Insurance denial for Lupron?

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Darumama
Darumama Member Posts: 135
edited January 2019 in Hormonal Therapy - Before, During, and After

Today I got a letter from my insurance company saying they do not deem my monthly Lupron shots as medically necessary. I’ve been on arimidex and lupron for about 3 and a half years, so it is more than a little surprising they waited so long to tell me this. A preliminary message from the doctor’s office indicated that in response they are thinking of stopping the Lupron and that “maybe” the ovaries won’t start up again. Feeling frightened. Anyone else have this happen? Anyone successfully fight for access to lupron? It’s amazing how even after mostly“moving on” something like this sends me reeling back to cancerland and it’s worries.

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  • jessie123
    jessie123 Member Posts: 532
    edited January 2019

    I formally appealed an insurance denial years ago for my husband --- and WON. However, you'll need medical documentation of your need for Lupron.

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  • Tresjoli2
    Tresjoli2 Member Posts: 868
    edited January 2019

    I had the same thing happen to me. Insurance company told me it couldn't be preventative because I had already had cancer. They covered some of it, but each shot cost me several hundred dollars. I stopped taking it. Hugs.

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