Insurance Not Covering Treatment

I am sure that this has been posted and asked before. Sorry in advance for repeating it if it has.
What happens if your Ins. says they are not going to cover treatment drugs? I think we are going to be in a pickle. We just called to see what our co-pay was going to be, and they said it is not covered at all as it exceeds our amount.
If there are any numbers or websites you wonderful people have to offer it would be much appreciated.

Prayers for All,
FTT

[nygirl7]

There are patient assistance programs for both of the Interferon med companies that will pay for you to get the drugs directly - mailed straight to your house as long as your doctor writes the script and you fit their criteria.  My company cut me off at week 48 and would not let me extend and the drug company actually approved me no problem (and I do make a good living in NY).

For Peg-Intron I called Commitment to Care program and for Pegasys they also have a program called Pegassist.

I don't have the phone numbers but you can google them and they come right up. That's how I found it.

I don't know which med you are on but I'll look for my number for PegIntron (ps they also sent ALL of the ribavirin I needed).

Then if you do develop problems with anemia...you can contact Procrit for their assistance plan and they will give you that med as well.

It's VERY expensive (10 shots of Procrit for 6,000) and I was using a box a month.

So they both take out the heavy duty expensive meds that you most likely aren't being approved for.

Good luck - you can do it even if the insurance company says no.  It just takes a tiny tiny bit of work.

[rosebud57]

you can also try   HopeRX.com   if you find you have other prescription needs just a good resource to know.  the website is user friendly and you can search for meds and programs by state (that you live in).

good luck,

[Kalio1]

Don't get me started on insurance companies! They are a joke, an expensive joke.

I can't say enough good things about Commitment to Care,(Schering) they have covered my meds for a year and a half already and have OKed me for another 6 months. I am "fully covered" which has slowly eroded away as time goes on. BCBS needs to be investigated her in California, something is very wrong when you are insured yet when you need treatments nothing is covered. Huh? Isn't that what we are paying for? To be covered if and when we get sick? Then once you are diagnosed you are then a "preexisting condition" patient forever. Im on Cobra so they have to insure me by law is the only reason I have any coverage at all. It is shameful is what it is. They are crooks.

Arranging patient assistance is well worth the effort. I beleive Commitment to Care's qualification guidelines are income based and Pegassist (Roche) is asset and income based.

I was told recently by  C2C that they are also supplying various counties with the drugs so you might want to check and see if yours is one of them.

[jmjm530]

Fight: What happens if your Ins. says they are not going to cover treatment drugs?
------------
The first thing you do is ask to speak to a supervisor. I was also told the same the first time I called my insurance company only to find out later that the treatment drugs were covered by a different division but still within my policy coverage. I'm certainly not going to toot the insurance company's horns -- but a lot of times what initially presents as non coverage is incorrect information. Reality is you have to be your own advocate and speak to a supervisor (or that supervisor's supervisor) until you are absolutely sure you're not covered. At that point, you can go to step 2, which might include some of the Committment to Care programs mentioned. I suggest you do the leg work yourself initially, but if you run into a wall, perhaps there's someone with your medical group who can check further.

Be well,

-- Jim

[new41]

DO I HAVE TO PAY FOR THESE MEDICINES AS I STAY IN SCOTLAND UK.ITS ALL SO SCARY

[l-horn]

The problem with insurance companies is all they want to do is insure healthy people. The thing is, if you don't insure EVERYONE, then the concept ( of insurance ) doesn't work.

The baby boomers are in *huge* trouble healthcare wise. Our parents had the boomers to keep their insurance rates down and take care of them. We're gonna be out in the cold. Already in Texas you can't get medicaid if you have certain criminal convictions on your record. And that's the way it's going to go from here on. They don't have enough money to take care of us all so they're going to start determining who is 'worthy' of healthcare and who isn't.

[wyntre9]

Insurancitis is my worst SX.  

I know how nerve wracking it can be.

They don't make it easy.

You have to try and be patient AND persistent.  

I really hope it works out soon.

Wyn

[Kalio1]

Here is one contact I found, maybe they can help you.

Dr Nicola Rowan (Manager)
UK Hepatitis C Resource CentreTel: 0141 353 6969 Mob: [phone]* Fax: [phone] Email: nrowan:mainliners.org.uk
Website: www.hepccentre.org.uk
UK Hepatitis C Information Line 0870 242 2467

[Fighting-this-Together]

Looks like Ins. is a bad subject LOL. Makes you wonder why you spend your hard earned money on it :( Sorry for everyone else that has had to hassle with them also.
Our prescription plan differs from our healthcare plan, which is confusing to me in itself. After talking to HR who talked to so and so. They said they have to cover it. In the mean time we did contact Pegassist and they are contacting the prescription people.

On a continuation of Dr. Office Saga they said that it will take 2 weeks for the Bx report. I called the Hospital Radiology, and they said it had been faxed over already. Someone is not keeping up somewhere. SIGH

[ladybug52]

Welcome to the insanity of dealing with ins, dr's offices and labs.Good luck, I'm surprised there hasn't been an article on someone walking into their dr's office/lab and holding a gun on everyone till they got some answers. Might still happen if I get ignored one more time!

[missy60051]

How horrible can it get?  This just makes me ill.  How could they?  
I remember I thought they were going to do this to me.  I got the call
from the pharmacy telling me my ins wouldn't approve.  My heart just stopped!

I called my ins. Immediately asking what the?  I was put through to maybe 3 to 4 different people.  Finally was told they would send it through the mail, but they were waiting approval of my ins.  8 days later still no word.  I had to call aggressively to get names and phones to several.  It all worked out.

I guess I'm trying to say, keep on as the others say until you get your answers with out a doubt before you move to step 2.

This just doesn't seem possible.
Ridiculous!

[Fighting-this-Together]

Thank you.
We are still waiting. Alas, the hurry up and wait.