Still waiting for approval from insurance company

[Redwolf8812]

For perjeta/herceptin/taxotere. It's been almost 3 weeks. I know the oncologist is on top of it. Is it normal to take this long? Any advice would be appreciated.

- Penny

[NEDenise]

sheesh!
I don't know if it's 'normal'...but it sure isn't very nice!
I often think how nice it would be if these companies would hang posters in their offices that read
"What if it was YOUR mom?"
I wonder if that might change a few perspectives!
Sending love and prayers, my friend!
Denise

[yanyan]

It works faster if you get involved by calling ur insurance. Ask them when did they received the request from ur doctor; what's the standard turn around time; urgent requests are expedited and take less than 48 hours, standard shouldn't take more than 10 business days unless they are requesting notes/proof that you progresses on herceptin and tykerb- in other words to determine the medical nessisity. The delay may be caused when they are waiting on ur doctors notes. If they tell u this is still pending you need to follow up with ur doctors office and have them fax in what's needed.
If requests is denied, you can appeal the denial. But let's worry about it if it happens. Hopefully u will get it approved very soon.

[Kkmom]

Penny,
I noticed you are taking a combination of herceptin and perjetta. I have estrogen/progesterone + and her 2 neu positive. My doctor offered for me to be in a clinical trial using herceptin and perjetta. I had a lumpectomy back on December 27. Are you taking the herceptin and perjetta through a clinical trial or is it the standard of care meds?

[Redwolf8812]

I'm not taking anything at the moment. The treatment the oncologist wants me on is a standard of care first-line for stage 4. Since I've already been treated with herceptin & tykerb I am not first-line which is what the hold up is all about.

I had a liver ablation on 12/31/12. I get a scan on the 6th to see what there is to see.

[CoolBreeze]

I'm sure every insurance is different, but it only took four days for me to get approved for perjeta with gemzar, and it hasn't been approved for use with Gemzar. So, I would say something is bogged down with your situation and it's time for a bit more persistance.

[Sdgirl]

I think three weeks is too long. Do you have a nurse case mgr at the ins? I would call and figure out what is going on and be persistent. I had problems getting it approved but had to keep calling and found out the problem was the med director at the ins and MO need to have a tel conversation. Good luck.

[karen z]

I would call the insurance company, the doc,............and keep at it. Be organized and be persistent.

[MikeF]

I was told the NCCN guidelines were updated the end of Sept. Barbs oncologist apparently wasnt aware of this as late as the end of Oct. when she started the Haloven. I asked for Perjeta then and was told that my insurance wouldnt pay for it because they had denied when she started TDM-1 in Aug. It definitely pays to shake the bushes I made several calls to our insurance and the doctors office trying to get them to see the change in the guidelines.

[conomyself]

I would call. I was trying to speed up my Perjeta approval, and I think it did some good. Now, in my case it was a standard use for Perjeta, but I was calling the person at the cancer center and I was calling the insurance company. They both knew I was calling the other and my "squeaky wheel" thing caused them to put my approval to the proper people sooner. I was very polite and a bit desperate but persistent.

[CoolBreeze]

I've been on the other end, working in a bureaucracy and I never minded people who called me (and were nice). Even if they called every day, I had no problem with it as long as they were pleasant. I understand they wanted to know something and I appreciated a call - it saved me from having to call them. And, if I didn't know I would tell them that I would call them back but if they wanted to call me, that would be fine too. We are all human and we understand that waiting is hard.

And, sometimes things do get lost in the shuffle and your phone call might make somebody go look for it and put it on the top of the pile. Your oncologist's secretary might have meant to ask for approval and then something happened and the paper or instructions got lost or something. A reminder might be all that's necessary. And, if she did it, then maybe it got lost on the insurance desk and a phone call might fix that.

Sometimes I think people confuse being persistent and making phone calls with being mean or something. I'm not talking about the OP or anybody in this thread but I've seen it happen.

It helps to know the timing of how long it *should* take, which is different for each insurance company. Mine takes 24 hours for approvals, so that's when I expect information although I will wait a day if somebody is out or something. It's all about being reasonable. Maybe yours takes a week.

My doctor's secretary told me never ever to apologize when I asked why something was taking a while, it was my right to have news! People do get busy and things get forgotten and a reminder is a good thing.

Nothing should take three weeks so I would definitely call and find out what is going on. Good luck and let us know!

I had no idea that perjeta had been approved for use with other drugs, that is good to know!