Insurance Considers Rituxan for Cancer to be under study?

PeprmntPat55 I am so sorry on top of everything else you are having to deal with the insurance company.  Rituxan has been being used for the treatment of Lymphoma for atleast the past 16 years.  I've been getting it since Jan 2008 and have never run into a problem with payment, over 30 infusions and counting.  I would first check with insurance and than contact your doctor or infusion center.  There may be a coding error causing confusion.  Point out to them that if it's still an experiment why has it just this year gone to being made generically.  It is used for many forms of autoimmune diseases but was first used for Lymphoma (yr 2000) and the literature documents survival has greatly increased since the application of this drug.  BTW, my hospital charges $25,000 per infusion.  Although insurance does not pay that much and the hospital than adjusts the charges.

Patty,

The refusal to pay for Rituxan is ridiculous.  Rituxan is often refused for HL, but that is because only one rare strain of HL has CD-20 cells, which is what Rituxan kills (I had that rare strain of HL, and did receive Rituxan).

Helath Insurance is in a quagmire right now, with many companies going out of business.  It is the duty of your doctor to appeal this and hopefully get a reveral of the carrier's decision.

max

PeprmntPat55 said:

Encouraged

Thank you all for your very helpful responses.  I have the paperwork confirming that my Dr did get pre-approval for treatment and hearing your responses helps me to feel a little bit better about this.  I am trying not to let it be a dark cloud.  

Rocquie, Day 1 of R & B stopped short halfway through due to reaction.  Day 2 of of Bendamustine went without any problems.  It was so short compared to Day 1.  
Both days I was totally wiped out.  Went home and slept through the night except for getting up to go to the bathroom. Only a tiny bit of nausea and the pills took care of that.  

I actually worked the day after #2 and worked full days the remainder of the week!  I can tell that I'm not up to par but really if this is the worst of it, I feel very fortunate! Thanks for asking.  

I'm so thankful to have this board.  You all have helped me so much already.  

Blessings, 

PP55

 

 

First insurnace. I learned years ago from a co-worker with a premi son who needed constant medical care for almost 10 years. The Drs and therapists would constantly recommend treatments or therapies and the insurnace would reject it. They would refile and it would pass or not. They would refile again and often it was then accepted. She learned though a support group this could be normal. The insurance will reject some claims knowing that some % of people will just pay and not refile. Then there is a % of people who give up wiht the seocn rejection. By the third filing those are the people that probably won't give up until the insurance approves the claim.  

Most of my claims went through the first time. Anytime it didn't I just contact my oncologist's nurse and she took care of it. Because of that co-worker I didn't panic when I saw a bill for $25,000 for a treatment. Never saw another bill for that.