Claim Denied

So, there was one more thing I learned while at chemo the other day that I failed to mention. Honestly, I just did not want to get into it...deal with it...face it. A couple of days later and here I am...with it.

Herceptin is breast cancer specific chemotherapy. It is also the most expensive form of chemo available today. Maybe because it is relatively new or because of what it can do in regard to pinpointing the cancer site. I don't know. All I do know is that my insurance company has denied my having it.

As we know, I was to undergo four "hard chemo" treatments with the Taxotere, the real poison, if you will, as far as side effects, etc. After those first four treatments, I would graduate to only Herceptin, once every three weeks, just as I take chemo now. Herceptin does not wreak havoc on your body the way the Taxotere does. In fact, there are few side effects associated with it. My hair will grow back. My nausea and vomiting will decrease. It's all good with Herceptin. This is what I have been waiting for. Chemo that does not kill you while trying to heal you.

The past four chemo treatments have included Herceptin in my cocktail. It has been Herceptin, Taxotere, and something else...all followed by a saline chaser. Herceptin is over $6,000 per dosage. This means I have been denied over $24,000 in chemotherapy coverage for the past four treatments. It's ok. I'll just write a check.

Now, I am scheduled to have Herceptin for the rest of my calendar year, which will end October 2010. So, at $6,000 a pop, once every three weeks for a year...that means I will only owe $104,000. Chump change, right? Since I am terrible at math, I will tell you how I came up with that figure, in case it is wrong...

52 weeks divided by 3 = 17.333
17.333 chemo treatments @ $6,000 = $104,000

Now, of course, my oncologist is writing a "letter of medical necessity" and I am hopeful that his course of action and care will be weighted appropriately against the expert knowledge of the insurance adjuster, as in NOT an oncologist. Ugh. In other words, my life could be in the hands of an angry, maladjusted depressed man who hates women because his mother made him wear bow ties to church on Sundays. Hey, it could happen. Hopefully it won't, but it could and you know it.

Lucy says that at this point, I must simply turn this over to Dr. Horn and allow him to fight this battle. He knows what he is doing and has surely done it before. The thing is, I like to fight my own battles and I like to be in charge of decisions which effect me so personally and profoundly. This fight, even though it is about me, has nothing to do with me. I am a subscriber number...I am not a person with a family or friends or hopes or dreams or passions to make the world a better place. I am an over-priced cancer patient who may not be worth the cost of saving.

I am a "Claim Denied".