Herceptin not covered by UHC/Medco????

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madarin
madarin Member Posts: 21
edited June 2014 in HER2+ (Positive) Breast Cancer

Hello ladies... I just learned that my insurance (United Healthcare/Medco) will not cover my one year of weekly herceptin treatments!! HELP!! Is anyone else in this boat? How did you get your insurance company to cover this drug? I have no idea how i will pay for this if they don't cover it. Thanks for your input...

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  • Brenda_R
    Brenda_R Member Posts: 509
    edited August 2007
    I ran into a situation where my Onc charged quite a bit more than my insurance would pay, and I couldn't afford the difference. Luckily, my Onc waived the difference.

    It's shocking that your insurance won't pay anything on it.
    Did they state why?

    First, I'd start an appeal process to get them to pay, and while you're doing that, also visit http://www.gene.com/gene/about/views/pricing/patient-access.jsp
    for Genentech's info on getting help with the cost of Herceptin.
    Hope that helps you.
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  • juanita63
    juanita63 Member Posts: 171
    edited August 2007

    I have UHC/ Definity and I got a year of herceptin covered with no problem. What reason did they give?

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  • bonny1963
    bonny1963 Member Posts: 450
    edited August 2007

    I also have UHC and they are paying for mine. That is so strange.

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  • madarin
    madarin Member Posts: 21
    edited August 2007

    Hi again... the prescription plan company didn't give a reason, just said not covered. But once I spoke with the billing manager my onc's office, I learned that the ins co will pay, but the doctor's office has to send a full copy of the pathology report with the claim, and then they are still very slow to pay. But since my onc's staff is aware, I'm going to let them handle it. Must be a "billing/coding" thing. Anyway, I feel MUCH BETTER now, knowing they are aware of this and can get it done... Thanks, Ladies!

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  • josied0
    josied0 Member Posts: 66
    edited September 2007

    I have UHC also and have finished my year of herceptin and they did pay it was slow however...???  Healthwell foundation is a foundation if you are able to get approved financially that will pay herceptin co pays etc.  you can do almost all the paperwork over the internet to see if you qualify....check it out...since it is towards the end of the year I have no idea how low their funds may be...but many do retro payments or reimburse also......it may be worth it for you if you qualify!!!  Good Luck...JoAnna

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