letter to my insurance company......

I recently received a letter indicating my peg-intron and ribavirin treatment could not be extended because

[Kalio1]

I think it's great, I'd add in there what you want from them, your right to treatment. I'd appeal their decision. Ins. companies bailing out on their responsibilities to us and denial of treatment when we get sick are all over the papers here. I pay 800 a month for "benefits" yet C2C provides my drugs! It is criminal what they do, we pay them for a service then they don't provide it when we need it. Ins. is dandy so long as you are WELL.

Sorry to hear you are having to cope with this, keep C2C in mind. Send them a copy of the ins. denial and the continue to treat recomendation from your doctor with the scrip and they will help I bet. It might take time to hassle out the ins. deal and with C2C you can continue meds and not compromise your tx.
Hang in there.

[Myown]

So sorry to hear all this. This is really terrible. I pray it all works out REAL SOON. The letter looks very good. Hopefully you can continue tx with meds from C2C as Kalio mentioned in the meantime.

Keep us posted. Wish you the best.

[sfbaygirl]

I had to laugh. How could all of us and all the docs not know you relapsed and they knew this? I guess if we don't laugh we cry, huh? I hadn't thought about it, but C2C does need a denial letter, which I don't have yet!! I have too much to get together this week. A trial, moving again, getting the meds...uggh.

Sorry you have to go through this. How many weeks of meds do you have left?

[honey11]

Hey Fishdoc! I hate to hear this,,,like you really need to deal with that when you are this far in the meds. I hope you get things straightened out so you can continue with your original plan!  

[OnAPrettyPoison]

Obviously you are sharper than your insurance company, even on the treatment drugs.....

Hope you get this straightened out soon.  How you been???

[painterlady13]

Fishy, Hi hon Good luck with this.  I would get C2C lined up Just in case.  These Ins companies are messed up.  and it may take longer than the meds you have lrft to get them to see your side of things. BTW I love the letter.  Factual, to the point and seems to put them in their place.
My Ins.  sent me to a local hematologist  Told me she would treat hep C.  Got there and she doesn't would just watch the cbc's (just to manage the sides) then they charged me $125 for going out of network and self referred.  The BCBS case manager was the one that sent me to her.  Screwy I tell ya. It took 5 mos to fix it.
Good luck.

[nygirl7]

Fishie - Friole wrote me an email.  A ton of riba (months worth) is going to be on the way for you. I have all of my leftovers (and I just got two new bottles) PLUS the ribas and copegus (same stuff) that Mrs. O sent to me.

I will mail it to you TOMORROW, as soon as I can get it from home.

Since your insurance denied you (for whatever reason) you should be a shoe in for C2C or Pegassist.

Also I have two or three Peg-Intron redipens if you are on that version. I can put them in a cooler and ship them out to you ASAP.

You just have to let me know. ANYTHING I can do to help you - I will do it gladly.

PLEASE just let me know.

This is so STUPID when you've been clear all along...get those doctors to call the insurance company DIRECTLY. They can do it and have it changed.

[wyntre9]

Sorry to hear about the glitch in your plans.

The letter is great, but, and I don't mean to impose, do you have a claims manager at the insurance company?

Have you contacted them?

If that didn't work, the next step, of course, is the supervisor.

I'm sure you've already gone through these steps but can't help mentioning it as I find I often get results only AFTER speaking at length to one or more real humans.

They don't like to be bothered.

But most have phones that record conversations so if, for example, you call your claims manager every day for a week and they don't get back to you you can go over their head to the next level, etc., etc., with the proof that you're trying to compy blahdeedahdeeddahdahdah.

Hate to say it but that old greasy wheel proverb often works when nothing else does.

And I KNOW how stressful all this is.  

Good luck and keep us posted.

(BTW - at the very least I would definitely follow-up with your letter in a couple of days, make sure it's been received, is under review, etc.  I would probably even send all correspondence certified mail with return receipt request.)

[friole]

Great letter, doc of fish! Now if the Aholes can read.  (apparantly they can't judging by their letter to you).

As we discussed, whether or not you do 72 or 60 weeks should be your choice - not some fracing insurance company's.  We slow responders just don't know if the extended time would help.  I know (in retrospect) that I wish I had done 72 but, at the time, it seemed silly to even do the 56 based on my stinking little viral load count of 40IU at 12 weeks.

Whether you go to 72 or 60, I think you can say you have done all you can do with the current drugs available. We just have to face facts that some strains of hepatitis C are just dang devious.  They hide and rebuild as soon as the cops leave.

You had asked about my AST and ALT post tx..... In December they were up to 83 and 114 - that was 4 months post tx.  They were always in the 20s pre tx and rose to the 30s once or twice on tx but that is the highest.