Perjeta … The Tennis Match Continues

William writes:

If you are following the Perjeta Tennis Match, here is the latest news.

Dawne’s AETNA Case Manager called  Monday, December 23, to let us know that she spoke with the medical provider’s Site Manager. There is an apparent change of heart at my doctor’s office, but with a twist. The original request for a $500 “deposit” against a $60,000 to $72,000 personal bill based on their false assumption that AETNA would not pay for Perjeta has been retooled. Now the medical provider wants $500 as an “advance payment” against what they think is a $2,000 “2104 Deductible”.

Me thinks the medical provider’s Site Manager tells AETNA, and thus us, one thing and her corporate policy makers another playing a dangerous gambit that no one will figure her out. It is beyond strange that a similar request has not been made by her as pertains to Dawne’s “2013 Deductible”. I don’t dare bring that point up and invite yet another last minute request for money.

Christmas Eve day and Christmas Day gave us a respite from what is beginning to feel like a job – working through the medical provider’s disjointed policies and procedures.

Today, Thursday, we sent off a FAX to Dawne’s Chemo Doctor – once again we are asking him to educate the medical provider’s finance people on standard insurance practices. Dawne’s “2014 Deductible” is $0.00 because she prepays AETNA $2,000 taking advantage of our government’s pretax medical provisions.  She has an AETNA PPO FSA HRA PLAN. Ok, it may seem like rocket science – but seriously, the medical provider is in a business dominated by payment from insurance companies. They ought to know this stuff backwards and forwards.   Dawne’s deductible is already met – by design.

Dawne has a doctors appointment on Friday am. Hoping our FAX to him explaining the above motivates him to get internal matters straightened out so he can order the Perjeta. I think I’ve mentioned before, he is an employee in this larger corporation. He must be as exasperated as I am. Dawne really needs this magical drug, without it I fear her chemo treatment is not adequate. This is an awful place to be since Dawne would have chosen surgery over chemo had it not been for the availability of Perjeta.


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