half letter about my history, quoted a study and submitted it to my insurance. It only took 2 weeks for approval...but here is the catch. (there is always one when talking paper, paper more paper) I HAD to be involved every single day. I followed up with the insurance to make sure I had the right FAX (we didn't), I called insurance to make sure they showed evidence of receiving the FAX (they hadn't). My insurance has an emergency review process. So make sure that you are in that process to expedite the decision. I was approved for Herceptin + Tykerb (darn diarrea causer...I hate it) + Abraxane. We all know that this is one of the toughest moments in this jouruney. The uncertainty is very stressful. Hang in there!! You can be successful with an appeal to insurance. And it may not take a month. Lori __________________ 2007 Oct - Diagnosed - Stage IV 5 c.m. IDC - Left Side er/pr- Her2+++ Node + 2/14 - Single Liver Met Double Mastectomy Nov - Begin T+H 2008 Feb-Complete 6 cycles- T&H- NED March - Continue - Herceptin Only April - Rads for 6 weeks 2009 Continue Herceptin - Continue NED April - Recurrance- 3 cm. Liver Met May - Cryosurgery June - November - Abraxane + Herceptin Aug - PET/CT - CTC = 0 Back to NED 2010 January - Continue NED July - Recurrance - 3 cm Liver Met CTC=1 August - Cryosurgery #2 August - November Navelbine November - Back to NED - End Navelbine 2011 Feb - Recur - 4 cm Liver Met - Same Left Lobe March Surgery it is -Couldn't get a clean margin July - Confirmed continued liver involvement August - Begin Herceptin + Tykerb October - Mixed results from H+T Add Abraxane + H + T - Nov - April 2012 January PET Scan - It's working!! April - Back to NED July - Recurrance August - Begin TDM-1 Trial (Taxol + TDM-1)