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Chemotherapy still pending insurance approval


Isabelle49

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Curious if anyone else here has United Health Care Medicare Advantage Plan? Been  waiting to hear from them for a week now.  From what I have read, Medicare Beneficiaries with Part A and B are covered for chemotherapy and radiation. Not sure what the hold up is. Thanks

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Yes. That's what I believe I saw also. Chemo is not a drug covered by D. It's covered by Medicare part B. But I stand corrected because I was just skimming through my coverages. I believe that my insurance has a co-pay of 20%. I don't have your same insurance company but I have a feeling that this is true across the board

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Hi Isabelle-

There was a hold up for my first chemo appointment too. When I tracked it down the hold up was at the hospital, they had not provided the necessary documentation to the insurance company. 

While my doctor’s documentation was picture perfect the finance team did the pre-cert, under chemo rational they wrote “ patient has cancer” duh.  

I’d start hounding the hospital precert team to see what they’ve been up to. Doctors are typically out of the loop and calling the insurance 800 customer service number is pointless.  

It you don’t get anywhere with the hospital precert team then call the patient advocate. Do not sign any papers at the hospital to assume financial liability, I refused and got my chemo treatment without the final approval in place  

I made a lot of noise after discovering the hold up and the precert got approved in one day. 

Michelle

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  • 2 weeks later...
On 6/30/2019 at 7:16 PM, Isabelle49 said:

Curious if anyone else here has United Health Care Medicare Advantage Plan? Been  waiting to hear from them for a week now.  From what I have read, Medicare Beneficiaries with Part A and B are covered for chemotherapy and radiation. Not sure what the hold up is. Thanks

Hi Isabelle49,

I have United Health Care Medicare Advantage Plan/dual complete and all of my cancer treatments have been approved.  Chemo/Immuno, MRI brain scan, and all the other scans...pet,ct,etc. Hopefully by the time you see this, your approval has been received and you have been going to treatment(s).  I just started chemo/immunotherapy this past Monday and i'm amazed by the process.  So far, so good!

Sending my thoughts and prayers to you and all of those that care and love you. 

Good luck to you and God Bless...

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