Breast Cancer India
2,238 members1,191 posts

Trastuzumab cover under insurance or not

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 anyone advice, how I can do it.

2 Replies
oldestnewest

Similar issue...My mother had BC metastasis. Was advised radiotherapy followed by Faslodex inj. AFter 6 months requesting unnecessary paperwork to 'prove' radiotherapy they paid.

Now, they are refusing paying for the Faslodex injections calling it 'hormone therapy' & although it is administered in day-care insurance co claims it can be done in OPD & hence is refusing to pay!

This is atrocious & some of us have to fight this. This is relatively new treatment with majorly advantage being hardly any side effects.

The insurance companies HAVE TO update their practises.

Reply

Hi Sray! I am sad to hear that and I remember you in my prayers. I am also a breast cancer survivor. I too faced the same issue in 2015. The Insurance company said they could cover the expenses when it is taken with Chemo injection. However my colleague who is dealing with Insurance, helped me a lot. He had various rounds of meeting with them over phone and in person to include the amount under insurance. We spent a few months negotiating with them. Finally a team from Insurance company visited my office and had a chat with me. And then they released the amount. It is possible for Insurance company, but it takes a lot of pain to convince them. We should convince them it is part of cancer treatment but it is hard.

I also got benefit from the Medical agent who supplied Herceptin injection(canmab). Every 4th vial is free and I got 2 vials free like that. You can explore this possibility with your oncologist

Reply

You may also like...