Topic: dense dose taxotere not covered???Help

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Posted on: Dec 2, 2010 07:09PM

Posted on: Dec 2, 2010 07:09PM

Rachel1 wrote:

My insurance won't cover 24 thousand dollars for 4 treatments of taxotere at two weeks apart -- dense dose.  They said it is because taxotere used in this way is experimental.  My oncologist never told me it was experimental. He only said that he could use taxol or taxotere, but chose taxotere because he felt is was more effective.  When the oncologist billing dept. called our insurance about chemotherapy, they simply said that there was no pre approved authorization needed.  What do I do now?? The oncologist is filing an appeal. But we can't afford 24,000 bill. Do I sue my oncologist?? Please someone help me understand this.

Rachel 

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Dec 2, 2010 09:08PM lauri wrote:

The first line person at the insurance company called it "expeimental" but your onc should be able to explain that it's a standard drug ...which the insurance company has probably paid fror thousands of times .. and a standard treatment method.

 My A/C + T in a clinical trial to compare alternate timing protocols was initially denied as being "experimental" but the trial coordinator got it taken care of quickly and they paid for everything.  But I was in a panic after my first conversation with the insurance bozo.

Deep breaths !!

From the ashes of disaster grow the roses of success Dx 3/8/2006, ILC, Left, 6cm+, Stage IIIB, metastasized to bone, Grade 2, 11/12 nodes, ER+/PR+, HER2- Dx 11/15/2021, ILC, Stage IV, metastasized to bone Hormonal Therapy 11/27/2021 Femara (letrozole) Targeted Therapy 12/2/2021 Ibrance (palbociclib) Radiation Therapy Whole breast: Breast Surgery Mastectomy: Left Chemotherapy AC + T (Taxol) Hormonal Therapy Arimidex (anastrozole)
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Dec 2, 2010 09:34PM sheila888 wrote:

5 years ago I had dose dense A/C every two weeks and dose dense Taxol every 2 weeks 4X each. There were no problems. Since Taxotere is considered the cousin of Taxol Why are they denying it?

Sheila♥ Dx 4/8/2005, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ Dx 8/21/2015, IDC, Left, 1cm, Stage IIB, Grade 2, 1/3 nodes, ER+/PR+, HER2- Surgery 10/12/2015 Mastectomy: Left; Prophylactic mastectomy: Right Dx 11/2018, IDC, Stage IV, metastasized to bone/liver/lungs, Grade 2, ER+/PR+, HER2-
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Dec 3, 2010 04:02AM lago wrote:

My insurance company refused to pay for my BS services to place my TE as phase I of reconstruction even though it was pre-approved and it's a law in this country that they have to pay for this. They also have refused to pay for the blood draw for my BRCA testing although did pay for the BRCA tests.

We finally got them to pay for the reconstruction. We are still working on the blood draw granted it's a small bill but we pay so much for our cobra insurance I want them to cover what they are supposed to cover.

My point here is don't let the insurance company scare you. They try to get out paying or delay paying all the time. Don't give up. That's what they want you to do.

DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2-
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Dec 7, 2010 04:43PM flash wrote:

the insurance company is hoping that if they deny and say no, you will eventually give in and just pay it.  Don't let them off the hook.  They use this as a standard tactic deliberately in addition to sometimes just being the poorly trained clerks fault.  Just keep pushing, let your oncs office handle it but, and i do mean but, make sure you get copies of everything they send to the insurance or recieve from the insurance, keep on top of it.  don't make the mistake of assuming it's all set and going past a filing date and getting stuck by default.

also, if you have the chance, make sure you have an actual copy of the details of your coverage. the full contract document.  it can pay sometimes in giving you ammunition to argue.

multifocal multicentric IDC, DCIS, pagets et al. - er+,pr+ her2+++, mast,chemo, ooph, hyst Dx 10/10/2007, Paget's, Grade 3, ER+/PR+, HER2+

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