Herceptin Covered By insurance

John21 · 10-07-2006, 05:30 AM

Has anyone had problems with insurance coverage for Heceptin?

Thanks

chrisy · 10-07-2006, 05:39 PM

My insurance requires a pre-certification for medical necessity (which can be done retroactively!) but hasn't refused to pay. My precert runs out this November - hope I haven't jinxed myself!

Bev · 10-07-2006, 08:01 PM

Hi John, Over a year ago Care First wouldn't commit to coverage until after treatment. We said at that price we wouldn't do treatment until we had a commitment. It took them about a month of thinking and a letter to our state insurance board before they committed to payment. I would think it's getting easier now. BB

tousled1 · 10-08-2006, 08:12 AM

I haven't had a problem with my insurance (United Health Care) paying for any of my treatments or tests, so far.

Lori S · 10-08-2006, 10:21 AM

In 4/04, I was originally denied by CareFirst BC BS of MD but this was before the release of the study for early stage bc. My oncologist even wrote a letter on my behalf and I was still denied. I then filed an appeal with the State Insurance Commission of MD and then my herceptin treatment was approved.

Hopefully, you won't have to go through the red tape for approval. Good Luck!

Ginagce · 10-08-2006, 10:49 AM

There's a great book here in PA called "Breast Cancer: Covered or Not?".

It was written by Dr. Linda Rhodes and Pat Halpin-Murphy, President of the PA Breast Cancer Coalition, a political action group here in PA. The book won the 2006 Non-Profit Innovation Award.

Although it's geared in some cases to PA residents, there's a lot of very good information in it about insurance in general, clinical trials, appeals and lots more. I think it is an excellent resource for all breast cancer patients.

You can order the book throught the Coalition at www.pabreastcancer.org or by calling them at 1-800-377-8828.

I have not yet had a problem getting coverage for herceptin but just had to change my insurance and I'm in my second year of herceptin so we'll see over the next few weeks where I stand.

All the best to you.

Ginagce

jener8er · 10-08-2006, 01:20 PM

No problems from my insurer either - HealthNet Individual PPO, and I'm just finshing up my second year. They also just agreed to pay for my genetic testing after 3 appeals and taking it to the State also. If they deny you, just keep trying until they give in. They are hoping that you'll give up first.

Colleen007 · 10-08-2006, 05:57 PM

I have been on Herceptin from the start of treatment...and have never had any issues with insurance. I'm covered by Tufts Health Plan here in Massachusetts.

Andi · 10-08-2006, 06:47 PM

My insurance (BCBS of Iowa) has paid for my year of herceptin, no questions asked.

Becky · 10-08-2006, 07:06 PM

Cigna gave me an open prescription for Herceptin and I did/do not have to reapply if I had wanted 2 yrs of adjuvant Herceptin versus one yr.

If I ever should need it and still have Cigna, I can just restart.

Kind regards

Becky

John21 · 10-09-2006, 08:52 AM

Thanks for the replies. There has never been a problem with insurance coverage before. They sent us a letter saying that the current chemo she took was experimental and not covered. Kinda crazy as they covered everything else before. Could be a new case worker deciding are benefits are out of control. I am sure we are all flagged in the system. We have good insurance PPO. We are currently working with her employer.

Thanks

John

Mary Anne in TX · 10-09-2006, 09:15 AM

My insurance company stopped paying for herceptin until I went for a Muga and passed the test! I believe they are paying now, but haven't seen a receipt that shows so yet! That would really be the pits!!!! But I do think they will. My clinic is affiliated with the NCI and the business office is amazing at solving any problems. I know that is lucky for me!