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lauri
Joined:
Apr 2006
Posts:
259
Latest activity:
Jan 4, 2022
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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)
S
sheila888
Joined:
Jul 2009
Posts:
25,415
Latest activity:
Aug 15, 2019
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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-
L
lago
Joined:
Jul 2010
Posts:
17,053
Latest activity:
Feb 15, 2022
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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-
F
flash
Joined:
Oct 2007
Posts:
1,686
Latest activity:
Mar 6, 2017
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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+
