Infergen...INSURANCE HELP?????

[shebee]

Hi all...just when we did not think that life could get any harder...

Our dr. called and said that our insurance company will not approve infergen because it was "experimental."  (however, they will pay for a liver transplant down the line.)

HELP!  Is there anyway to get around this?  Any articles...
andbody else had to deal with this?

Hubby is on unemployment now, and with all the med. bill, we are broke.  (but happy...LOL)

Does makers of inferen help out patients?

Crumb!  What next?

Your,
Shebee

P.S...so sorry to take up space, please feel free to post other questions & etc.

[TravelGrl]

Yes, we had the same problem when we went to start twice a week Peg...Just have your doctor write a really good letter stating that your husband has life-threatening rapidly progressing fibrosis/cirrhosis due to  hepatitis c and has not responded to any other treatments.  Also print out any articles that you can find that support positive results with daily infergen...There are several, I will see if I can find them and send you the links.  Also have him state that the extraordinary nature of this therapy is certainly justified by your husbands lack of response to date, with the only alternative course being certain progression to liver failure..

That should do it..If I can help further, let me know...Good Luck to you...Don't give up!

By the way, what insurance do you have?
Jodi

[jonihs]

Janis7hepc.com has a really good link for both insurance and numbers to contact in the drug companies. They are pretty good at providing free or reduced price meds. Good luck,    Joni

[MichaelT]

Infergen has been approved, FOR YEARS, by the FDA as okay for treating relapsers of HCV treatment. Someone is full of doo-doo, but this isn't news.

[oldhippiechick67]

Have you applied for SSI or SI?  I have an article that can help you apply if you want to email me I will send it to you.  Also do you live in a big city, cuz there is always Clinical Trials for free, especially for non-responders.  My email is ***@****   Best to ya at such a trying time!  OHC67

[nurse12hr]

Infergen is pretty old treatment now.  Hubby had it years ago.  I don't think it is experimental in the least.

Always appeal denials from insurance companies.  They live to try to reject people, hoping they'll just roll over and go away.  

[Galen]

Christie is right.  Most people fold up when faced with rejection from the Ins Co.  Remember that it isn't a doctor who is reviewing your file, it is a low paid clerk or nurse.  Their computers are set to reject lots of things automatically.  Have your doc appeal the decision.

[sgabb]

God do I feel like a dummy now, I am sorry for wasting a thread everyone.  Please dont beat me to hard.  I will make sure I read all the posts BEFORE I waste a thread again.
  Sheebee, it makes things easier for me hearing what you are going through and seeing the positive way you keep your self at. I wish I had an answer but if you read my post you know I am having insurance troubles also.  I know I am new here but I think I will be around for awhile. I do include you and heebee in my prayers and hope the best for you both.
                 Shawn

[shebee]

Thank you all!  I talked with the new dr today and he was shocked that the insurance denied infergen.  He uses this stuff on a regular basis with other patients.

(The old doctor's office called and told us that our insurance company would not pay for infergen. )

Anyway, we will fight this and get him on tx.  Thanks once again for all of the information.  You all are the greatest people on earth.

If any of us become millionaires....let's send tickets to everyone for a retreat!  LOL!  

Shebee

PLEASE SEND ANY ARTICLES YOU HAVE...***@****

[TravelGrl]

Just forwarded a bunch of articles to your Hotmail address...

Good Luck!!!

Jodi

[TravelGrl]

Here are some articles...


http://www.hepcresearch.com/article.php?article=0016

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12558913&dopt=Abstract

http://www.hepcresearch.com/article.php?article=0016

http://www.medonscene.com/liverdisease/aasld1999/846.php

Jodi

[TravelGrl]

One More

http://www.medonscene.com/liverdisease/aasld1999/150.php

[Southernboy]

Hi Shebee,

Go to www.intermune.com/wt/itmn/infergen and read the company description.  It states, "It (INFERGEN) is currently the only FDA approved, bio-optimized interferon developed through rational drug design and the only interferon with data in the label specifically for non-responding or refractory patients".

Hope this helps,
Steve

[shebee]

You guys are the Greatest!

I called my insurance Company and was ARMED!  I decided that infergen should be covered because of you all.  When I was asked, "Is it FDA Approved?"  I was able to response, "Of Course.  Would I be wasting your time if it wasn't?"

When I finished talking with our rep, she agreed and told me to give her telephone number to everyone.  (I did.)  I gave her websites & etc.  Thank you EveryONE!!!!!!!!!!!!!!!!!!!!  
It is important to be extra polite...and insistent!...and more.




Our meds will arrive on our doorstep in the morning.  WoW!However, Hubby can't take them until his next dr. visit next week.  LOL!  (Is this life? or what?)

Gee, If I had not fought this, hubby would be without meds....or our house would be up for sale.



I do believe that he would have cleared if his other dr. had kept him on for a few months longer.

He showed clear at 12 weeks, but he is a cirrhosis stage.  
Dr. Cecil said that he had a great chance of clearing with prolonged meds.  24 week was not enough.  

Anyway, Here we go again....THE ROLLER-COASTER FROM HELL!
I am goin' buy an extra seat belt!  Does anyone want to sit beside us?



mY JOB starts next week...hubby will be staying home (at my insistence) for 2-3 months.  My pay will be great.  
If I don't make the grade we’ll starve.  
LOL...what an incentive to work hard.  :)

You’re whining,
Shebee

LIFE IS HARD, BUT THIS HAS BEEN THE BEST DAY OF MY LIFE!!!!

[oldhippiechick67]

That is FANTASTIC News!!  I am so HappY HappY for you both!   Way to Go Girl!!  You fought the system and you WON~  Im doin the Happy Dance for ya!   OHC