Insurance suddenly denied ALL chemo

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Jvseattle
Jvseattle Member Posts: 1
edited April 2017 in Stage IV/Metastatic Breast Cancer ONLY

I'm a 15 year breast cancer survivor (12 since mets), on targeted therapy. Went for chemo today and was told that the insurance company won't approve any more unless the dr can prove I still have cancer.

I have metastatic HER/2 neu positive, ER- PR- breast cancer. Originally diagnosed in 2001, chemo (including AC and Herceptin), lumpectomy, radiation.

Extensive bone mets found in 2005. PET scan indicated cancer throughout skeletal system. Needed surgery to stabilize femur/pelvis. Dr started Herceptin and Xeloda. Cancer went into full remission.

In 2008 had a spinal fracture due to damage from bone mets. Unclear if this was old damage or cancer progression. Radiation on spine. Dr. added Tykerb. I've been on these 3 ever since.

Today I went in for Herceptin infusion and found out that the insurance company needs proof I still have cancer to continue to cover ANY chemo. Dr is beside himself. He believes this cocktail has saved my life and that metastatic cancer is not cured / curable. He is appealing but I feel abandoned and terrified.

Has anyone heard of this happening? If the medical community says that mets are not curable how can the insurance co make me prove I still have cancer?

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  • JoniB
    JoniB Member Posts: 346
    edited April 2017

    I know how upset you must be. You would think insurance companies would be more compassionate to cancer patients but I  see that. I was on Herceptin this past year and my insurance company would not cover it initially either. They wanted proof that Herceptin was applicable to my type of cancer. As it turns out, getting  authorization just required the hospital providing the insurance company with the information they wanted. I had problems getting the claims paid after the authorization, but only because of the insurance company's incompetence. They all got paid eventually (I have two more that the hospital still needs to send in). Have your doctor find out from the company exactly what they need for them to accept you have cancer. It may not  be hard to continue with your treatment. Wishing you success getting the authorization.

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