Humana ins

rooster6
rooster6 Member Posts: 9
in Prostate Cancer #1

Husband having trouble with getting Xtandi thru Humana.  They stated in refusal letter they said patient must meet following criteria: has progressive disease following treatmen t with abiraterone acetate (rising prostrate-specific antigen shouldn't be used as the sole criteria for progression.   Husband is in chemical castration phase, testosterone 0 psa .01.  His cancer has moved beyond the psa it doesn't even register.It is growing rapidly in his bladder, and there is a spot on his lung.  After 3-4 weeks going to oncologist,  still no meds, he is on Trelstar and 50 mg casodex and it is still progressing.  He passed blood for 21 hrs last week end, bleeding stopped, urologist said a blood vessel in bladder filled up and burst. He is trying to get meds for husband concologist has failed. So frustrated, all we get is the run around, automatic messages,  people  putting you off.  Have heard  that he should be placed on Zytigia when that fails then Humana might pay for Xtandi, anyone else here having trouble with Humana part D

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,641 Member
    #2
    MD Anderson may help with Humana refusal

    I am sorry for the news. Quite common we hear about the failure from the insurances when we most need them. You could discuss with your husband’s doctor about any possibility in starting the new protocol while waiting for the insurer’s approval. Some doctors manage to get approval earlier or even to introduce patients with similar advanced status into trials that use those meds.

    In any case, if cancer has become hormonal resistant and spread to lungs, then he may need a combination therapy with chemo. You need to get the opinion of a PCa oncologist, specialised in target medications. Who is attending you at MD Anderson?
     Care with the lipids (anemia).

    Best wishes in his continuing treatment.

    Your story;  http://csn.cancer.org/node/289055

    VG

    http://www.topix.com/forum/com/hum/TURUE6TNO4CH2F5U4/p2

     

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #3
    Appeal to Department of Insurance?

    Don't know if you have the time or energy to do it, but in CA anyone denied coverage for a medical condition can appeal to the Dept of Insurance for a review of the company's decision AND the Dept can force them to pay for coverage if they decide that it is/was a valid claim.  Every state is required to provide a method of appeal under the Affordale Care Act.

    Here's a link to an NPR article about how "most" people win when they appeal: http://www.npr.org/blogs/health/2014/04/14/302547851/patients-often-win-if-they-appeal-a-denied-health-claim.

    Good luck!!!

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