Herceptin is covered under medical ins... - Breast Cancer India

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Herceptin is covered under medical insurance?

sppande
sppande

As I mentioned earlier in my post,My wife is diagnosed with Breast cancer and out of 06,three chemotherapy have completed. She is under medical family floater policy (The new India Assurance company). 5th and 6th Chemotherapy with Herceptin will start by 27th Feb 17 and another in march 17..

1)Would like to know any one claim is accepted by the new India Assurance company as far as Herceptin is considered?

2) Any kind of supporting letter is required from Oncologist to get it through.

Please advice.

regards

sp

16 Replies
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sumeet_shah
sumeet_shahAdministrator

I do not give chemotherapy, so am not the right person to guide you fully. To answer your questions:

1. All insurance companies pass claims on Herceptin

2. Letter may be needed only if things do not pass through.

Vadil
Vadil in reply to sumeet_shah

What type of letter from oncologist for herceptin her2positive breast cancer for mediclaim is required.

Thanks

sumeet_shah
sumeet_shahAdministrator in reply to Vadil

If Herceptin has been rejected by the Insurance provider as being a gene therapy, take a letter from your treating Oncologist that this is a standard treatment for breast cancer world wide, covered under insurance. It is not a genetic therapy for some congenital gene defect. It is a ‘targeted therapy’ targeted over certain genetic level targets involved in causing the breast cancer. Ask your Oncologist to provide some evidence, maybe a print out of NCCN guidelines, showing it to be a standard treatment.

Vadil
Vadil in reply to sumeet_shah

Thanks

Hello sppande ..

I had few problems in Getting Herceptin bills approved by Health Insurance company. But a letter from the Doctor was needed and many supporting Documents requested.

Best is talk to your Insurance company representative before hand (in my case my company had a corporate insurance so the HR directed me to a insurance representative who came to my place and took lots of supporting documents)

Also please note my first/second bill was rejected. But after 3 months I got all my claims.

Let me know if you have any quetsions

Check this post too

healthunlocked.com/breastca...

If herceptin is taken along with chemo medicine it is covered under insurance. This is what the insurance company says. However we need to talk to the insurance company. In my case my organisation helped a lot in the negotiation and I could claim the amount after 3-4 months. I took herceptin along with chemo for 6 months and alone for another 9 months. Totally 17 cycles

Sray
Sray in reply to GJoe

Hi Gjoe,

I have similar case, my mom is taking taking herceptin injection from last may 2017.when she was taking with chemotherapy ,the insurance was approving cashless transaction. But now when all chemo completed , the insurance is not approving the trastzumab injection alone saying alone this injection does not come under insurance policy. The insurance is corporate insurance , my doctor wrote a reconsideration letter to insurance for Trastuzumab, targeted therapy, but still they are not approving. Can you help me in this, how in your case you get it done.

Hi sir,

my mom is taking taking herceptin injection from last may 2017.when she was taking with chemotherapy ,the insurance was approving cashless transaction. But now when all chemo completed , the insurance is not approving the trastzumab injection alone saying alone this injection does not come under insurance policy. The insurance is corporate insurance , my doctor wrote a reconsideration letter to insurance for Trastuzumab, targeted therapy, but still they are not approving saying its monoclonal antibody, part of immunotherapy which is not cover able under insurance . The insurance people are saying we have our own sets of doctor and they don't approve this injection alone. I am not able to understand the concept when it can be approved with chemotherapy , why it is not when given alone. This injection cost is very high which is not possible for normal middle class to afford every 21 days from own. We have to go by insurance , I tried all possible way to convince them, produced doctors note what exactly Trastuzumab but didn't workout. Can you help me in this, how I can make it done.

ango
ango in reply to Sray

Hi Sray,

I am facing the same problem for my mothers treatment, wanted to check how did you proceed with the claim. I have Oriental mediclaim and they are also rejecting the trastuzumab standalone claims

prasad_231
prasad_231 in reply to ango

Hello, I am facing the same problem. Was your issue solved? Can you please provide more details on what we should be doing!

prasad_231
prasad_231 in reply to Sray

Hello, I am facing the same problem. Was your issue solved? Can you please provide more details on what we should be doing!

Hi sir

I need to have herceptin 18 cycles. I have mediassist- New India Insurance corporate policy. Do they cover for this drug? What kinda letter do they need.. thanks.

Hi All - I faced a similar issue with my mother's treatment where Herceptin injections were rejected by New India Assurance. However I followed the official channels and lodged a complaint with the Ombudsman and received 50% of claim amount awarded.

I strongly suggest everyone to file complaints with the Ombudsman for relief against non payment of herceptin claims by Insurance Companies. It also helps to refer to copies of previous ombudsman orders on Ombudsman website where previous such cases rulings have been made in favor of consumers.

Sir,

I am facing the same situation with United India insurance company and with its TPA MDIndia karol bagh, new delhi. I have submitted my complaint to Grievance Cell and Ombudsman office but no reply. Kindly suggest me where should I go for justice at the age of 64 years. There is corruption everywhere.

Kindly advise.

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