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 in reply to sumeet_shah

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

Thanks

Reply (0)Report

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.

Reply (0)Report

Vadil in reply to sumeet_shah

Thanks

Reply (0)Report

pprabhu

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

pprabhu

Check this post too

healthunlocked.com/breastca...

GJoe

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 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.

Reply (0)Report

Sray

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 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

Reply (0)Report

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!

Reply (0)Report

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!

Reply (0)Report

Karthikaj

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.

swethaj in reply to Karthikaj

Hi Karthika,

Did you claim for Herceptin? I also have same New India Issurance Policy and would need to know if it is claimable or not. Could you please provide me details?

Reply (0)Report

GotoOmbudsman

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.

balakrishnaga in reply to GotoOmbudsman

Hi,

Could you please share the process which you followed? Even I have corporate insurance with new india assurance where they are rejected claims for my mother.

Reply (0)Report

GotoOmbudsman in reply to balakrishnaga

1st Step: Please lodge complaint with Grievance Cell of Insurance Company

2nd Step: Post this lodge second complaint with Grievance Company

3rd Step: Lodge complaint with Ombudsman

Also Get this DRAFT OF LETTER FROM YOUR TREATING DOCTOR (Pls modify to your specific case) while making complaints in steps 1 to 3

This is to Certify that xxxxxx is under my treatment for Breast Cancer since xxxxxx and continues to be under my care as on date.

As part of her treatment to treat HER2 Positive Breast Cancer, I have made a Chemotherapy Treatment Plan under which Herceptin Trastuzumab Injections are a mandatory part of her treatment without which her treatment will be incomplete.

Furthermore, as part of the treatment plan, while Chemotherapy is administered for destroying existing cancer cells, Herceptin Trastuzumab is administered to prevent recurrence of cancer cells.

There is no difference in the manner of administering the Herceptin Trastuzumab drug compared to Chemotherapy Drug. Both treatments are administered intravenously and needs special care and attention of an Oncologist.

The discharge summary also clearly states that Herceptin Trastuzumab is a Chemotherapy dose.

Herceptin Trastuzumab injections are required for a full and effective recovery of HER2 Positive Breast Cancer Patients.

Reply (1)Report

balakrishnaga in reply to GotoOmbudsman

Thank you 🙏

Reply (0)Report

bga1 in reply to GotoOmbudsman

Hi GotoOmbudsman ,

I'm planning to for Ombudsman for reimbursement claim.

Can you please share the link of Ombudsman website where i can get the copies of previous orders made in favor of consumers ?

Reply (0)Report

Rmyadav

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.

Vadil in reply to Rmyadav

Go to obdusman, you will get

Reply (0)Report

GotoOmbudsman

DRAFT OF LETTER THAT WORKED FOR US

This is to Certify that xxxxxx is under my treatment for Breast Cancer since xxxxxx and continues to be under my care as on date.

As part of her treatment to treat HER2 Positive Breast Cancer, I have made a Chemotherapy Treatment Plan under which Herceptin Trastuzumab Injections are a mandatory part of her treatment without which her treatment will be incomplete.

Furthermore, as part of the treatment plan, while Chemotherapy is administered for destroying existing cancer cells, Herceptin Trastuzumab is administered to prevent recurrence of cancer cells.

There is no difference in the manner of administering the Herceptin Trastuzumab drug compared to Chemotherapy Drug. Both treatments are administered intravenously and needs special care and attention of an Oncologist.

The discharge summary also clearly states that Herceptin Trastuzumab is a Chemotherapy dose.

Herceptin Trastuzumab injections are required for a full and effective recovery of HER2 Positive Breast Cancer Patients.