cisplatin taxol combo therapy. help

tonyanddenise

my insurance company is saying that cisplatin and taxol combo therapy falls into an experimental category and they will not pay. My tx is now being postponed. I need a link to prove otherwise. Why I need to do this and they are not listening to my med. oncologist is beyond me. Can anyone help?

tonyanddenise

it continues
My wife and I have been on the phone most of the afternoon trying to iron out what the problem is with this combination and why they wont pay for it. my mo has been on the phone with them sent all results into a third party for review and approval. I just am angry! how can the insurance company indicate what is suitable for me without not even meeting me? I did not want to be part of a trial, simply a part of a proven plan for hope of no reoccurance. Dee and I went to 3 sets of oncologist teams before making a decision. Now they ins. says this is not approved by the fda? not the norm? experimental? I thought that the erbitux was experimental!
now finally they are saying that if I were part of a trial it would all be covered! WTF? Seriously. Peg was put in 2 days ago. was up and about yesterday, today It hurts terrible. I took the kids to swim team and the dog ran off. I stopped and asked the little kids a block down the road if they had seen her and the cops just left! the mom reported me. I just want to scream!!!!! and radiation starts tomorrow.......argh...

Kent Cass

tonyanddenise said:

it continues
My wife and I have been on the phone most of the afternoon trying to iron out what the problem is with this combination and why they wont pay for it. my mo has been on the phone with them sent all results into a third party for review and approval. I just am angry! how can the insurance company indicate what is suitable for me without not even meeting me? I did not want to be part of a trial, simply a part of a proven plan for hope of no reoccurance. Dee and I went to 3 sets of oncologist teams before making a decision. Now they ins. says this is not approved by the fda? not the norm? experimental? I thought that the erbitux was experimental!
now finally they are saying that if I were part of a trial it would all be covered! WTF? Seriously. Peg was put in 2 days ago. was up and about yesterday, today It hurts terrible. I took the kids to swim team and the dog ran off. I stopped and asked the little kids a block down the road if they had seen her and the cops just left! the mom reported me. I just want to scream!!!!! and radiation starts tomorrow.......argh...

what little I know-
is that not so long ago Erbitux was experimental as a stand-alone/first line Chemo, as it was originally follow-up to an initial platinum-based Chemo (perhaps Cisplatin). England approved it a couple years ago as a first line Chemo, and I'm not sure about the US- other than others, here, have been given it. I had United Healthcare coverage, and had no problems.

As far as the Cisplatin- a number of us were given it with FU5, as was I. Cisplatin's been around for quite awhile, so, I would assume it is the Taxol that's the problem, or it as a combo w/Cisplatin. Seems your Oncologist's office should have someone talking to the insurance people, bigtime, to get it cleared. Either that, or switch you to a combo that isn't questionable.

Something you should realize, Tony, is that we are still somewhat early in the H&N C treatment/cure thing. The rough road of treatment is likely part of the arguement for trying new ways to treat H&N. I wondered if I was experimental, because my delivery of Cisplatin and FU5 was unlike any others active on our forum, but it now is my understanding that it's more of the old way than the new- though the old way involved hospital stays, which I didn't have. Did your Oncologist say anything about your combo being part of "a study," or experiment? If the combo isn't approved by the FDA, then I do think your Onco should come clean with you on that fact.

Just try to keep moving forward, Tony. You must get the C taken care of, and the sooner the better.

kcass

D Lewis

Kent Cass said:

what little I know-
is that not so long ago Erbitux was experimental as a stand-alone/first line Chemo, as it was originally follow-up to an initial platinum-based Chemo (perhaps Cisplatin). England approved it a couple years ago as a first line Chemo, and I'm not sure about the US- other than others, here, have been given it. I had United Healthcare coverage, and had no problems.

As far as the Cisplatin- a number of us were given it with FU5, as was I. Cisplatin's been around for quite awhile, so, I would assume it is the Taxol that's the problem, or it as a combo w/Cisplatin. Seems your Oncologist's office should have someone talking to the insurance people, bigtime, to get it cleared. Either that, or switch you to a combo that isn't questionable.

Something you should realize, Tony, is that we are still somewhat early in the H&N C treatment/cure thing. The rough road of treatment is likely part of the arguement for trying new ways to treat H&N. I wondered if I was experimental, because my delivery of Cisplatin and FU5 was unlike any others active on our forum, but it now is my understanding that it's more of the old way than the new- though the old way involved hospital stays, which I didn't have. Did your Oncologist say anything about your combo being part of "a study," or experiment? If the combo isn't approved by the FDA, then I do think your Onco should come clean with you on that fact.

Just try to keep moving forward, Tony. You must get the C taken care of, and the sooner the better.

kcass

Formal appeal / consult
My insurance company initially denied some treatment protocols for me. The next step in the process was for my doctor to contact the insurance company physician directly, for a "physician to physician" consultation to justify the need for the treatment. That worked. If you've had no success, your oncologist should be speaking with their doctor. Good luck! Hang in there. Many of us have been through the same rounds of denials.

Deb

Kent Cass

Kent Cass said:

what little I know-
is that not so long ago Erbitux was experimental as a stand-alone/first line Chemo, as it was originally follow-up to an initial platinum-based Chemo (perhaps Cisplatin). England approved it a couple years ago as a first line Chemo, and I'm not sure about the US- other than others, here, have been given it. I had United Healthcare coverage, and had no problems.

As far as the Cisplatin- a number of us were given it with FU5, as was I. Cisplatin's been around for quite awhile, so, I would assume it is the Taxol that's the problem, or it as a combo w/Cisplatin. Seems your Oncologist's office should have someone talking to the insurance people, bigtime, to get it cleared. Either that, or switch you to a combo that isn't questionable.

Something you should realize, Tony, is that we are still somewhat early in the H&N C treatment/cure thing. The rough road of treatment is likely part of the arguement for trying new ways to treat H&N. I wondered if I was experimental, because my delivery of Cisplatin and FU5 was unlike any others active on our forum, but it now is my understanding that it's more of the old way than the new- though the old way involved hospital stays, which I didn't have. Did your Oncologist say anything about your combo being part of "a study," or experiment? If the combo isn't approved by the FDA, then I do think your Onco should come clean with you on that fact.

Just try to keep moving forward, Tony. You must get the C taken care of, and the sooner the better.

kcass

taxol
Tony- might try researching Taxol on Wikepedia. Just might be experimental for H&N, and a problem for the FDA. Has been used in C treatment for a number of years, though, and is regarded as effective. H&N, though, with Cisplatin? Hmmmm...

kcass

Skiffin16

Cisplaten, Taxotere, and 5FU
I thought someone, just posted that this combination was kind of the new standard recently. I know there have been several (including myself) that have had this combination...Taxol is another name for Taxotere, if I'm not mistaken, or at least a variant of each other....

Greg53

Skiffin16 said:

Cisplaten, Taxotere, and 5FU
I thought someone, just posted that this combination was kind of the new standard recently. I know there have been several (including myself) that have had this combination...Taxol is another name for Taxotere, if I'm not mistaken, or at least a variant of each other....

Insurance hassels
Tony,

Sorry what a PITA insurance companies are. I can't help you out on the chemo combination thing. Mine was straight Cisplatin and later switched to Erbitux, due to hearing loss caused by Cisplatin, but not in combo. However had 2 major disagreements with insurance company. One over a procedure they said was not necessary which just happened to cost $6000 and another over paying for a perscribed drug, also very expensive, about $2000. They said no exceptions! My wife was on the phone for days getting it straightened out. Luckily she's in the medical profession and that helped getting in touch with the right people.

First line of attack should be thru your doc's. They have a vested interest since insurance company will be paying them. The only other thing is the squeaky wheel gets the oil. Stay on the insurance company about it and make them explain it to you and the doctors if they still won't pay. We finally got them to agree to pay after many tiresome calls and letters.

Best of luck!
Greg

Pam M

Argh!!
Sorry you're getting the runaround. My insurance company didn't flinch at my Cisplatin/Taxotere/5-FU combo. They did have an issue at first with my Amifostine - doc's nurse was on the phone off and on for about three hours, but it did get sorted out. Hope your doc's office can convince your insurance company to get with the program.

tonyanddenise

Kent Cass said:

what little I know-
is that not so long ago Erbitux was experimental as a stand-alone/first line Chemo, as it was originally follow-up to an initial platinum-based Chemo (perhaps Cisplatin). England approved it a couple years ago as a first line Chemo, and I'm not sure about the US- other than others, here, have been given it. I had United Healthcare coverage, and had no problems.

As far as the Cisplatin- a number of us were given it with FU5, as was I. Cisplatin's been around for quite awhile, so, I would assume it is the Taxol that's the problem, or it as a combo w/Cisplatin. Seems your Oncologist's office should have someone talking to the insurance people, bigtime, to get it cleared. Either that, or switch you to a combo that isn't questionable.

Something you should realize, Tony, is that we are still somewhat early in the H&N C treatment/cure thing. The rough road of treatment is likely part of the arguement for trying new ways to treat H&N. I wondered if I was experimental, because my delivery of Cisplatin and FU5 was unlike any others active on our forum, but it now is my understanding that it's more of the old way than the new- though the old way involved hospital stays, which I didn't have. Did your Oncologist say anything about your combo being part of "a study," or experiment? If the combo isn't approved by the FDA, then I do think your Onco should come clean with you on that fact.

Just try to keep moving forward, Tony. You must get the C taken care of, and the sooner the better.

kcass

old vs new
Medical Mutual is my provider. Core source is a middle man outfit that mediates fees for the dr's and such. C. S. is the problem. They are not seeing the cisplatin/taxol combo as the norm. I have spoken @ great length today with both rad. & Med. oncologists. the tx plan is based on a previous study, all have been fda approved. However the fda approval is not where the study info came from. It is beyond my understanding at this time. I don't know what Fu5 is. That is approved w/o question. My M.O. Is persistent about the taxol.
Thanks for the response. I and Dee have had a challenging day.