Forum Discussion

Mrs_H1's avatar
Mrs_H1
Member
8 years ago

Herceptin not covered by private health fund

Has anyone else had the issue that your Herceptin treatment wasn’t covered by your health fund?

I’m getting treatment through Greenslopes Private in Brisbane and have just found out that they haven’t been forwarding my hospital admissions to my health fund as they (the hospital) believe my health fund won’t pay it. The reasons they’ve cited are
  1. Herceptin isn’t on the PBS
  2. It’s an outpatient procedure (despite being admitted every time and also paying my hospital excess for admission at the start of this year)
  3. It’s not a contracted drug between the hospital and my health fund.
I’m so confused. How do you get 6 months into treatment before someone tells you that you have to fork out for the treatment? I feel like I go around in circles between the health fund and the hospital as they both say different, contradictory information which still leaves me with the bill.

Thanks, Jen.

herceptin
  • kmakm's avatar
    kmakm
    Member
    8 years ago
    It sounds completely insane. How can you run a organisation/business like that??
  • Mrs_H1's avatar
    Mrs_H1
    Member
    8 years ago
    That’s what I thought. The hospital told me they don’t bother sending the account to the health fund as the health fund won’t pay it. Health fund says they will if it’s on the PBS and an inpatient procedure (check and check). However, if the hospital doesn’t even send the paperwork I don’t get reimbursement for pathology and the oncologist doesn’t get paid. Guess who’ll have to cover that if they decide to continue this bull****. The hospital is trying to say that they absorb the costs of the Herceptin treatment until the administrators decide if they will charge the patients or not. WHAT!?!?! I’m afraid I didn’t keep my cool with the lady from the hospital when she said that. Yeah right, no one works for free and especially not in private practice/hospital! Feeling very frustrated that’s for sure.
  • Zoffiel's avatar
    Zoffiel
    Member
    8 years ago
    Oh bullshit. Herceptin is on the PBS, there was a huge fight for that a decade ago. Tell Greenslopes to jam it or sort it. 

    They can't bill you for months of treatment if they haven't told you about it previously. It will be some idiot in the office of either the health fund or the hospital. Possibly both: they've probably got all chummy discussing your case and are going to run off and have idiot children together--which is a gender neutral statement.

    If you have metastatic disease you can still be subbed, but it's another bloody form.

    @marianne_BCNA or @giovanna_BCNA have you got a link to this info for @Mrs_H ?
  • Jane221's avatar
    Jane221
    Member
    8 years ago
    Hi @Mrs_H, as I understand it, Herceptin has been on the PBS since2006: http://www.pbs.gov.au/info/news/2006/10/listing-of-herceptin

    I had my chemo privately, including Herceptin, in 2012/13 and other than the hospital excess didn't have to pay for anything else so I'm not sure why you'd be having to pay and, even so, it is extremely poor form to be halfway through treatment and then to be faced with this issue. 

    Perhaps your Breast care nurse (if you've got one) or @Giovanna_BCNA or one of the other BCNA staff can help you to work with the health fund / hospital as this seems to be an unusual situation.

    Best of luck. I hope you get it sorted soon, you certainly don't need the added stress. Jane xx