Perjeta: Still Battling Denial of Service


For those who have asked, the Perjeta financing saga goes on.

William continues his work with the AETNA Case Manager to sway my medical provider to change their misinformed house policies pertaining to charging a $500 deposit per infusion of an AETNA approved and covered (i.e. scheduled) drug since December 2012.  I’ll leave explaining the details of this wild and wooly project for William to relate once the matter is satisfactorily resolved.  If I wasn’t feeling so disjointed and pestered by the side affects of the Chemo drug, the ride on this roller-coaster wouldn’t be near as nauseating.

William has properly identified and resolved the business reason for the financial staff at the medical provider not getting paid for Perjeta over the last year – wrong diagnostic and/or billing codes – and yet they have been sticking to their guns.  Something like – it’s their policy to make the patients assume 100% of the financial risk (responsibility) for this drug until AETNA miraculously starts paying for it.  Mind you, re-submitting their standing claims with the proper billing code and letting me move on without signing our financial life away for this FDA and AETNA protocol-required drug isn’t something they see as doable.  Well, at least not as of last Friday evening.

William tells me today, Monday evening, that AETNA believes the medical provider is moving towards correcting their course.  We hope to know more this coming Thursday, the day after Christmas.  Keep your fingers crossed.  January 7th is coming up quickly and the Perjeta infusion is critical – like I’m not able to miss it without jeopardizing the continuity of my pre-surgery treatment regime.  I’m betting on William. If anybody can he can make this happen, one way or another, he can.

My advice to those having to walk this road in the future is to take your team with you.  The natural conclusion is that once Chemo starts you will need someone at your side to help with the financial/insurance matters.  I’m here to tell you gathering that team right from the beginning and having them join you as early as the post-diagnosis telephone call has huge advantages.  There is so much to remember and do.  For sure, once “chemo brain” sets in and the general fatigue hits having help is critical.


 

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