dense dose taxotere not covered???Help

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Rachel1
Rachel1 Member Posts: 363
edited June 2014 in Employment, Insurance, and Other Financial Issues

My insurance won't cover 24 thousand dollars for 4 treatments of taxotere at two weeks apart -- dense dose.  They said it is because taxotere used in this way is experimental.  My oncologist never told me it was experimental. He only said that he could use taxol or taxotere, but chose taxotere because he felt is was more effective.  When the oncologist billing dept. called our insurance about chemotherapy, they simply said that there was no pre approved authorization needed.  What do I do now?? The oncologist is filing an appeal. But we can't afford 24,000 bill. Do I sue my oncologist?? Please someone help me understand this.

Rachel 

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  • lauri
    lauri Member Posts: 267
    edited December 2010

    The first line person at the insurance company called it "expeimental" but your onc should be able to explain that it's a standard drug ...which the insurance company has probably paid fror thousands of times .. and a standard treatment method.

     My A/C + T in a clinical trial to compare alternate timing protocols was initially denied as being "experimental" but the trial coordinator got it taken care of quickly and they paid for everything.  But I was in a panic after my first conversation with the insurance bozo.

    Deep breaths !!

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  • sheila888
    sheila888 Member Posts: 25,634
    edited December 2010

    5 years ago I had dose dense A/C every two weeks and dose dense Taxol every 2 weeks 4X each. There were no problems. Since Taxotere is considered the cousin of Taxol Why are they denying it?

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  • lago
    lago Member Posts: 17,186
    edited December 2010

    My insurance company refused to pay for my BS services to place my TE as phase I of reconstruction even though it was pre-approved and it's a law in this country that they have to pay for this. They also have refused to pay for the blood draw for my BRCA testing although did pay for the BRCA tests.

    We finally got them to pay for the reconstruction. We are still working on the blood draw granted it's a small bill but we pay so much for our cobra insurance I want them to cover what they are supposed to cover.

    My point here is don't let the insurance company scare you. They try to get out paying or delay paying all the time. Don't give up. That's what they want you to do.

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  • flash
    flash Member Posts: 1,685
    edited December 2010

    the insurance company is hoping that if they deny and say no, you will eventually give in and just pay it.  Don't let them off the hook.  They use this as a standard tactic deliberately in addition to sometimes just being the poorly trained clerks fault.  Just keep pushing, let your oncs office handle it but, and i do mean but, make sure you get copies of everything they send to the insurance or recieve from the insurance, keep on top of it.  don't make the mistake of assuming it's all set and going past a filing date and getting stuck by default.

    also, if you have the chance, make sure you have an actual copy of the details of your coverage. the full contract document.  it can pay sometimes in giving you ammunition to argue.

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