Anyone with Federal BC/BS getting Herceptin?

PatS · 11-11-2005, 10:37 AM

I'm just trying to figure out the financial aspect if I decide on doing Herceptin.
I looked at my plan and it looks like I would be responsible for 10% of the BC/BS allowable charge. So I was wondering what the allowable amount generally is.
Thanks for all your help.

Pat

Lolly · 11-11-2005, 11:45 AM

Hi Pat; I have BC/BS of Oregon, although not Federal. My most recent statement for weekly Herceptin showed the billed amount at $2,562, less Provider Discount of $1,398 which left $1,163 as the allowable balance. If you have an annual cap on "Out of Pocket Expense" it doesn't take long to reach the point where your plan pays at 100%. Hope this is helpful in giving you a ballpark.

<3 Lolly

Sheila · 11-11-2005, 02:08 PM

Pat
I live in the midwest and I get Herceptin every 3 weeks...I have BC/BS of Illinois, and as long as I use a PPO provider, they pay the predetermined rate for PPO & I pay nothing....Herceptin here is much higher priced then some areas...mine is $9,000 every 3 weeks....if you are going to have to pay any out of pocket, I would call around and find out what the prices are...believe me, there is a big price difference here in IL from one hospital or Onc group to the next. I could be getting the Herceptin for $4,000 at the chemo center here where I live...I just dont like the oncologists, so I choose to travel to Chicago where they have top notch Oncologists....but then I also must get my Herceptin there.

Ginger · 11-20-2005, 04:52 PM

Pat, I am also Federal BC/BS not getting Herceptin however. would like to know if its covered as have been trying to get my Onc to give it to me and so far he will not. I am 2 yrs out almost w/no recurrence. Stage IIa, neg nodes, 2.7cm, ER/PR+. AC Chemo, rad.

DeborahNC · 11-21-2005, 09:53 AM

I have BCBS FEP (retired). Have had 3 Taxol/Herceptin infusions, but so far no EOB's pertaining to them. I've met my deductible and all PPO's are being paid at 90%. Did you hear something that makes you think Herceptin would not be covered?

PatS · 11-22-2005, 05:36 AM

Ginger

I talked to my oncs nurse last week and she said my onc will give
give me herceptin if insurance covers it but shouldn't pursue it anymore if they don't, so I agreed for now and will see what BC/BS says. The
oncs office is checking with BC/BS (Standard) . I'll let you know what
they say.

Phaeduamen

I'll be 3 years out from chemo on Jan 10 and currently NED.
I wasn't able to do Herceptin during my initial treatment, so am considering doing a year now. My onc. really doesn't think
it will do any good but is willing to give it to me if my insurance
covers it (although I don't think she's really happy about it). So,
I need to check with BC/BS and see if they will cover it this far out.

Pat