Re: CAL-101 combination trials and insurance coverage

[Guest guest]

If I am not mistaken, each state decides if insurance

companies licensed in that state must pay for adjunct

treatments when part of a trial. hence it may be that your

carrier would cover these costs in one state, and not in

another. Also, there are probably hundreds of types of Blue

Cross policies, as there are for any carrier. Union or

group policies, and individual policies. There's no one

answer. This is also true of Medicare coverage. In

Medicare, the same policy must cover the same things within

a state, but the cost for the same policy can differ wildly

from one county to another. This is a question you will

have to deal with by contacting your insurance carrier.

The exception there is again, Medicare. They will not pre

approve anything. However the law in your state as to

whether Medicare must cover adjunct drugs are covered are on

line on the Medicare site. Probably also on the American

Cancer Society page. They may also be able to help with

these type of questions since they deal with them all the

time.

It is also possible that the physician who is heading the

trial can advocate for the 'medical necessity' if they

refuse to cover a portion of the actual medication used that

is not considered the 'trial drug'..

hope that helps somewhat. beth fillman

[Guest guest]

Here's the link/pdf concerning state by state coverage. if

Empire is NY, it may not be mandated that it be covered

since NY has no such laws at this time, or so it seems.

That does not mean that a particular policy/ or company may

not cover it, or that you can't appeal to get it.

Clinical Trials: State Laws Regarding Insurance Coverage

http://www.cancer.org/acs/groups/cid/documents/webcontent/002552-pdf.pdf

and here's an interesting site. National Coalition for

Cancer Survivorship. when you do get there, be sure to take

a look at the entire site since there are many sources and

booklets on there that may help during different phases of

our journey. on this page, go down to the heading

for " what cancer survivors need to know about insurance " and

click on it. it will open a PDF file. (where it says

order now, you can also order copies for a group if you

like)

http://www.canceradvocacy.org/resources/publications/

this site has a lot of good information for self advocacy,

such as how to find aid, how to talk to your doctor, etc.

I was given some of their publications when I went to Mayo,

and found them quite helpful.

hope this helps, beth fillman