Denial of treatment by insurance company was overturned . . . Hooray!

[Marc1955]

I've been going through a tough time for the last month as my insurance company denied the extension of my treatment to 72 weeks. I've been maintaining treatment with samples supplied by my doc. That was going to run out next week.

i just learned today that I won my appeal and the treatment has been approved. Needless to say that is a huge relief. Turns out that although I was railing at the insurance company, my doctor's office was at least partially to blame. Back in January the insurance company had requested medical records from my doctor in order to authorize an extension of treatment. Those papers were never sent so after a month  the insurance company cut off the approval for the medication. Of course, I never knew that the forms had been requested.

So what have I learned from this episode? This treatment is damn near impossible. They have to come up with something shorter and simpler. The folks on this board are the experts, who plod on through advocating for themselves, getting approval for rescue drugs, etc. But how many people can do that? You can say I've got a bum doctor. Well, I do and I'm in the process of looking for another one. But my doctor is the Chairman of the Hepatology Department at the University of Maryland Medical Center. How was I to know going in that he is an incompetent clinician (there are a host of other issues on which I base that statement)? Because so little is understood about HCV treatment, it's very hard to find people to help you when you do have a problem.

God help you if you start this treatment. Please, try in any way possible to make a judgement about your treating physician and his support staff. If they don't seem on the ball, look elsewhere. This is a very complicated course of treatment. Also line yourself up with a great specialist pharmacy. They will be more helpful than you can know. I guess I'm just feeling a bit overwhelmed right now.

[Isobella]

Sorry you've had to put up with all that.  Talk about insult to injury.

Great advice for all those thinking about starting tx....you really need to choose docs carefully.  I'm a big fan of stockpiling meds, too.  

I don't know how people tx without this forum.  Thank goodness for all the pros here.

I am glad things worked out in your favor. Wish ya the best with the remainder of tx.  

[FlGuy]

Glad things finally worked out.

[springfever]

"The folks on this board are the experts, who plod on through advocating for themselves,"  

You got that right!  I can't imagine HCV life without this forum.

Congratulations on winning your right to the medications to save your life.  Now drink lots of water, get plenty of rest, take a riba, and feel better soon.

[Marc1955]

Guys, your words mean a great deal. Thank you for your support.

[fretboard]

Great news!  I wonder how many ppl this happens to and they just never know.  good luck with the rest of your journey

[Tippyclubb]

You can say I've got a bum doctor. Well, I do and I'm in the process of looking for another one. But my doctor is the Chairman of the Hepatology Department at the University of Maryland Medical Center. How was I to know going in that he is an incompetent clinician (there are a host of other issues on which I base that statement)?
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Unbelievable! One would think with a position ( title ) like that, you could feel confident with your decision to let him handle your medical condition.  You just really don't know who to trust and who is really competent, until its to late.

Glad to hear you got the insurance part of it straighten out.  Undoubtedly, this added to your stress level, of a already stressful situation.  Its always something is my motto.  Hopefully rest of tx will run smooth for you.

[justme53]

I'm so glad everything worked out in your favor after all the hoops you had to jump through.

You make valid points about another important aspect of tx....getting the darn meds and in a timely fashion. A good piece of advice someone offered was to stockpile the meds a couple weeks before actually beginning tx thus allowing a couple weeks leeway in case of problems/red tape. The other is one you've used as well, getting meds in a pinch from the Gr./clinic. This is another question thatr should be addressed prior to tx...what to do in a pinch..would they help out?

I cannot for the life of me imagine how I would deal with this stuff if I was knocked silly by sx. It makes me all the more aware of these problems as my folks get older and more challenged healthwise.

Good heads up....Pam