insurance for minimal damage

Does anyone have any experience with Blue Cross/Blue Shield insurance? I am in Oklahoma. The insurance co. has said they will not pay for my treatment. They said because my records showed no fibrosis or chirrosis (cirrhosis). My Dr. is now forwarding my liver biopsy to them but it shows only minimal damage, mildly active, level 1 stage 0. I am a genotype 1a and my liver enzymes have been over 350 and my hcv/pcr is 660,000 iu.  I know some people go through treatment before their liver shows alot of damage. Does anyone have any ideas or opinions?

[nurse12hr]

This makes me so angry, and it is foot dragging on the part of the insurance company.
They hope to make you "go away" and drop your attempts for treatment to save themselves money.

Do not simply "go away".  Appeal.  Would they rather pay for treatment now, or liver transplant later?

I have appealed a denial of services a couple of times with my insurance company and have prevailed each time.  They are counting on the fact that most people don't appeal.  You may be surprised at how easily they cave.

[mikesimon]

I agree with Christie. Don't give up on. I think you will get approved if your doctor is aggressively advocating your position. Here is an article that was on www.medscape.com in which the cost effectiveness of treatment for hep c is set forth. It is a very informative article. You must be registered to medscape but it's free and simple. Here's the site
http://www.medscape.com/viewprogram/2053. Good luck. Mike

[OkieJim]

Don't let them stop you. Today I have become a dragon slayer. I started TX this morning tonight is shot time.  If you want TX then you should get it.  Hoping all goes well with your fight.

[hepc_avenger]

I have Blue Cross/Blue Shield with prescription coverage with Advance RX.  My info is very similar to yours, except my viral load started out at 1,250,000.  So far, I haven't had any problem with coverage.  Whether I'm just very fortunate, lucky, I don't know what, I can't say.  It seems they shouldn't deny the coverage.  I also had/have steatosis (fatty liver), but no other damage and only mild inflammation.  Maybe the steatosis figured in.  
By the way, I get my 24 week pcr results sometime between now and next Wednesday.  All good thoughts would be appreciated!

[Revenire]

I hate insurance companies, they all are blood-thirsty vampires. Fight them. How dare they deny you treatment just because your liver isn't as bad as they want before they start paying.

[scruffy]

I'm on week eleven of Tx. Blue cross/blue shield aware gold. I chose to treat without biopsy since I,ve been infected for approx. 30 years.At this point insurance has been cooperative.
My Doctor said that they are approving treatment without biopsy much more than in the past. I wish you luck.

[oldhippiechick67]

BTW, I found an interesting article about SSI getting benefits, financial income. Help with filling out the forms etc. Also Americans with Disabilities Act article, so if anyone is wanting to read it (quite long) email me and I will send it to you.  My addy: ***@****    OHC67

[Ambush]

Insurance companies.........ugh!  I have had to switch companies three times in the last three months.  We were on COBRA coverage when I started tx, then that ended and we had to switch to an individual plan and then my husband got a new job and we switched to the coverage through his new employer.  So, July, August and now September have been each with a different company.  I can say that the riba doesn't hold a candle to the rage caused by dealing with the red tape of the insurance companies!  Thankfully, I have the best couple of gals in my GI's office and pharmacy who have gone WAY above and beyond to help me through this.......but there have been three times we were not sure we could attain the pre-authorization in time to get the meds for the next shot.  Gray hair galore......I don't even mind that it is falling out!  
ambush  :)

[meandhepc]

When I started tx last year my insurance company didn't want to pay either, I am/was 1B with minimal liver damage, I was in the doctor's office and when I told him what the Insurance company said, he flipped open his cell phone right then and there and got on their butt!  he wanted to know: "Who thinks they are a doctor there and can say who can or cannot be treated???!!!!"  Then asked: Do you want to pay for this woman's treatment or pay for her to have a transplant later ??!!?  Well, I have had no more problems since. If your doctor doesn't fight for ya then FIGHT for your-self! Insurance Companies make me sick..more than treatment at times! Hahah

[minneapolis]

you are some sort of government employee? i have bc/bs at the city level. been on procrit, neupogen and they have never said a thing. are your co-pays going through the roof? heard ours were going to 50.00 an office visit. one week off the treatment and i am coming out of the fog........lynn

[Galen]

I have BCBS Health Options (small business HMO) in Forida and have had no problem either.  I am also a 1b, minimal damage, starting PCR of 900,000.  Giv'em'hell!!

[doll face]

The first time I was treated My insurance company didn't want to pay either, but my doctor got right on the phone with them and 15 min later came back with an okay. $20  a month co-pay lots better than $1200.00 they were talking about. Now this time they didn't even argue about it but want $60 a month I can handle that. Don't give up on it though. Get your doctor involved. Make a fuss.Hang in there and good luck.

[mycoldfeet]

Hey mll, I am a Hep C geno 1 in week 26 of 48 and tested clear at 20 weeks. I have blue cross blue shield of louisiana and have never had a problem, I am a Paramedic and exposed at work and fighting workmans Comp at this time, but Blue Cross has not missed a beat. for the labs,pegasys and ribavirin Dr.s visits when i informed them that workmans comp was fighting it they came right in and started paying, of course i have a co pay with the meds and some out of pocket expence but not all that much. My wife is the billing officer for the ambulance service we work at and if there is anything we can do to give you any advice let me know. I have been extremely lucky with my sides and that I have only missed one day in 26 wks. hope your journey is as smooth. except for an extemely aggrivating rash behind my legs and a little tired at times the tx hasnt been that bad (for me) I did learn here on the forum about the epsum salt bath for the rash and now thats even better (wish I would have read that advice at week 4) lol good luck and a better day tommorow.

[pearse]

I have bc/bs and a company rx plan. I never had problems. Do you belong to a Union if so see your rep!

[sugie]

talking about insurance,,,,,,,,,,,Has anyone gotten a new job and tryed to change health insurance coverage? I have coverage now and just figure I couldn't get anything new,,,,,,,,,, so I would have to try to keep the coverage I have if I change jobs. Thanks for input.

[mll]

Thanks so much for all of your input. I intend of fighting them! You guys have given me more ammo. Thanks