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Avatar universal

Insurance denied my retreatment

hi again,
I posted last May and got great help, so here I am back again.
Facts: Hep C, type 1A with liver damage 3-4, completed 48 weeks of Pegintron/Riba in Sept 06.  My biopsy improved to early stage 3.  The bad news is I never cleared the virus by the more sensitive Hep C test.

My doc and I agree it would be worth a second try since I missed a week of dose during my first 12 weeks.  After a letter from my doc and calls (not returned) from me my current insurance company is refusing to pay for the drugs.  

I am not sure what to do next...(it is so weird to be fighting for drugs I need but really dread).  Anybody run into this?
Hope all is well with the fight you'all are in.  
Rawhide/Laura
24 Responses
Avatar universal
Did your ins. give a reason?  Did you get something in the mail?  Curious which pcr the virus showed up on, EOT, 1 month?

There is always the program where the companies give it to you.  Others who used it will post soon.  Hang in there.

miss
Avatar universal
I think we all three pushed post at the same time!
Avatar universal
Nice to hear back so soon on my question.  JMJM, you are right about the insurance maze...so far I have been unable to have a talk with a living human when I call.  
Thanks for the info on other options.

I did get a letter of denial and it said I didn't meet the criteria for medical necessity....They don't approve retreatment if you failed previous regimen of pegylated interferon.

History of bld test..I had 3log drop at 12 weeks, quit my 1st doc who was naive at 24 weeks, at 28 weeks my Quant RNA =undetected(below 615) and my Qual TMA at 30 weeks was detected.
I stopped ribavirin and have continued on with Pegintron as an antifibrotic.

Laura
Avatar universal
Sorry Laura. Two suggestions. First, continue pressing with the insurance company. Call, call again, and always ask to speak to a supervisor. And if they can't help you, ask to speak to the supervisor's supervisor, etc. Make sure to ask what the "criteria" is for re-treatment. Maybe they need a certain kind of note from the doctor (or doctors) saying certain specific things. Or, maybe they need some sort of documentation. In any event, find out what they require and then get it to them. Think of an insurance company as large maze with someone in the center who can help you. Your quest is to find that person and it  may take numerous attempts.

If this doesn't work, or as an alternative, contact the two drug companies at the drug assistance help lines (I'm sure someone will post the phone numbers soon) and apply for free drugs. There may be an income requirement but I hear it's flexible. My uderstanding is there's no asset requirement.

All the best moving forward.

-- Jim
Avatar universal
I'd apply to Commitment to Care ( if you are using PegIntron) or Pegassist.com for Pegasys.
C2C phone is 800 521 7157. Pegasys has a website with the info @ Pegassist.com.

Very generous qualification standards. They ship the meds to your door. You will need a scrip. Your doc office can supply them with the info.

Take care, let us know how it goes.
Avatar universal
Laura,

I was denied extending treatment meds by my insurance company (I am going to 72 weeks) and I did what Kalio has advised and called Committment to Care. They were prompt, easy and FREE and they send the meds right in the mail to me.

The insurance company does pay for my Epogen (so far) but even if they start refusing that one - most of the companies now DO have programs to help us out.

And the good news is you really don't have to be a pauper - they allow you to make a living and still approve you.

I think that they would definitely be worth a try!
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