Insurance Won't Pay for Herceptin; not yet...

We've been in a long struggle (May 05) with our insurance company over payment for Herceptin. They finally agreed to pay, and made one payment, then after more reviewing of the Herceptin dilema, they determined that they would not pay.

They are asking for names of other companies who were faced with the same questions regarding Heceptin not being FDA approved for non-metestatic cancer, but who are now paying for this drug. They said that they would like to talk to these companies and see their rationale for payment.

If anyone would be willing to share the names of these insurance companies it would be greatly appreciated. You could email me if you prefer. rbmjoyce@abe.midco.net

Thanks so much.

How many times have they turned you down? One consistent policy is to turn down claims the first time for many people, turn down a large percentage of those who try again, then pay for those who have the "guts" to try again. This from a former insurance company employee (not me).

I've had 2 companies pay, but I've had mets: United Healthcare and Aetna.

Love and light,

Lisa

Barbara:

I have BC/BS (personal choice) of Pa. They are paying with no problem. My oncologist's office applied for me and got the approval the next day.

Linda

bcbs of TX paid without any problems

I have Healthpartners and they are paying for herceptin. They told me that they will cover a drug as long as it is approved by the FDA for that disease. Herceptin is approved for breast cancer, so they will cover it for me, regardless of what stage I am. (I am stage 2) Laurie

Laurie,

Genentech may offer some assistance in paying.

Regards
Joe

Genentech Patient Assistance Program

I have BC/BS of Florida. Stage I

Maria

bc/bs of vA--stage 2, pAying

sassy

I have Oxford Freedom Select in NY and they pay for my Herceptin.

Hi, Barbara,

I am so sorry to hear this, but glad you got at least one paid for. I have mets as you know, but Carefirst, BlueCross/BlueShield has paid no problem. If you can qualify for FULL disability...even temporarily, while on it, Medicare will also probably pay for it. I like the suggestion though about going to Genentech directly.

Gina

P.S. If you get a chance, tell me more how the Herceptin has been hitting you. I am interested in your case. I think you are A- blood type with two kids positive and one negative. I am still charting the negative blood stuff, nothing definitive yet, will keep you posted as I am A- with one positive blood child. What was your mom, again??? Take it easy, -GP

Hi Barbara: I have had 4 herceptin treatments and am Stage I. When I called my insurance company, they had only said , they would pay for any "medically necessary " treatment. I was sweating this until yesterday when I received my explanation of benefits and they did in fact pay 100% of the cost. My insurance company is Key Benefits out of Indianapolis. Good Luck. BERTA

Thanks so much for your replies. It all helps. I will let our insurance company know names of the other companies that are paying. We plan to appeal our insurance's decision to deny payment for herceptin. Will also look to Genentech for help.

Barbara