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 areHerceptin isn’t on the PBSIt’s an outpatient procedure (despite being admitted every time and also paying my hospital excess for admission at the start of this year)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.

@Mrs_H as all these responses say, Herceptin is covered by the PBS. I'm sorry you are having to engage in a dispute over this with your treating hospital. I will post the link to relevant documentation about Herceptin tomorrow because I can't locate it at the moment. Rest assured BCNA can assist with with this issue. Rosie

@Mrs_H, as everyone above has stated regarding charges, if you we 're e going to be billed, you should have been advised from the start. If you get no joy from the hospital, each state has a version of a healthcare complaints commission. Sometimes even mentioning those magic words in your communicatikn will get you action, but I would certInly suggest you look into what's available in Qld.Thay should be able to provide some adviceregarding your rights.Why do these things always seem to ha0pen when we have minimal emotional resources to deal with them?

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-herceptinI 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

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 ?

It sounds completely insane. How can you run a organisation/business like that??

Herceptin not covered by private health fund

14 Replies

Giovanna_BCNA
Member
8 years ago
Hello @primek,

I have just spoken with our policy team and as you have all stated, Herceptin is covered on the PBS, see below.
http://www.pbs.gov.au/info/news/2006/10/listing-of-herceptin

Thanks primek for posting the link to the injections which states that 'a new form of Herceptin that is easier and quicker to administer than the standard intravenous (IV) drip has been listed on the PBS for people with HER2-positive breast cancer.
@Mrs_H, I would suggest speaking with the breast care nurse who may be able to assist you with this issue. You could also speak with your treating Medical Oncologist and explain what has been happening. Has the hospital pharmacist been consulted regarding this issue? I have spoken with Rosie today regarding your concerns . It must be so frustrating, and so not needed at this point in your treatment. Please keep us posted, you can always call us on 1800 500 258.
kezmusc
Member
8 years ago
I had a friend with the same issue. Seems some health funds deem chemo as an outpatient appointment/day procedure not inpatient.. Cost her nearly $10000.!
primek
Member
8 years ago
No its okay . It is covered. Phew.
https://www.bcna.org.au/news/2016/04/new-form-of-herceptin-available-on-the-pbs/
iserbrown
Member
8 years ago
Oh goodness!

primek said:

I don't think herceptin intramuscular was covered. I know there was some discussion about that. But I thought that was just in public hospitals. And yes you are admitted to the day unit each time you come in. @Giovanna_BCNA Is it different for injection?
primek
Member
8 years ago
I don't think herceptin intramuscular was covered. I know there was some discussion about that. But I thought that was just in public hospitals. And yes you are admitted to the day unit each time you come in. @Giovanna_BCNA Is it different for injection?
iserbrown
Member
8 years ago
It sounds like someone has given you unnecessary grief over this! Hopefully tomorrow @Rosie_BCNA will have found the information for you to use to sort this dilemma. It will be okay! You were just unlucky to find someone who is perhaps inefficient at their job!

Take care x
lrb_03
Member
8 years ago
@Mrs_H, as everyone above has stated regarding charges, if you we 're e going to be billed, you should have been advised from the start.
If you get no joy from the hospital, each state has a version of a healthcare complaints commission. Sometimes even mentioning those magic words in your communicatikn will get you action, but I would certInly suggest you look into what's available in Qld.
Thay should be able to provide some adviceregarding your rights.
Why do these things always seem to ha0pen when we have minimal emotional resources to deal with them?
Rosie_BCNA
Member
8 years ago
@Mrs_H as all these responses say, Herceptin is covered by the PBS. I'm sorry you are having to engage in a dispute over this with your treating hospital. I will post the link to relevant documentation about Herceptin tomorrow because I can't locate it at the moment. Rest assured BCNA can assist with with this issue. Rosie
Anonymous
Not applicable
8 years ago
The user and all related content has been deleted.
Afraser
Member
8 years ago
What @zoffiel said!! That's rubbish in every way. I was covered for herceptin and even if you weren't, you get told what it will cost before treatment! It's the same process as chemo, for goodness sake!