Avastin for Brain Tumor - outpatient only ?!?

Hi everyone, my husband is currently in very bad situation. Brain stem tumor recurrence, progressing with more enhancement and was admitted to major cancer center in NYC for 2 1/2 weeks. During this time, they sought to get approval for Avastin and were denied. What?!? My husband is not well enough to be at home. They informed us that Avastin is only covered if the patient is at home and going to outpatient clinic. He was discharged to home and we arranged 24/7 home aide, and next day taken by ambulance to local ER after sudden edema caused falling and slurred speech. Tomorrow supposed to be transported back to NYC. Is this true about Avastin? Is there any way around this? He has Medicare primary plus another secondary. Thank you.

 

On 6/28/2009 carli8020 wrote:

Hi everyone, my husband is currently in very bad situation. Brain stem tumor recurrence, progressing with more enhancement and was admitted to major cancer center in NYC for 2 1/2 weeks. During this time, they sought to get approval for Avastin and were denied. What?!? My husband is not well enough to be at home. They informed us that Avastin is only covered if the patient is at home and going to outpatient clinic. He was discharged to home and we arranged 24/7 home aide, and next day taken by ambulance to local ER after sudden edema caused falling and slurred speech. Tomorrow supposed to be transported back to NYC. Is this true about Avastin? Is there any way around this? He has Medicare primary plus another secondary. Thank you.

You should call your State HIICAP program, which provides free advocacy and assistance for people with Medicare.  I found this number for NY, 1-800-701-0501.

You might also try the Medicare Rights Center, www.medicarerights.org    1-800-333-4114.  They have done work around medicare drug coverage issues.

Best of luck.

 

I've just been told that Avastin infusion as inpatient varies by facility. Some places don't do it. So it's not Medicare saying no it's the hospital. I am expecting my husband to receive the drug in a day or two, here at local hospital...then I'll know for sure whether this is true.