Sage:
Was supposed to start Mavyret yesterday. I have been trying for several years to get treated for this disease and my HMO doctors denied me every time. Finally on medicare and found a Dr. to treat me and now the insurance denied me saying I have to see a specialist. This Dr. has been treating people on other insurance plans without denials. They will send a letter and try to get approval so now it’s wait some more. Errrg! So apprehensive about the side effects and being denied that I hardly sleep. Anyone else being treated by a regular Dr? Do you think I will have to or would I be better off seeing a specialist?
LindaBalz:
Don't give up! I was denied by BCBS at first because of a clerical error, which was quickly resolved. Then I got help with the copay which was 250. and it went down to 5. a month. Now I am cured. Its worth the fight!
Linda
badbradley:
--- Quote from: Sage on May 25, 2019, 07:02:02 pm ---Was supposed to start Mavyret yesterday. I have been trying for several years to get treated for this disease and my HMO doctors denied me every time. Finally on medicare and found a Dr. to treat me and now the insurance denied me saying I have to see a specialist. This Dr. has been treating people on other insurance plans without denials. They will send a letter and try to get approval so now it’s wait some more. Errrg! So apprehensive about the side effects and being denied that I hardly sleep. Anyone else being treated by a regular Dr? Do you think I will have to or would I be better off seeing a specialist?
--- End quote --- Call to Action: Physicians Needed to Alleviate HCV Treatment Restrictions
Most states require prescribing by specialists — generally, gastroenterologists, hepatologists and infectious disease specialists — or prescribing in consultation with a specialist. Serving as gatekeepers puts specialist in a very difficult situation, as without them, in most states, no one living with HCV can be treated. ...there are many health care providers who have significant experience treating patients with HCV who do not fall into the specialist category. By making specialists the gatekeeper to care, state Medicaid programs have created a bottleneck that saves them money by keeping individuals from receiving the curative HCV treatment they need. There is clear a solution to this gatekeeping problem. Specialists could play a leading role in a successful effort to end unfair and discriminatory treatment access restrictions, including the prescriber limitations in their state’s Medicaid programs. In particular, specialists could make it clear to state policymakers that these restrictions are unjustified, defy established treatment standards and violate federal Medicaid law. The restrictions also often violate state law.
Your dr may be able to appeal the decision also, I think. Don't be scared, you'll be fine.
I'm up here in Canada and I go through a specialist but that's what's required up here.
Good luck! I was on Epclusa and the side effects, for me, were very minimal. I've heard similar stories from other folks who are on Mavyret and they mostly seem to tolerate it well.
If you've had to endure chemo and/or radiation, this is so much less invasive. Trust me, I went through that too.