Perjeta … No! Final Answer!

The truth is finally out and on the table!

Recall the medical provider’s representations (to our Aetna Case Manager) that the magical $500 was now to be part of our 2014 deductible – these were misrepresentations.  At the close of business yesterday, during our scheduled conference call, we got to the bottom of it all.  The medical provider’s Clinic Director officially notified us that they will not change their self-insurance policy on Perjeta.  Yup, it’s been about the Perjeta all along.  Such a shame!  Our insurance carrier has repeatedly made it clear that the medical provider has no compelling need to do this, yet they are leaving this requirement in place. William has worked so hard to make this a win-win solution.  He worked everyday over weeks to resolve this satisfactorily with my medical provider, but to no avail.

Sad day!  We simply don’t have the money to self-insure this bill.  No Perjeta for me!

So … Cycle 2 Chemo is scheduled for January 7, 2104.  I will go forward with the 2-drug treatment regime, while we looking for other options.  This news is very scary for me.  Their doctor prescribed Perjeta and as a national standard it is the most effective drug treating HER2-positive Breast Cancer.  Get this!  According to the clinical tests submitted to the FDA in support of its approval, Perjeta (when given in conjunction with the other drugs they are already giving me) completely shrinks tumors before surgery in about 40% of the cases.

William and I picked up copies of my medical records today.  We will take the weekend to consider our options.  For sure, Second Opinions are next.  This is terrible.  Who knows this stuff.  We’re innocent patients, not attorneys.  I know in my heart of hearts that things will work out.  The Perjeta protocol is far to powerful to not be available somewhere where my insurance company is not made to be the bad guy, especially when that insurance company has documentation on-line explaining the very advantage I spoke to above.

Head-up and moving forward with my hubby, we’re walking hand-in-hand to a successful end to this mess!


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