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Phase I Trials- Costs of Usual Care and Health Insurance Payment

Forums General Melanoma Community Phase I Trials- Costs of Usual Care and Health Insurance Payment

  • Post
    Eileen L
    Participant
    Hi gang. I am now doing battle with my HMO, trying to get them to cover the cost of tests required by this Pase I trial I am trying to qualify for. The study sponsors want the health insurers to pay for tests they consider usual care for melanoma patients. My insurer is telling me they don’t cooperate/participate in Phase I trials. Any of you had any experience getting a health insurance company to pay for lab work, imaging studies, etc for a Phase I trial? I am appealing their decision but I would love to know if other HMOs and PPOs are covering this stuff.

    Hi gang. I am now doing battle with my HMO, trying to get them to cover the cost of tests required by this Pase I trial I am trying to qualify for. The study sponsors want the health insurers to pay for tests they consider usual care for melanoma patients. My insurer is telling me they don’t cooperate/participate in Phase I trials. Any of you had any experience getting a health insurance company to pay for lab work, imaging studies, etc for a Phase I trial? I am appealing their decision but I would love to know if other HMOs and PPOs are covering this stuff. BTW, I am covered by Northern Ca Kaiser.

    Thanks!

    Eileen L

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  • Replies
      killmel
      Participant

      Eileen,

      What trial are you trying to get into?Who is the sponsor?

      You should ask your study nurse, but it is my understanding that if your insurance denies to pick up cost  of scans, labs, etc then the sponsor usually will pick up cost once you are denied by your insurance company.

      AnnMarie

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      killmel
      Participant

      Eileen,

      What trial are you trying to get into?Who is the sponsor?

      You should ask your study nurse, but it is my understanding that if your insurance denies to pick up cost  of scans, labs, etc then the sponsor usually will pick up cost once you are denied by your insurance company.

      AnnMarie

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        Eileen L
        Participant
        Thx for the suggestion. I am trying to contact the trial coordinator and will see if they are willing to pick up the costs.

        Eileen L

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        Eileen L
        Participant
        Thx for the suggestion. I am trying to contact the trial coordinator and will see if they are willing to pick up the costs.

        Eileen L

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        Eileen L
        Participant
        Thx for the suggestion. I am trying to contact the trial coordinator and will see if they are willing to pick up the costs.

        Eileen L

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      killmel
      Participant

      Eileen,

      What trial are you trying to get into?Who is the sponsor?

      You should ask your study nurse, but it is my understanding that if your insurance denies to pick up cost  of scans, labs, etc then the sponsor usually will pick up cost once you are denied by your insurance company.

      AnnMarie

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      Harry in Fair Oaks
      Participant

      Are you on Social Security Disability and do you have Medicare?  (They go together, but as I remember, there is a waiting period to get Medicare.)  I'm also with No. CA Kaiser and I'm in a BRAF/MEK trial sponsored by Glaxo SmithKline.  As part of the trial, I get scanned every 8 weeks.  My Kaiser oncologist at first gasped at this frequent scanning and wondered if Kaiser will pay for it, but then realized I had Medicare.  Kaiser apparently bills Medicare for my scans, so I have no difficulty in getting them.

      Best wishes,

      Harry

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      Harry in Fair Oaks
      Participant

      Are you on Social Security Disability and do you have Medicare?  (They go together, but as I remember, there is a waiting period to get Medicare.)  I'm also with No. CA Kaiser and I'm in a BRAF/MEK trial sponsored by Glaxo SmithKline.  As part of the trial, I get scanned every 8 weeks.  My Kaiser oncologist at first gasped at this frequent scanning and wondered if Kaiser will pay for it, but then realized I had Medicare.  Kaiser apparently bills Medicare for my scans, so I have no difficulty in getting them.

      Best wishes,

      Harry

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        Eileen L
        Participant
        Hi Harry. I was told by my Kaiserboncologist that because the trial I am trying to get into is a Phase I trial Kaiser wouldn’t cooperate. I am on Medicare, do they bill Medicare directly even if you are on a Senior Advantage plan?

        Is the trial you are on a Phase I or Phase II? Which Kaiser do you go to? I am appealing my oncologist’s decision to not support my participation in the trial so I am curious to know if Kaiser is paying for your scans for a Phase I trial!

        Thx,
        Eileen L

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        Eileen L
        Participant
        Hi Harry. I was told by my Kaiserboncologist that because the trial I am trying to get into is a Phase I trial Kaiser wouldn’t cooperate. I am on Medicare, do they bill Medicare directly even if you are on a Senior Advantage plan?

        Is the trial you are on a Phase I or Phase II? Which Kaiser do you go to? I am appealing my oncologist’s decision to not support my participation in the trial so I am curious to know if Kaiser is paying for your scans for a Phase I trial!

        Thx,
        Eileen L

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        Harry in Fair Oaks
        Participant

        Good question regarding the phase.  Here's the description from the consent document:  "An Open-Label, Dose-Escalation, Phase I/II Study to Investigate the Safety, Pharmacokinetics, Pharmacodynamics and Clinical Activity of the BRAF Inhibitor GSK2118436 in Combination with the MEK Inhibitor GSK1120212 in Subjects with BRAF Mutant Metastatic Melanoma."  So a combination of Phase I and II, with some elements of the date used for a Phase I and some for Phase II?  I don't recall the issue of the phase of the trial being a factor in any of my conversations with Kaiser people.  

        I go to Kaiser Roseville (near Sacramento).  I have no idea how Kaiser handles the financials vis a vis Medicare.  I'm not quite a senior citizen yet (58), so I don't think I have Senior Advantage.  I qualified for Medicare through SS Disability.

        Good luck,

        Harry

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        Harry in Fair Oaks
        Participant

        Good question regarding the phase.  Here's the description from the consent document:  "An Open-Label, Dose-Escalation, Phase I/II Study to Investigate the Safety, Pharmacokinetics, Pharmacodynamics and Clinical Activity of the BRAF Inhibitor GSK2118436 in Combination with the MEK Inhibitor GSK1120212 in Subjects with BRAF Mutant Metastatic Melanoma."  So a combination of Phase I and II, with some elements of the date used for a Phase I and some for Phase II?  I don't recall the issue of the phase of the trial being a factor in any of my conversations with Kaiser people.  

        I go to Kaiser Roseville (near Sacramento).  I have no idea how Kaiser handles the financials vis a vis Medicare.  I'm not quite a senior citizen yet (58), so I don't think I have Senior Advantage.  I qualified for Medicare through SS Disability.

        Good luck,

        Harry

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        Eileen L
        Participant
        Thx Harry. I wonder if your oncologist put the study through the internal review process or just referred you to the study institution. Perhaps because it was a hybrid of two phases you didn’t have the same issue since part of the goal was to measure clinical activity!

        Hope you are having good results!

        Eileen L

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        Eileen L
        Participant
        Thx Harry. I wonder if your oncologist put the study through the internal review process or just referred you to the study institution. Perhaps because it was a hybrid of two phases you didn’t have the same issue since part of the goal was to measure clinical activity!

        Hope you are having good results!

        Eileen L

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        Eileen L
        Participant
        Thx Harry. I wonder if your oncologist put the study through the internal review process or just referred you to the study institution. Perhaps because it was a hybrid of two phases you didn’t have the same issue since part of the goal was to measure clinical activity!

        Hope you are having good results!

        Eileen L

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        Harry in Fair Oaks
        Participant

        Good question regarding the phase.  Here's the description from the consent document:  "An Open-Label, Dose-Escalation, Phase I/II Study to Investigate the Safety, Pharmacokinetics, Pharmacodynamics and Clinical Activity of the BRAF Inhibitor GSK2118436 in Combination with the MEK Inhibitor GSK1120212 in Subjects with BRAF Mutant Metastatic Melanoma."  So a combination of Phase I and II, with some elements of the date used for a Phase I and some for Phase II?  I don't recall the issue of the phase of the trial being a factor in any of my conversations with Kaiser people.  

        I go to Kaiser Roseville (near Sacramento).  I have no idea how Kaiser handles the financials vis a vis Medicare.  I'm not quite a senior citizen yet (58), so I don't think I have Senior Advantage.  I qualified for Medicare through SS Disability.

        Good luck,

        Harry

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        Eileen L
        Participant
        Hi Harry. I was told by my Kaiserboncologist that because the trial I am trying to get into is a Phase I trial Kaiser wouldn’t cooperate. I am on Medicare, do they bill Medicare directly even if you are on a Senior Advantage plan?

        Is the trial you are on a Phase I or Phase II? Which Kaiser do you go to? I am appealing my oncologist’s decision to not support my participation in the trial so I am curious to know if Kaiser is paying for your scans for a Phase I trial!

        Thx,
        Eileen L

        Loading spinner
      Harry in Fair Oaks
      Participant

      Are you on Social Security Disability and do you have Medicare?  (They go together, but as I remember, there is a waiting period to get Medicare.)  I'm also with No. CA Kaiser and I'm in a BRAF/MEK trial sponsored by Glaxo SmithKline.  As part of the trial, I get scanned every 8 weeks.  My Kaiser oncologist at first gasped at this frequent scanning and wondered if Kaiser will pay for it, but then realized I had Medicare.  Kaiser apparently bills Medicare for my scans, so I have no difficulty in getting them.

      Best wishes,

      Harry

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