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Insurance denied treatment for HCV
My insurance company (a Medicare HMO Advantage Plan) just denied me treatment for HCV saying it is not medically necessary. What a bunch of crock, they have been denying everything lately. I asked my doctor's office for a letter and they said they would send one but it hasn't arrived before the deadline coming up. Help!
I can never reach anyone at my doctor's office and left 4 messages asking for this letter the doctor said he would fax me and never did. The ins. co. denied HCV tx based upon it not being medically necessary and the doctor wasn't in network. The doctor IS in the network and is the ONLY dr. within the network who treats for HCV.
My viral load count has been 2 million a couple of times now recently, its high. I feel like crap, I have liver pain and burning and exhaustion. They just want me to die rather than get treatment.
Keep at it. It seems like hard work with everything else you have to do just to get mentally and physically ready for tx. Grrrr. Don't give up. You have every right to treatment and any rescue meds if dr. orders it.
Karen :)
Karen :)
The same thing happened to me five years ago, my health plan told me I wasn't sick enough! I've since switched jobs and have a new health insurance carrier that had no problem with treatment. It's unbelievable that they could deny treatment. Crazy.
Ow! I certainly don't know much about Medicare yet, but I just applied for it this week in anticipation of my 65th birthday. I wondered how hepatitis C would be treated under medicare so chose to treat before I turned 65 -- just in case -- while I still had great insurance. Glad I did.
As I understand it, Medicare Advantage is like an HMO or PPO. It is different from Medicare Part B and sometimes called Medicare Part C -- they are health plans approved by Medicare and offered by private insurance companies. Medicare pays a fixed amount for care every month to the companies offering Medicare advantage plans and the companies must follow the rules set by Medicare. MA plans had health and drug coverage. This is not supplemental insurance. Apparently they all work differently.
Joining switching or dropping a Medicare advantage plan:
-Before turning 65 (3 months before)
-If the Medicare is due to disability you can change during the 3-months before the the 3 months after the 25th month of disability
-between 11/15 - 12/31 each year (and new coverage will begin 01/01 of the next year
Sounds like you may need to switch plans right now.
Kathy
As I understand it, Medicare Advantage is like an HMO or PPO. It is different from Medicare Part B and sometimes called Medicare Part C -- they are health plans approved by Medicare and offered by private insurance companies. Medicare pays a fixed amount for care every month to the companies offering Medicare advantage plans and the companies must follow the rules set by Medicare. MA plans had health and drug coverage. This is not supplemental insurance. Apparently they all work differently.
Joining switching or dropping a Medicare advantage plan:
-Before turning 65 (3 months before)
-If the Medicare is due to disability you can change during the 3-months before the the 3 months after the 25th month of disability
-between 11/15 - 12/31 each year (and new coverage will begin 01/01 of the next year
Sounds like you may need to switch plans right now.
Kathy
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