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442340 tn?1326821017

Blue Shild PPO Denied peg-intron?

Did any of you have problems getting a PPO to approve meds?  I got two letters today, one saying that I am denied Peg-Intron beacuse I did not try pegasys.  And the second said I was denied Ribaviron because that is only approved for people with  hep C using peg-intron or pegasys with geno 2 or 3.   HELLO INSURANCE CO....I'm HCV and geno 3!!!!  SOOOO FRUSTRATING!  Sorry, needed to vent.  Any advice would be great!  Thanks!

14 Responses
408795 tn?1324939275
That sux big time, I'm not on treatment yet, but I have Blue Shield as my HMO and I've always wondered what they would cover, should I need their assistance.  I'm not even the same geno type as you are, but I can understand why you needed to vent.  Society has to accept this virus and quit treating us heppers like they did the leppers.  It seems to me that we have been dealt a double whammy.  We are sick with a virus and if that wasn't bad enough, we have a virus that has an unshakable stigma attached to it.  Once society accepts this virus as just something that millions of Americans caught, we will continue to get the short end of the stick.  Your post is just a symptom of the bureaucratic BS that can be easily passed off as making sense by the insurance companies.  Once again they squeeze their way out of paying by saying "oh you didn't take the medication we picked for you", that's like communism.  God Bless
Avatar universal
Blue Shield hasn't changed a bit.  30 years ago I had Blue Cross/Blue Shield insurance in Illinois.  They played this game of denying benefits, and once you put up a figght, they would cave in and give you what you needed.  They also made it quite difficult to fight them, but if you went through the paces, you almost always won.  I'm sure that many people just gave up.  Imagine how much money that saved Blue Shield.
Avatar universal
I agree with Pigeonca. Don't give up! Same thing happened to me 6 months into treatment last year. Got a letter from Blue Shield stating that they had to interrupt Tx because Interferon/Riba has only be FDA approved for 6 months max. (which is not true, it really depends on your genotype). I informed my Hepatologist which sent them the justification they needed.
To me Blue Shield is managed in a very capitalist and efficient way. It has nothing to do with communism. Why insure sick people? It just cost money. So yes, they artificially introduce some bureaucratic elements to discourage more people but that's just an illusion of inefficiency. I bet they send the same letter to everyone. Even if a few percents of the people give up, it translate into millions of $ saved every year.
Good luck!
362971 tn?1201990634
   Who ever sent you those letters doesn't know what they are talking about. Get your Dr involved. He should be able to explain it to them. If not him then one of his PA's or nurses.

Good luck

87972 tn?1322664839
You just might have unknowingly been dealt a slick hand here. HCV drug manufacturers have Patient Assistance Programs (PAP’s) in place to deal with scenarios like this. I don’t know if you have been prescribed PEG-Intron or Pegasys, but often a letter of denial by insurance opens the door for no/low cost assistance.

Call either (which ever is appropriate):

Pegassist (Roche Pegasys system): 1-877-734-2797

Commitment to Care (Schering- Plough PEG-Intron system): 1-800-521-7157

and ask to speak to a counselor regarding your situation. You may qualify for no cost HCV meds shipped to your home or office hassle free. I’ve received almost two years of free meds, no co-pays required from Commitment to Care. The people there rock, and the approval process moves quickly; it can take as little as a few days.

Good luck to you—

Avatar universal
What's wrong with Pegasys ?
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