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Asthma and Allergy (Expert Forum)
Xolair
This forum is for questions and support regarding: Allergies, Asthma, Chronic Cough, Sinusitis, and other Respiratory Disorders.
Xolair
by MaggiMaggi, Jun 01, 2007 12:00AM
Dx COPD 3/2003 - am now 59 yr old female with 34% lung function. Smoked apx 45 years; quit couple years ago. On Advair 500/50, Spiriva, Theophylline, Asmanex, Flonase, Mucinex daily. Rarely placed on Prednisone, Allegra 180, Diflucan. Cannot nebulize due to paradoxical bronchospasm. Have no other illnesses. Was
hospitalized once for pneumonia 5 days in 8/06. Was on Xolair shots for 18months and employer-provided insurance carrier changed first of the year and deemed xolair "not medically necessary". SOB increasing extremely over past months and QOL is worsening - just past date marking last 5 shots missed. Pulmonologist appeals to insurance company denied twice - now going to independent panel for review. IF the outcome is in my favor, the insurance company must abide by the decision, conversely so must I (or sue) if the decision isn't in my favor. Might I have a chance winning such a case? Might I have any recourse with my employer (of over 15 years?). Do insurance companies ever make exceptions (I've googled this and found no info at all). Help, help, help. I want my Xolair. It's made a huge difference.
hospitalized once for pneumonia 5 days in 8/06. Was on Xolair shots for 18months and employer-provided insurance carrier changed first of the year and deemed xolair "not medically necessary". SOB increasing extremely over past months and QOL is worsening - just past date marking last 5 shots missed. Pulmonologist appeals to insurance company denied twice - now going to independent panel for review. IF the outcome is in my favor, the insurance company must abide by the decision, conversely so must I (or sue) if the decision isn't in my favor. Might I have a chance winning such a case? Might I have any recourse with my employer (of over 15 years?). Do insurance companies ever make exceptions (I've googled this and found no info at all). Help, help, help. I want my Xolair. It's made a huge difference.
