My Mother was diagnosed with Breast Cancer PT2N3MO, with HER2+ ER+ PR+ last year in September.
Undergone with modified radical mastectomy, followed by Chemotherapy (ECF * 3 & T*3) then Radiation therapy.
All were covered under Insurance (Surgery, Chemo, Radiation) Except Trastuzumab.
We were suggested to consider Trastuzumab (18cycles * 21days), which we started after radiation.
Currently 4cycles Trastuzumab(Hertraz) completed.
As initially planned, we thought Insurance would cover major chunk of medical expense.
But as shock it got rejected considering it as Hormonal therapy. After providing a letter from our doctor of nature of medicine as Monoclonal antibody later it got rejected as under a clause.
“Procedures/treatments usually done in Out Patient Department (OPD) are not payable under the policy even if converted to Day Care Surgery Procedure or as inpatient in hospital for more than 24 hours.”
Does Trastuzumab really considered under OPD/Is there any turnaround for this kind of scenarios.
It’s Very disappointing that even for this kind of malignant disease these reasons would apply.
At this point am really worried as with whom we need to fight!!! Is it with Disease? Or roam around this Insurance providers.
Still we are due with 14 cycles and am really worried on future course of action.