Inj. Hertraz insurance cover

[MdSal]

Hi Everyone,

This is regarding insurance cover for Trastuzumab(Hertraz Inj.). The cashless claim for this was rejected recently for 2nd cycle claiming it was not payable by UHC TPA, while the same was approved for the 1st cycle. I don't know why they rejected it for 2nd cycle. I have applied for reimbursement, but still in a dilemma whether they will approve it or not.

Can anyone suggest appropriate steps to get my reimbursement if they reject it again? And for the rest of the cycles can we still apply for cashless as it has been rejected now?

Thanks for your time!

[Rmyadav]

Loop

[Vadil]

Recently Obdusman has given judgments

to reimburse Herceptin inj to insurance companies.

[MdSal in reply to Vadil]

Is there a copy of it so that I can forward to them?

[Joedev]

Some insurance companies reject , but most private pay. I also experienced same cashless rejection.

However please do not let go keep on following up and escalate through their Grievance process. They will pay eventually.

[kanhaiya2]

Hi Sal.

Hertraz if administered along with other chemo drug will be approved by insurance as it is chemo therepy. Only hertraz is considered hormoncal teherapy which is not covered by insurance.

Hope this helps.