My insurance doesn't want to pay for chemo

Hi Mags,

Well, that sucks. But there are options for you. I had really crappy insurance too when I was diagnosed and I found a bunch of programs that could help. Try CancerCare -- give them a call and see how they can help. Also, for the drugs you need, you can contact the drug companies directly -- most of them have a program to help patients in need. There's one for Neulasta, and one for Emend, the anti-nausea drug you will likely need. I'm sure there are others too. You will have to spend a lot of time on the phone and filling out forms. Start organizing and saving all your financial info -- your rent/mortgage payment, utility bills, credit card bills, pay stubs, etc. -- but if you are persistent, you can get the help you need. My efforts along these lines saved me tens of thousands of dollars. Another thing to consider is applying for financial aid directly to your hospital/clinic/doctor's office. If worse comes to worst, get the care you need, rack up the bills, then declare bankruptcy. It would suck, I know, but really, what choice do you have? You need this treatment to save your life.

Good luck! 

I too would call the insurance company yourself and double check that information.  I've heard of insurance paying very little toward treatments but denying it completely seems way out of line.

They certainly can't say it is not medically necessary ... unless they need more information from the onc or something has been coded incorrectly??

Best wishes to you ... you certainly didn't need this aggravation too  (((hugs)))

Mags,

Have an attorney file a grievance and handle any necessary appeals.   

WHY doesn't the insurance company think they should not pay for Neulasta ??  Obviously they don't WANT to pay for anything, but where in their contract with you do they specifically deny coverage ?

In my experience, they often deny first ... and when challenged, back down or give a reason that you can get around (for example, moving the location iof your chemo as you have done.)  Would they cover the Neulasta if you self-injected at home?? (Did it -- no biggie.)  Or if your oncologist wrote the reason it's necessary in your case ??  

My SO got denied several times for lab tests -- finally the hospital noticed that they had misspelled his name on the claim so the insurance company kept denying as "no current insurance".  And on my bills I had to tell the hospital three times (in writing) that my OLD Blue Cross had been replaced by a NEW Blue Cross -- finally wrote this across the front of the "this is about to go to collections" notice with a note that "If you send it to the right place, you will get paid."

However, coverage that you have to fight for is better than no coverage at all.  

Keep fighting !

My insurance didn't want to pay for the Neulasta they did pay for Nupogen instead check into that.

Mags,

I got through chemo fine without Neulasta shots. They will check your blood counts weekly and if they are good then there is no need to boost your counts artifically. You can just wait and see on this. Like SpecialK said, they might pay for it IF it becomes necessary, but not until. It also has side effects, so do some research first.

I just finally had a bill from January paid that the hospital was trying to collect from ME because insurance hadn't paid it and it turned out they were sending the bill to the wrong P.O. Box at Blue Cross Blue Shield. You really have to watch them!

Maggie, that's great! I'm so glad you can finally  relax about the insurance so you can focus on getting well. Good luck today, I guess the good news is that there is no right or wrong way to feel, its just kind of a roller coaster ride of ups, downs, twists and turns. Lets hope its all downhill from here