• Health insurance refusing to pay for Avastin for lung cancer patient - any one else had this experience?

    Asked by attypatty on Saturday, April 28, 2012

    Health insurance refusing to pay for Avastin for lung cancer patient - any one else had this experience?

    Has anyone has their insurance company refuse to pay for Avastin for lung cancer treatment? It is happening to a friend of mine who has Stage 4 lung cancer (never smoked), adding a $60K insult to injury. And the drug was preapproved before she started the treatment. Any advice?

    4 Answers from the Community

    4 answers
    • joyce's Avatar

      Insurance companies often refuse to pay initial requests because many people don't appeal thendenial and pay the bill themselves. Sometimes if you keep appealing, the insurance company will pay. My husband's initial hospital bill was $110,000, and the insurance company denied it. Fortunately, it eventually worked out.

      over 4 years ago
    • mykidshavepaws' Avatar

      I have the same diagnosos as your friend. My insurance, a Medicare Advantage Plan is covering it but the co-pay is still very expensive. I'm receiving assistance from Cancer Care, a non-profit organization. The division that helps with costs is Cancer Copay. It is easlily found online. I'm not sure how it works if insurance won't pay at all but they may have suggestions for appealing, which as Joyce said, is often the best recourse. If there is a social worker available at her place of treatment they can be very helpful.
      Good Luck!

      over 4 years ago
    • hikerchick's Avatar

      Also try contacting the drug maker directly. I've heard of situations where they have directly sent the drugs free to the patients, but only one month at a time and I have no idea what your chances of success with this will be.
      Good luck!

      over 4 years ago
    • Carol55's Avatar

      Most states have a Division or Department of Insurance or Insurance Board to which you can report unethical practices. If the drug was truly pre-approved by the insurance and then they pulled their coverage they should be reported to the state in which your friend resides. They can help you decide if you have an actionable claim against them.

      over 4 years ago

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