Insurance and Neulasta

adawn24

Hi,

I had an insurance coverage question. I'm scheduled to start AC on Thursday. My onc explained Neulasta and said it would be a part of my treatment.

I had a letter from my insurance company in the mail tonight denying it since, as a breast cancer patient, I'm only at a ten percent risk for the low WBC and they require a 20% risk to cover.

Of course, the onc office was closed and I'm having port placement tomorrow. My doctor can appeal but only before the chemo, not retroactively.

So, finally my questions. Is this standard insurance co denial? Do you think my onc will get it covered? I plan to continue teaching high school while taking treatment so does that increase my risk enough to appeal? Is the Neulasta that big a deal? Based on the prices I see online there's no way i can pay for that out of pocket if the insurance denies.

It's nearly four am and I can't sleep so I'm posting. At least I feel like I'm taking some sort of action while I'm in a holding pattern to talk to my onc.

Thanks!