Help!!! Insurance denying drug coverage

[mphillips]

Dr's office just called and told me my insurance co is denying authorization for drugs. I am geno 2b with cirrhosis. compeleted 24 weeks tx April 08. Und at weeks 12 &24 and then detectable 6 weeks after EOT. Dr suggests I go for 48 weeks same TX which I started 07/08, which I have been UND at 4 &12 weeks. Now the insurance co is saying that because I have had 48 weeks total Tx they will not pay for the next 24 weeks. Has anyone else had this happen? Can anyone tell me what to do or if I can do anything. Dr says that we will have to monitor my blood and if I relapse we will have to cross that bridge when we come to it. What a bunch of BS.........

[nygirl7]

I don't know which med you are on but contact the drug company right away, they are GREAT about supplying the rest of the meds. I too was denied on my extension to 72 weeks as well.  I contacted Comittment to Care (I was on peg-intron) and they immediately sent me a months worth of both meds - even before I was approved.  All my doc had to do was write the script for it and fax it over. All they asked was my income (which isn't all that low). Then you need to get the denial letter from the insurance company and mail it to them and bing bang boom.......that was it.

If you are on pegasys the program is called pegassist. I'm sure someone will come on with the numbers but if you google them they will come up. I've been SVR for two years and don't have them any longer but wanted to write you and give you hope right away.

I'm telling you they could NOT have made it easier.  It was like a gift from God - not just the meds but how willing the companies are to give them to us.

Good luck.

[can-do-man]

Sorry but this seems to happen alot, just don't give up and if all else fails the drugs companies have programs that will cover things like this and they are very liberal on their income levels........... Wishing you the best

cando

[Bill1954]

As already mentioned, call one of these numbers and explain what the insurance company has done. If you can get in this year, it might benefit you. I qualified for assistance with Schering-Plough; they let me use the cost of *any* prescription drugs I’d purchased earlier in the year to use against the initial down payment they required.

Have last years federal form 1040 available, along with a list of out-of-pocket expenses for prescription drugs paid this year. Also have a copy of the letter of refusal from your insurance company handy. You should be able to do most of this over the phone; they might have you fax some of these documents to them for approval.

Yup- what a bunch of BS :o).

Good luck—

Bill

[mphillips]

Thanks for the suggestions I will call Pegassist asap.

[Deb_c430]

best of luck!  i waiting for mine now to say its over normal tx,

[Bill1954]

Sorry; I forgot to add the numbers:

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

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

[Rockerforlife]

Are you in Canada>?....cause TRUILLIUM will help

[Mary4now]

Every single person should stop paying the insurance companies, maybe then they will listen to us.

[kickboxingmom]

I also had problems with the Ins.Com,Although not with an extention.I would write them a personal letter, explaining,WHY.I don't think ins. com doctors have a clue.Explain to them facts and if you are the only one working , children, etc.Make them SOB's listen.I did. and will again, if need be.That's what we pay for.Good Luck and let us know.
Tammy P.S.I won after four appeals !

[kickboxingmom]

I also had problems with the Ins.Com,Although not with an extention.I would write them a personal letter, explaining,WHY.I don't think ins. com doctors have a clue.Explain to them facts and if you are the only one working , children, etc.Make them SOB's listen.I did. and will again, if need be.That's what we pay for.Good Luck and let us know.
Tammy P.S.I won after four appeals !

[burned74]

I would suggest writing a certified letter to the insurance company with a cc to your  State Insurance Commissioner.

I own a small  contracting business and have found that to be an effective way to get attention to a problem quickly. Some of the people on this site have done this successfully in the past

[justme53]

I've been given the run around by my insurance company (large risk insurance group) and pharmacy trying to get the meds I need to double dose per doctor's orders. They approved the higher dose Ribavirin, but having problems with the Peg as double dose. The insurance co. says the pharmacy is not keying it in properly, the drug store says the insurance co. is denying it....back and forth, back and forth. The clinic just called and said they will give me the extra Peg themselves so I don't have to pay out of pocket.

Maybe your doc. might have some help for you in this way. Also would it make any difference if you started after the first of the year for insurance purposes since you ended tx in 2008?

It's an outrage that we have to fight for these meds. It's not like we're going to get high on them or abuse them, for Pete's sake. We're finally getting docs. to think outside SOC, and now another roadblock, getting the insurance companies to approve it.

Pam

[mphillips]

Thanks for the suggestion. I spoke with the insurance co yesterday about appealing and once I explained that I relapsed and was told to tx for 48 weeks they seemed to think that it wouldn't be a problem. They said that they were sending an appeal letter to the dr for him to explain what is going on.

[GrandmaBRZ]

I had same problem.  When the doc's office sent the updated studies to the ins. co, my extension was approved to go to 72 weeks.