Xeloda approval delayed by BC/BS

molly64
molly64 Member Posts: 5
in Breast Cancer #1
I found out last week that my breast cancer (in remission for 39 months) has metastasized to my bones (severe backaches last month led me to bone scans which showed my bones lit up like a Christmas tree). My onc prescribed radiation for the most painful pelvic area and Xgeva to help "cement" my bones and an oral chemo called Xeloda (2 weeks on and one week off-8 500mg pills per day).

Problem is my BC/BS insurance is dragging their heels "pending review" of my Xeloda treatment and I am so angry because I know that every day delayed is another day for the cancer to spread. I have talked to many levels of BC/BS insurance management and my onc's nurse has called also but nothing seems to help speed up the approval process. Frustrated, angry, upset and worried. What if they don't approve the Xeloda? It's the weekend and no one at BC/BS is working on my case!!!!

Comments

  • MAJW
    MAJW Member Posts: 2,510 Member
    #2
    Oh Molly!
    This sucks! My insurance company has no problem with Xeloda...I've been on it since July....I took it for 5 days a week along with radiation 5 days a week...Xeloda increases the effects of radiation.....which is a good thing...I have a recurrence in my lymph nodes...showed up 2 1/2 years after initial dx......I was really tired during that time...since then I take it for 7 days and then off for 7 days..this evening dose is the last for this week....yeah! And I have to say, Xeloda has been really easy for me....I take 3= 1500 mg in the morning and the same 10-12 hours later...just take my Zofran, generic, 1/2 hour before the Xeloda....BUT you have to eat first....I've been getting along in the mornings with two pieces of toast and jelly...and a glass of milk...all this after a cup of coffee....evenings no problem, just about an hour or so after dinner...

    I assume you had chemo your first go round...so if your insurance company covered that, it's hard to understand why they are dragging their feet on this......especially because the cost is so much less.......according to my oncologist, chemo is chemo, oral or IV......if not already,your oncologist's office needs to get involved and go to bat for you....

    Please keep us posted....we care and I wish you the very best!
    Hugs, Nancy
  • molly64
    molly64 Member Posts: 5
    #3
    MAJW said:

    Oh Molly!
    This sucks! My insurance company has no problem with Xeloda...I've been on it since July....I took it for 5 days a week along with radiation 5 days a week...Xeloda increases the effects of radiation.....which is a good thing...I have a recurrence in my lymph nodes...showed up 2 1/2 years after initial dx......I was really tired during that time...since then I take it for 7 days and then off for 7 days..this evening dose is the last for this week....yeah! And I have to say, Xeloda has been really easy for me....I take 3= 1500 mg in the morning and the same 10-12 hours later...just take my Zofran, generic, 1/2 hour before the Xeloda....BUT you have to eat first....I've been getting along in the mornings with two pieces of toast and jelly...and a glass of milk...all this after a cup of coffee....evenings no problem, just about an hour or so after dinner...

    I assume you had chemo your first go round...so if your insurance company covered that, it's hard to understand why they are dragging their feet on this......especially because the cost is so much less.......according to my oncologist, chemo is chemo, oral or IV......if not already,your oncologist's office needs to get involved and go to bat for you....

    Please keep us posted....we care and I wish you the very best!
    Hugs, Nancy

    Xeloda treatment delay
    Thanks for the hugs Nancy...Re: BC/BS coverage of Xeloda, I read somewhere in another forum that oral chemo drugs (like Xeloda)are considered as part of prescription drugs, while IV chemo is a procedure. I don't understand why this would take longer for approval from the insurance company. Thanks for the treatment tips - I will use them if I ever get my approval. What is Zofran used for?

    Thanks again,
    Molly
  • MAJW
    MAJW Member Posts: 2,510 Member
    #4
    molly64 said:

    Xeloda treatment delay
    Thanks for the hugs Nancy...Re: BC/BS coverage of Xeloda, I read somewhere in another forum that oral chemo drugs (like Xeloda)are considered as part of prescription drugs, while IV chemo is a procedure. I don't understand why this would take longer for approval from the insurance company. Thanks for the treatment tips - I will use them if I ever get my approval. What is Zofran used for?

    Thanks again,
    Molly

    Zofran..
    I take the generic form as Zofran is extremely expensive...anyway it is an anti nausea drug.....make sure when the the time comes to get an Rx for it.... Insurance companies look for any darn excuse! My Xeloda comes Fed Ex from an oncology pharmacy...

    Keep us posted...
    More hugs, Nancy
  • CypressCynthia
    CypressCynthia Member Posts: 4,014 Member
    #5
    Molly, you might also try
    Molly, you might also try sending a certified letter asap. If you get no result, you might also try talking with an attorney. This just sucks and I hate that you are having to go through both cancer and then having to deal with insurance idiocy also. Hugs and prayers coming your way. Good luck and keep us posted.
  • Gabe N Abby Mom
    Gabe N Abby Mom Member Posts: 2,413
    #6
    Molly, I'm on the Xeloda
    Molly, I'm on the Xeloda too, 1500 mg am and pm, two weeks on one week off. I don't need Zofran, my doc prescribed compazine (also for nausea) and I haven't even filled that scrip. I do take omeprozole in the am and pm with the Xeloda...I was having trouble with a heartburn type feeling but lower in my stomach, not upper. The omeprozole (pepcid, I think) takes care of that pretty well.

    I'm also having a some diarrhea here and there...not bad, but I do keep Immodium with me for that. And then I have the dry, red palms and soles of my feet. For that, I use Eucerin daily replenishing lotion several times a day. If it gets bad, I do the aquaphor overnight with gloves or socks.

    The Xeloda has been much easier than my original chemo. I hope it's easy on you too...once you finally get it approved.

    Hugs,

    Linda
  • Megan M
    Megan M Member Posts: 3,000
    #7
    molly64 said:

    Xeloda treatment delay
    Thanks for the hugs Nancy...Re: BC/BS coverage of Xeloda, I read somewhere in another forum that oral chemo drugs (like Xeloda)are considered as part of prescription drugs, while IV chemo is a procedure. I don't understand why this would take longer for approval from the insurance company. Thanks for the treatment tips - I will use them if I ever get my approval. What is Zofran used for?

    Thanks again,
    Molly

    I am so sorry Molly. I hope
    I am so sorry Molly. I hope that your insurance will come to their senses soon for you.


    Praying for you,

    Megan
  • New Flower
    New Flower Member Posts: 4,294
    #8
    CypressCynthia said:

    Molly, you might also try
    Molly, you might also try sending a certified letter asap. If you get no result, you might also try talking with an attorney. This just sucks and I hate that you are having to go through both cancer and then having to deal with insurance idiocy also. Hugs and prayers coming your way. Good luck and keep us posted.

    Molly please use formal written communication & fax
    I am very sorry for the problem. I am not surprised as I have been with BC/BS for several years through my treatment and it was not fun. Phone conversations did not lead anywhere. Ask for case-management nurse and fax formal letter. If your claim is denied you should go through a formal appeal process. They cannot hold it forever, there are requirement and time frame for each type of conditions. I alway fax my appeal papers , making sure there is traceable record of my written communications with BCBS.
    Let keep us posted.
    Good luck with your treatment
  • camul
    camul Member Posts: 2,537
    #9
    Molly, I am so sorry to hear
    Molly, I am so sorry to hear that the cancer has spread. I didn't think that the radiation was doing much when I first had my pelvic, hips and tailbone done, then about 2 weeks after finishing radiation, I realized that I was able to roll over in bed, walk and sit so much easier. It was amazing how effective it was.

    I am so sorry that you are having trouble with your insurance company dragging their feet. Keep being persistent. I have been told that many of the insurance companies are denying so many claims because only about a quarter of those that are denied are challenged even though they are legitimate claims. Your oncologists office advocating for you should help, like everyone says, put your correspondence in writing.
  • CypressCynthia
    CypressCynthia Member Posts: 4,014 Member
    #10
    New Flower said:

    Molly please use formal written communication & fax
    I am very sorry for the problem. I am not surprised as I have been with BC/BS for several years through my treatment and it was not fun. Phone conversations did not lead anywhere. Ask for case-management nurse and fax formal letter. If your claim is denied you should go through a formal appeal process. They cannot hold it forever, there are requirement and time frame for each type of conditions. I alway fax my appeal papers , making sure there is traceable record of my written communications with BCBS.
    Let keep us posted.
    Good luck with your treatment

    Great idea! Why didn't I
    Great idea! Why didn't I think of that New Flower?
  • Alexis F
    Alexis F Member Posts: 3,598
    #11
    CypressCynthia said:

    Molly, you might also try
    Molly, you might also try sending a certified letter asap. If you get no result, you might also try talking with an attorney. This just sucks and I hate that you are having to go through both cancer and then having to deal with insurance idiocy also. Hugs and prayers coming your way. Good luck and keep us posted.

    Wishing you good luck! Keep
    Wishing you good luck! Keep us updated.


    Lex

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