Herceptin not covered by insurance

[NaveenVaradaraj]

My mom has been diagnosed with Her2+ breast cancer. She has undergone 6 rounds of chemo+herceptin completely covered by insurance. Now for the remaining 11 rounds of only herceptin my insurance company (United India Insurance Company) is refusing to cover it. The documentation clearly says chemotherapy is covered and UIIC claim that herceptin is hormone therapy. Has anyone else faced this issue and did you overcome it?

[sumeet_shah Administrator]

Herceptin is definitely covered by Insurance. It is not a hormonal therapy at all, it is a targeted therapy and all insurance companies will pay for it.

The problem is, the system. A person of a level of clerk or an basic doctor, who does not even know medicine fully, is usually hired by these insurance companies to look into claims and they are always encouraged (by various means) to refute as many claims as possible. It's very painful and I too very much see it regularly, on and off, with my patients. If your mediclaim amount is sufficient enough, they should definitely sanction for Herceptin. You must talk to your agent and if need be, request your treating Oncologist to help here. Till date, in my patients, where such claims have been refused for dubious reasons, I have always given a very kind and explaining letter (without any harsh words), and to my knowledge, almost all of them have got their claims settled. Your doctor will help you out here.

[Rmyadav in reply to sumeet_shah]

Dear Sumeet Shah,

My doctors in AIIMS, New Delhi have written all types of cancer certificate but UIIC has no views and do not like to reimburse. Please advise what should I do? I have put my case to ombudsman but I am waiting their result. United India is a worse insurance provider.

Please help me.

[pprabhu]

Same happened to me under Mediclaim. They refused to pay for herceptin. Took a lot of calls, letters from Doctors, email exchanges etc and a lot of time and tension to prove the insurance company that herecptin is targeted therapy and is needed for my treatment! . But luckily as the insurance was from my office there was a dedicated agent who got the corporate insurance. So he was my punch bag everytime insurance was rejected. But at last got it after 2-3months wait. So do try and do not give up on these insurance companies. or else write to IRDA in case they still don't approve

[AjayKK in reply to pprabhu]

I am also facing same problem. Please share your email id.

[Amit9184 in reply to pprabhu]

Hi pprabhu, i am also going through the same phase. I also have corporate mediclaim. But the dedicated agent who looks into all these, is asking for reference of the identical claims, which have got settled. It would be very kind, if you can share your reference of the claim. It would be very helpful for me.

you can mail me at [e-mail]

[chandraa]

I faced same issue with medimanage.They refused to pay for Herceptin . They paid only if it was given with chemo.As prabu said please do follow-up with doctor letters.

[NaveenVaradaraj in reply to chandraa]

Were you able to get medimanage to finallly

pay?

[ranjitk]

We are also facing the same problem and after raising these complaints with United India they dont even care to respond. Pathetic!

[NaveenVaradaraj in reply to ranjitk]

Keep your status posted. I was unable to convince the insurance guys at HAL and at United India. Even the doctors at Shankara Cancer Centre asked us to go for a cheaper Indian alternative instead of trying to convince the insurance compnaies

[Sharathkumar in reply to NaveenVaradaraj]

which doctor informed you about alternative medicine in Shankara cancer center

[kanhaiya2 in reply to Sharathkumar]

Generally there first prefrence is for Indian variant.

[kmotiyani_7253]

Can anybody confirmed that have you received the claim finally in spite of the fact the intially it is rejected by United insurance.

[rohit1234]

I got denied for the cover for the insurance amount reasoning that Trastuzumab is not covered. What to do?

[drjbvin]

I am also refused claim for Herceptin by MDindia. Can anybody help me ,what to do now to get the claim

[ango]

Hi all,

I am facing the same problem wherein the standalone trastuzumab cycles are being rejected by the Oriental insurance company. Request your help and guidance as to how to tackle this problem.

[ango]

Hi Naveen,

I am facing the same problem with my mothers treatment wherein Oriental Insurance company is rejecting the trastuzumab cycles. Request your help and support on how did you get your claims approved.

[D1002]

I am Deval Patel, a solicitor who has suffered the same misery at the hands of United India, my insurance company.

I have taken up this issue both with the Insurance Ombudsman and the IRDA.

Last week I have submitted a 200 page compilation, including opinions of Medical Oncologists, Articles on the criticality of Trastuzumab and Technical papers on the subject. I am waiting for their responses.

In the meantime, if you would like to receive updates on my crusade for the inclusion of Trastuzumab in insurance claims, please contact me by email with your case details on [e-mail].

[AttorneyHealth in reply to D1002]

Hi deval. I’m Rimali and I’m an attorney who’s trying to get this issue settled either with involvement of IRDA or with High Court. Can I please have your email address so that we can connect or you can write to me at [e-mail]. Thanks.

[bhavika23]

Same issue....my herceptin was not covered in insurance😒

[Vadil]

Herceptin is covered. Latest Obdusman has given judgments in favor of patients.

[Jsvs in reply to Vadil]

Sir,Where can I get the judgement copy? Plz give link.

[Griever in reply to Jsvs]

sir pl provide the link. I am facing the same problem. My email is [e-mail]. Regards n thanks Alka

[Jsvs]

Sir,Finally you got the claim sanctioned? I have similar problem. Please help me. [e-mail]