Insurance Companies - BAD People at a BAD Place (cont)

[GrandOak]

Hows about we all write nygirls insurance company to express our outrage over their denial of service which has been properly authorized by a renowned authority in the disease she is battling.  We could ask them to identify what person is directing their decision to make their call and request their credentials with respect to the understanding and treatment of HCV.  We could ask them if they would like to have several riba-raged HCV patients in their lobby or picketing outside their headquarters.  It might even make National news if enough outraged HCV patients where to be seen picketing an insurance company in NY City.

While we're at it we could all write our congressional representatives as well to identify them the insensativity and injustice of the insurance/hmo/whateveritscalledinyourarea when it comes to allowing proper medical treatment, especially when it is prescribed by an authority in the field.  These folks generally take notice when several of them get the same feedback from consituents at the same time on a common issue.

It's about time that us Knights Against the Dragon take a stand against the injustices we, as well as though who have gone before us, have had to endure on top of dealing with the ravages of the treatment endured in the hope of being cured.

[Mister beagle bailey]

I have not been on the forum in about a week.  What happened to NYgirl?  What did I miss?

Beagle

[GrandOak]

You can catch the entire thread below at:

http://www.medhelp.org/perl6/hepatitis/messages/42875.html


In a nutshell, her insurance is denying coverage of her treatment beyond 48 wks because that is the FDA recommended length of treatment for her infection.  Despite a strong recommendation from Dr. Jacobsen as an authority in this disease, they are calling in "experimental" and thus not covered.

[Morgaina]

So, what do you figure us Canadians can do? I'm sorry but I'm so pissed that health care is treated like big business down there but I'm sure my ramblings wont mean squat to them. I cant even cast a vote!
NY.... I only have pegasys and co-peg (Riba) but if you have any need, I have 2 wks. worth and could transport it Quick. I also have Eprex (procrit). If you need it for any reason, please let me know. I know you've been using the other but it's here.

[Mister beagle bailey]

Thanks, I found the thread below. The ins. companies are big business and big business controls the country.  How are you doing?

Beagle

[Lady E]

I can't help but get the feeling that if a bunch of us HCV patients went to bat or demonstrated in front of a health insurance place, we would publically be called a bunch of protesting recovering junkies. Sorry, just my overview of how the rest of the world views us. Because public ignorance is bliss (for them) it's that damn stigma again.

[bikeaddict]

NY Girl - I have a friend who dropped out of treatment early who has a pile of Riba laying around.  Email me at ***@**** and I'll put you in touch.

[SlideJames]

I was sooooo p****d off last night at my gig that I couldn't remember the lyrics to my own songs! How could they do this to OUR girl?

I've been clean & sober for five years now, and It's amazing how much extra money I have these days.

Grand Oak- I agree with your post, but NYgirl needs help now! I wanto send her $500.00 but I don't know how or where. Do you? How do I work this?

NYgirl- If you won't take the money, then give it to your mother.
Wher are you?
Much love, James

[jmjm530]

I applaud Grand Oak's loyalty and intentions, but my guess is that a few calls and supporting paperwork from her treating doctor and/or Dr. A, will finally get her the medications.

It's not unusual for insurance companies to initially turn down requests outside their guidelines, but it's also not unusual for them to become more flexible when doctors make an appeal based on case data. I found this time and time again with my insurance company.

My understanding is that NYGirl hasn't had time yet to have her doctors make the necessary calls.

The unfortunate part is that this happened at the 11th hour and could have cost NY a Peg injection, had not her mother come up with the cash.

One lesson therefore, is to ANTICIPATE this sort of thing, be with an rx for a simple PPI like Nexium (which is often non-formulary) -- a rescue drug you may need in the future -- or as in NY's case, needing more Peg and Riba because of a treatment extension beyond 48 weeks.

When I decided to extend, I also forgot to double-check my med coverage with the insurance company, but I got lucky and it turned out not to be a problem.

You CANNOT count on the doctors to initiate the insurance procedures, you have to be proactive and get personally involved  and the earlier the better. Easier said than done when under the treatment haze, but an unfortunate reality.

-- Jim

[jmjm530]

That should be "Dr. J" (not Dr. "A") in the first paragraph of my last post.  

-- Jim

[Forseegood]

Good posts Jim, I tend to agree with you, I guess I've been wandering around these boards for awhile, and have heard similar stories of people who were eventually able to work this problem out to their satisfaction, I hope NYGirl can, she's such a warrior...thanks to GO for helping her with this...perhaps she can go to some other boards, Janis in particular because there are so many posters, to ask how others were able to overcome this obstacle?

[jmjm530]

While time consuming, it's not really all that complicated. If your doctor has someone who specializes in insurance approvals, by all means give them the first shot at it.

If not, you just got to get on the phone yourself and speak to a supervisor (never anyone who answers the phone). Then find out exactly why the medication/procedure was turned down, and most important -- what criteria/documentation would be necessary to reverse the decision plus a contact name and phone number for who and where the stuff goes to. Then get back to your doctor's office and based on what the insurance company says, tell them exactly what is needed, and who to send it to. In other words, you want to be a nice, thoughtful and persistent pain in the a*s.

[mycoldfeet]

I had no luck with Blue Cross, I went through both my Hep Doc and Gastro, both very good but not world renowned experts, but argued for me. I know NYgirl is on a different med than Pegasys, but Pegasys approved my meds and send them overnight to me, but seems to me most Med Co's are the same, they like Doc's that aggresivly treat with the latest studies, the more that clear are a feather in their cap. Approval took me 3 days and they even sent the riba with. I know my insurance should pay, but I'll take it where I can get it.

[sfbaygirl]

I agree, you almost have to anticipate ins. co's NOT doing what you expect and be proactive yourself. I ran into a problem with ins. approval even though my dr. had sent in two approvals to continue meds. I had to get on the phone and make it happen. Make sure you know when your meds will run out. I know I have approval until December, so in December or sooner, I will call and make sure this is going to be continued. Luckily, my pharm called me to let me know of the ins co not sending approval a week or two ahead of time, or I would have assumed that it would just come in the mail as always.