Maia wrote:BeansMama wrote:
Insurance is being a pain about paying for my Keytruda so the battle is on with them. My oncologist is quite peeved as we have proof it was approved then all of a sudden they went back and changed their mind and denied every treatment I have had (at 31,000.00 a pop) just had my 11th treatment this week, they have told me not to worry, I won't have to pay a thing. They have other ways of getting it covered for me. I called the insurance myself when I first found out about the denials. The representative I spoke to said it was because it was expiramental - sad that I had to inform him that the FDA had actually approved it for use in CRC treatment in May... Then they started saying it wasn't medically necessary - um, hello this stuff is the only thing that has succeeded in beating back my cancer therefore it is the main reason I am alive... Not medically necessary my ass. .
I'm outraged reading this. Get Merk --Keytruda manufacturers-- lawyers deal with your insurance. Your doctor can contact them too: https://www.merckaccessprogram-keytruda ... e-program/
If that fails, you can ask Laurie Todd to help you: https://www.statnews.com/2016/04/25/insurance-warrior/
She's a fellow of us in Colontown; post your problem and tag her in Downtown, she's a member there too: https://www.facebook.com/laurie.j.todd
My docs office has been working with Merck and they are aware of the crap my insurance company is pulling. It has been almost 2 months I think of back and forth with the insurance. They were able to get merck to cover my treatments going forward and I just received a letter from them today stating that they are giving me copay assistance as well. We will have to see how this all comes out in the wash. BCBS of TX did cover 2 treatments recently - I only found that out because I went to get a script and there was no copay. Found the entry where they covered it but hit me with deductible and coinsurance, it wouldn't let me pull up the eob. I will have to go back and see if it will allow me to view it now. Since I am now at my out of pocket max they will have to pay for it all anyway, seems kind of pointless to fight about it so much. My onc was so upset he thought I should hire a lawyer and sue the insurance company.