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The Avastin Saga Continues

Hatshepsut's picture
Hatshepsut
Posts: 340
Joined: Nov 2006

Thank you to everyone who gave me information and support regarding Blue Cross' denial of coverage of my husband's Avastin treatments.

To update you, we still have no resolution.

You may recall that Blue Cross is denying Avastin coverage because my husband did not also have 5FU infusions (he had Camptosar). My husband began his treatments months ago; Blue Cross' denial is the result of a "retrospective" review that began months after the treatments started.

Today I learned that, because my husband's Blue Cross PPO insurance is through the California Public Employees Retirement System, we have no right to an appeal through the California Insurance Commissioner. We do, apparently, have a number of options (including an initial review, several other levels of review and, finally, a lawsuit) through the California Public Employees Retirement System. Apparently, if one's insurance is "self-funded," (as is CalPERS Care) the State Insurance Board has no jurisdiction.

I have been fighting this battle with the insurance company since December of 2006. I'm exhausted and today's information about our lack of access to the state insurance board is really upsetting. (I know that there are financial assistance programs through Genentech, but I believe we fall just outside the financial limits to receive that assistance!)

So, my bottom line in this message, is to beware of your insurance coverage. I hope our issues will be resolved in the internal review that is going on, but I can't believe I have to deal with this stress along with the enormous stress I feel dealing with my husband's illness.

Sorry for venting.

Hatshepsut

hopefulone
Posts: 1048
Joined: Jan 2007

I'm sorry that you have to deal with this on top of everything else. My husband is on avastin (not sure if he will continue though since he has now developed a blood clot in his leg which is probably due to the avastin) He's stage IV and I'm worried that w/o the avastin his mets will progress. I know it's hard to stay persistant, but hang in there. Sometimes the outcomes we pray for are not exactly what we want, but nonetheless, there is a reason for it that we may never know while we're here. Good luck and keep us posted. God Bless
Diane

AuthorUnknown
Posts: 1560
Joined: May 2006

Sorry you are dealing with so much at this time.

My husband also had Avastin and Camptosar (with 5FU). I am insured with BCBS through Teacher Retirement System (Alabama). They have never denied any claim and husband was on Avastin when I added him to my insurance during open enrollment. All that to say that you should keep trying. My insurance is now covering Xeloda.

Do you have an insurance rep at work that could contact someone at the state level for you. I work for a college and several times our insurance officer has made contact with the retirement system regarding insurance questions/claims. Just a thought. Good luck and hope that the Avastin does a great job.

Also, has your onc exhausted all means to get your husband's treatment covered. Sometimes the insurance company will cover treatment if contacted by onc and given a thorough understanding of the case.

One more thought, in Alabama, we have the option of a case manager from BCBS. This person is suppose to see to all your needs during care. I have not used one but maybe a case manager could help you plead your case to BCBS. You are in my prayers.

Betty

goldfinch's picture
goldfinch
Posts: 737
Joined: Oct 2003

I have no words of wisdom or suggestions, but my thoughts are with you. Good luck with this fight!
Mary

Hatshepsut's picture
Hatshepsut
Posts: 340
Joined: Nov 2006

Thank you to everyone who has given me encouragement in our fight with Blue Cross/California over their denial of my husband's costs for Avastin. I am happy to report that their denial has been overturned. After fighting them for seven to eight months (sometimes calling them two and three times a day), I feel that their refusal to cover my husband's bills was unconscionable. The fight took a toll on both of us and distracted us from the real task at hand--geting well. My husband is doing well.

Hatshepsut

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