hep c treatment

[layla2907]

What insurance plans are now paying for new hep c treatment   we took out united health' s platinum for $300.00 a month because they assured us that they would pay for whatever treatment was prescribed.  However, the dr's office cant seem to get a pre - auth in place.

[m13m]

For myself I live in Oregon . have the states health care system. They don't want to pay. I know three people . two were approved for sofarie  geno type 2b . Myself and the other person have geno 1a. So we wanted harvoni . We were denied. Iam appealing. they say I am not sick enough or they  do  not cover that drug. Your doctor is the one that has to be on it ..--- I research, and try to find a Dr. that will fight for me. the ones I have do not even know about it. so they don't push my specialist or the state hard enough.  You have to push, and not give up. They will change ,there  are to many of us.

[Bilrac]

I recently got six months of Harvoni (hep c, genotype 1a, cirrhosis) through United (a group plan from work) but have recently transferred to United Platinum for individual payer and was assured by a broker that the latter plan would afford me the same benefits as United under the group plan.  The pharmacy I received the meds from was Optim Rx.  The nurse at my liver doctor's office did have to do a lot of negotiating to get me the meds and submitted a lot of results (labs, FibroScan and CT scans), and then she went back and negotiated further for me to get the six months versus 12 weeks.  I am ugely grateful to all who helped; it's working.  I wish you every success in getting your treatment.  United have been very good to me and I hope will be for you.    

[patra_]

I love you mantra!  May need to practive it myself! lol

Layla:  To be on the safe side, try both, you calling the Ins Co, AND getting with your Dr so he can write a letter, or fill out their form, etc.  You go, girl, and advocate for yourself!  It will help you feel better to know that you are going all that you can to get your meds!

Blessing all,

Pat

[Rbeth]

Hi Pat,
Your memory seems perfect to me gf!, like on everything you post ;) I believe it's Optum Rx, but I just finished not long ago & still have the box label lol

Love you & blessings,
Ran

'What memory' is my mantra xx

[Rbeth]

Hi Layla,
Like Pat I'm not sure of the answer, but a couple weeks ago, I can't find article, sorry, UHC made some kind of statement about not paying exorbitant cost of Harvoni( a price war tactic for sure). They covered my Tx ( Harvoni) in a day in November, they were great w/ coverage. I don't know if above statement is true. I do know your doctor NEEDS to make a case(appeal letter) to them stating that Harvoni is the ONLY Tx med appropriate for you & give reasons why.
So I think your first move is to speak with your doctor & ASK for that to be done. I believe if correct letter is written they cannot deny you Tx coverage! Of course, again, I'm not positive about this, BUT, I believe it's your doctor who HAS TO convince them.

It will work out! I'm hoping soon!

All blessings,
Randy

[patra_]

I Don't know the answer to your question, but, if it were me, I would call United first thing in the morning and find out what the problem is!  If they want a form from the Dr. or the wording different, or a definitive diagnosis, then you know what you are dealing with.  If THEY, don't make that call, then get the phone number to the Pharmacy Service that does, and call them.  I have UHCare as supplement to Medicare, and they approved my Dr's request for Sol/Riba in less than a week.  The really sad thing is I cannot even remember if the Pharma was Express Scripts or Optimum RX (I really have a bad memory problem - sorry!).

Be proactive!

Good luck and good treating!

Blessings,

Pat