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Old 07-07-2012, 05:06 AM   #5
Lauriesh
Senior Member
 
Join Date: Oct 2005
Location: Lakeville, Minnesota
Posts: 199
Re: Pertuzumab not avaliable to stage 4 contrary to what you have heard

I am wondering if it is your dr or your ins co saying this. I have a hard time believing that an ins co would tell you that " even though you got preauthorization and we said it would be covered, we may not cover it" That is one of the reasons that ins companies have the preauthorization process, so people will know if expensive drugs or procedures are covered.

Myi ins co denied tykerb because I was taking it off label. I went through the appeal process and got them to cover it. If they deny you, you have the right to appeal.
I would call your ins co directly and go up the chain of command until you get a yes or no answer of whether this drug will be covered for you. If you get a yes, have them send you something in writing stating they said it would be covered.



Laurie
__________________
diagnosed stage 2- 3/2005
4.5 cm & 2+ nodes , er/pr- & HER2+
4 AC
12 taxol/Herceptin
Year of Herceptin
liver mets- July-2010
7 taxotere/Herceptin
RFA- Feb.2011
NED
U of Wa vaccine trial-oct 2011-Feb 2012
Herceptin/tykerb
Ned - 2 1/2 years
Herceptin & perjeta
Ned 3 years
Herceptin- reducing treatments , due to s/e, to 5-6 a year
NED- 3 1/2 years
Ned - 4 years
2/15- stopped herceptin - on no treatment
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