any advise, please help!! denied insurance

I am not sure if any of you remember me, i dont post much, me and my daughter are on treatment, week 23 of 24 for genotype 3a.  I went negative at week 8 and she did not until week 12.  Our insurance company is denying extension of treatment and I am completely beside myself with grief and frustration.  We have applied to the commitment for care program (yesterday) and they said it will take about 5-7 days to hear if they will help.  Does anybody have any advice as to where i can turn for help?  I am at work now and will not talk to my dr. until tonight or tom. morning.  Just wondering too if we do not reach SVR will be denied to retreat as I see so many of you have had to repeat treatment how did that work for you???   Sorry to ramble.

[Trinity4]

Has your doctor tried to contact your insurance company and present data which justifies the extention?  I know in certain cases insurance companies will pay as long as data is provided by the treating physician to support it.

Trinity

[nygirl7]

Commitment to Care helped me greatly as I needed to extend from week 48 to 72 and insurance denied me too saying it was experimental but they'd talk to me about transplant later. Thanks for nothing Aetna.

Anyway while I was waiting for it all to go through, C2C had my doctor write a script for a months worth of meds - BEFORE I was approved.  They came a few days later.  

As late responders you really DO need to extend and I would think if your doctor could intervene on your behalf and explain the situation they could do something......I would ask the doctor to go to both C2C and the insurance company.  Really you have nothing to lose by asking. But don't give up.  Call C2C every day and speak to someone so they know how dedicated you are to this. You never know gettting one nice person willing to go out on a limb might help....there are almost always exception to the rules and you have to continue to FIGHT here as hard as you can. Don't give up......when it comes to $$$ you just have to do it.

I wish you the best of luck.  I hope when you get this straightened out shortly you will come back and post and fill us all in.  We'll be looking to see your good news.

[bdr3a]

Thanks for getting back to me so fast, I have contacted C2C and they assigned someone to my file  right then as I explained the situation to her and did sound very genuine! and NYgirl I will be faxing your response to my Drs office tomorrow, I feel as if they have dropped the ball and have not been happy with them throughout this whole process with many other situations.  My dr. is out of town but most certainly knew where we stood as i spoke with him on Friday and the nurse told me today they are waiting for "forms" from the insurance company they need to fill out.  I will not be giving up and will def. be a squeaking wheel over the next few days!!!    Will keep you posted

Barb

[nygirl7]

See thats it your doctor should have known way back when you didn't respond right away (everyone knows geno3 is supposed to be a 'lucky, easy geno' but that is NOT always true and when it's not true it's every bit as hard as a geno1!!!!!) that you needed to extend to have the very best chance of success possible.

And the fact that you are not dealing with just your own treatment but your childs at the same time..........I wish you had posted to us sooner. Certainly, we aren't doctors but we all have some sort of basic knowledge about the big studies (Berg, Sanchez Tapias) and what they mean not only to geno1 but also geno3!  We've seen too many relapses and care too much not to try to help all we can.

I'm glad you got somewhere today!

[FlGuy]

It's not so surprising that the insurance co would question any treatment extension.  They've got this big books that says if geno type = 3,  then 24 weeks is the standard of care. In case C2C does not come through you can appeal the situation, with your doc's involvement.  I also had to do some hoop-jumping to get a second go-round of 48 weeks after failing with 24 weeks.  If you need to talk to the insurance company, inform your doc in case he needs to send some treatment documentation. Being UND at 8 weeks is good for you.  At 12 weeks und, your daughter is borderline for extending.

[bdr3a]

Just wondering what does the borderline for extending for my daughter relate to?? ( Im not sure what that means and not sure if this matters but she was almost there at week 8 with a VL of 403) And yes I started questioning my dr. about extending treatment atleast 2 months ago, got a second opinion from a hepatologist in another city to get us more backing, which he did do and my dr. obviously sat on it all.  But... i do feel good about C2C and pretty sure i meet the financial guidelines.