Anthem Blue Cross has Harvoni

[tobila]

Prior Authorization form here. Similar to Solvaldi.

http://www.anthem.com/provider/noapplication/f0/s0/t0/pw_e225443.pdf?na=pharminfo

[hepcandme]

thanks for the great advice, Sun

I will send the email tonight

Interesting side note, when I asked for a second opinion a year ago, my Kaiser doc told me that I could have a second opinion - from a Kaiser doctor! (I had asked to see Dr. Terrault specifically or someone on her team)

Everyone at Kaiser thinks my doc is a rock star but, except for the off label treatment (which, believe me, I am So grateful for), I have been so unimpressed with him

But I also have been given a glimpse of the incredible work being done at UCSF and the passion and concern that those people bring to their work

I even thought about changing insurance companies but the folks at UCSF say that Kaiser is one of the easier companies for them to work with

It's one of the things that you never consider when you are diagnosed with a life-threatening illness. Oh great, figure out the insurance, how to pay for treatment, how to get the best care, how to jump through every hoop they can throw at you, how to keep working, how much info to share with friends, well, you know, the list goes on and on

So grateful that I found this support group. No one can proffer advice like someone who is going through the same thing with the same anxieties, frustrations, highs and lows

[sunru]

Hi, I understand what you are saying as I found it confusing some of the responses I'd get from my GI dr. it seemed at one point he was not accepting their recommendations and then do nothing to follow-up with the ucsf doctor.

All I remember is at one point it was so frustating that I had to start asking questions at member services started to  learn a few things I did not know. They told me that kaiser patients were entitled to ONE second opinion referral and they referred me to my PC dr. for the referral to see a hepatologist. I did this and of course in turn my PC dr said I had to request it from my GI dr. Sent an email to my GI dr and he sent the referral in to be seen at UCSF. I learned from UCSF back in Dec. they had recently added a more expansive partnership with GI drs at kaiser. It appears to me that kaiser had not fully embraced the idea of a cooperative dr. to dr. relationship at that time. I'm not sure where they currently stand on this issue.

You do not need to go over their head to be your own advocate for life saving treatments. But you can email your GI dr and get him to commit to what protocol they will be recommending for you and go from there. The important part is you need to get started the sooner the better given your relapse. They might start the process immediately given your cirrhosis, or they might say it may take them a few months to get you started. If they say it will only be few months,I would go to member services and explain your situation asking if they could make an exception for you to start tx immediately or you would like a second opinion.

Please let me know how you are doing and I'm wish you well with a big hug in total support to your getting started on tx asap.

I liked my GI dr - he'd been so helpful to me over the years, bottom line he did not seem to be honest with me and I finally got tired of it.

[sunru]

Thanks, I did not complain about my doctor but the whole GI department for putting me on hold for such a long time, months. It was a lesson for me because I learned to start demanding and not just settle for being smoozed by the doctor. It all worked out well in the end and everyone is happy!

[hepcandme]

My doc seemed very defensive when I asked for a referral to Dr. Terrault or when I asked to be seen by a hepatologist for that matter (a year ago)

I was treated "off label" with S/O beginning last March

My doc insists that UCSF is part of the "team" that makes decisions for Kaiser liver patients. It seemed odd for me to learn at a support group meeting from a UCSF staff person that Kaiser and UCSF don't even share data!

How does that make sense? In the same city, same treatments for people with the same or similar stages of liver disease, that they are not sharing data with one another?

Is this true across the board for insurance companies? What do they gain by Not sharing data? And what is lost when they don't?

OK, I am going to start with my regular doc and ask him to approve treatment with Harvoni for 24 weeks. Don't want to start writing appeals or going over his head before he has said definitively no (although he his last response was quite upsetting to me - basically, be patient, people live for years with your condition...)

I know not every doctor has a great bedside manner but I don't think it unprofessional to respond with - We are so excited about this new course of treatment and will do everything possible to see that you are treated straight away

I am 1B, cirrhotic, relapsed after treatment with S/O. Treatment naive before that

Thanks to everyone here for your kind support

[dontworry_behappy1]

I grew up with Kaiser as my family plan.   Both my parents and many more relatives have died there after long illness.  They do have a complaint line that has to give you an answer within 24 hours.  I found that falling down on the floor and screaming and kicking your feet.... gets you answers to just about all your questions.  And I do mean literally screaming your head off.
For some reason nobody at Kaiser seems to hear you if you don't talk real loud.  Seem you can be put off for the rest of your life if you don't make big deal out getting what you need.  Demand service!  It's what you pay for.

Best to you....glad it worked out for you

[sunru]

Or quickly go to kaiser member services and write a letter to appeal the GI dept. taking too much time to make a decision on which protocol they want you to be treated on. Since I had a serious rash with previous Peg/rbv this gave them an excuse to delay. Kaiser can delay this process for months if you let them. After they deny your request for whatever reason, then you just appeal their denial. Your appeal will automatically be sent to the State dept of Managed Healthcare for review. In my case the State called kaiser the next day and a kaiser senior exec.called me immediately to offer their support in many ways. I had to do this when my GI dr took months and delayed decide which tx to put me on because in Feb they WERE NOT YET prescribing S&O. I asked kaiser for a second opinion referral to see a hepatologist at ucsf and Dr.Terrault gave her recommends of which tx's would be best given my host factors.