INSURANCE DENIED - STAGE 4 BREAST CANCER

[Srikalakm]

HI everyone, my mother is diagnosed with stage 4 breast cancer and doctor to give phesgo ( pertuzumab and transtuzumab) but insurance people told its a immunotheraphy so they wont apporve, but my oncologist told its a targeted therapy not immuno. my insurance is new india insurance under tpa being mediassist.Did any one face this issue and how they resolved it. I have doctor draft as well which says its targeted.

[Sidduram]

If the mentioned drug for your mother is given along with regular chemotherapy drugs then it will be approved by the insurance company, if it is given seperatly it will be refused by the insurance company, Get a letter from your oncologist and attach it along, it may work, I got my insurance claim from New india assurance co, best of luck

[Srikalakm in reply to Sidduram]

No even with chemotherapy they didn’t approve . They told monoclonal antibodies so they can’t cover it 🙁 even with oncologist letter

[Srikalakm in reply to Sidduram]

was it approved fully for pertuzumab and transtuzumab?

[Sidduram in reply to Srikalakm]

fully approved for Herceptin 6 doses