AETNA and CA19-9

I think I posted this in the wrong place originally; in short AETNA is not paying for my husband’s tumor marker tests, CA19-9, as they indicated that AFP is the test for this. I didn’t find anything on the Web to support that, it all indicated CA19-9. His markers are coming down, so that says something too. I’ve appealed.

I’m hearing that they are also not paying for Avistan. They are paying for my husband’s GEMZAR and Tarceva, which is quite expensive and they’ve been covering all the other things…. so far. But if many of us are having trouble with this same company, I’m wondering if it’s because they have not had much experience with cholangiocarcinoma?

I’m “raising sand” and hope that they will look more into what’s going on for this cancer. My husband is better in many ways, markers are down, bilirubin is down, although he keeps loosing weight and is very very thin.

I know my complaint about the marker tests is trivial compared to carriers not covering the needed chemo/treatments that cost so much more, so forgive me, but the costs at $159 per test do add up. If any of you have experience with appeals at AETNA please let me know. If they deny my appeal I already have the Colorado Insurance Commissioner’s complaint web site bookmarked and I will fight to the finish. I suspect we may all have to do this because this is not a common cancer and insurance carriers seem to need education. I will keep you all posted.

God Bless