Hepatitis Forums
Hepatitis C Main Forums => Considering Hepatitis C Treatment => Topic started by: FutureThinker on February 13, 2016, 12:31:22 pm
-
To all who have been fighting, fighting, fighting with their insurance companies to get treatment for this potentially terminal disease: don't hesitate to take your denials to your state insurance board. Talk to your doctors about this option. My insurance company wasn't going to BUDGE on their denial w/o the state stepping in and telling them they HAVE to cover my doctor's request for 12 weeks of Harvoni. We absolutely should not have to go through all of this, only adds more stress and anxiety to our already compromised lives, but don't give up until you've at least gone to the state for help. They were the one who came through for me (other than my docs & their staff).
I will be starting my Harvoni treatment 1 year after my doc originally wrote the Rx for it. It hasn't been a fun year, either, but "better late than never"! So do not give up, even when you are so tired and feeling crummy. We deserve this treatment and to live quality lives again. As another member says, Fight the Good Fight -- Future Thinker
-
Congratulations FutureThinker!!!! 8) 8) 8) That's a huge victory for you. All aboard the Harvoni train. You will be cured before you know it. :)
kim
-
Congratulations!
You beat me by a year!
I spent two years in a constant battle. Work, battle the insurance company and suffer. Two years gone....
It is a crime.
Happy for you!
CM
-
Coach Mike, how sad is this, in this country, that I "beat you by a year" in my fight to get coverage?????? Thank God things seem to be changing, now that there's going to be competition/generics in the market, esp. by summer, as I anticipate Gilead's new drug will be approved. It's just not right, playing with our lives like this while these CEOs make millions/billions. Something's wrong here. I think I am still in shock that I am actually going to start treatment this month.... now the real fight begins, and it is LONG overdue! FT
-
Hi again,
Your signature says, in my humble lay opinion, your biggest fight is over!
You are almost home.
Consume and destroy!
CM
-
FT,
I'm with coach. All down hill from here...in a good way. Nice going, keeping up the fight. You will be an inspiration to many folks in the wings of Harvoni denial. I personally will never feel completely cured until we all are. I think most on this forum would agree. Very happy for you my friend.
-
Thank you all so much, I really appreciate this forum to let us vent some of this STUFF that we just can't talk to everyone about, and provide support to others when we can. This isn't a fun fight, but we do win more often than not.
I will find out tomorrow just what the next step is, now that Pres. holiday is behind us. But I finally know this ball is going to start rolling!! APPEAL, APPEAL AND APPEAL!! FT
-
I was denied 3 times by Anthem Blue Cross, my Dr. was awesome and gave me the name of a Lawyer who took the case on contingency. They had me pull the appeal to the State Board, they said if that gets a final "Denial" then it's over. I was one of 13 cases in California. The good news: As of Jan 1 2016 Anthem Blue Cross no longer denies these claims.
They approved my Harvoni and must approve others. Hope this helps some one who may have been denied and does not know this.
All the best to everyone.
-
Vicki777 -- I was able to file my own state IMR after 2 denials. It only took ~5 weeks from sending in the app to getting Harvoni approved -- yes, the tide is definitely changing for the better!! I am hopeful that fewer and fewer people will have to go thru the anxiety/stress/anger we had to, to ask our state insurance boards to MAKE these greedy insurance companies do their job. Still makes me mad, but at least I will be starting treatment for this condition in the next couple of days, for which I am extremely grateful. The future now seems bright! So glad to hear your got approval, too!! FT
-
That is truly great news!
But now, the flip side is going to start becoming apparent. Insurance companies are going to raise all the premiums so Gilead can get their blood money.
But still, at least the cost will be spread out and people can get well.
In a perfect world......
Happy for you and everyone getting their deserved coverage.
CM
-
You know, Coach, that has crossed my mind........... we just can't ever win when it comes to insurance/utilities/gas, etc!! Big $$$ always gets big $$$ in the end. I also wonder how the introduction of the overseas generics has played into all this, both with insurance cos and pharm cos....... FT
-
Good points.
When Dr. Freeman presents his first REDEMPTION results at EASL, some heads are going to turn. They are spectacular.
CM
-
Vicki - I'm so glad you shared that. And congratulations!
Coach, you're still the man. ;)
FT - I hear ya on the corporate greed. Then again, that Midas Touch of greed will come back to bite the actual people behind these decisions. The story of Midas wasn't a happy one. I've always wondered how that saying caught on.
-
Yes, one of my favorite sayings is "What goes around, comes around"........ still don't have a clue how these people can sleep at night! FT
-
I was denied 3 times by Anthem Blue Cross, my Dr. was awesome and gave me the name of a Lawyer who took the case on contingency. They had me pull the appeal to the State Board, they said if that gets a final "Denial" then it's over. I was one of 13 cases in California. The good news: As of Jan 1 2016 Anthem Blue Cross no longer denies these claims.
They approved my Harvoni and must approve others. Hope this helps some one who may have been denied and does not know this.
All the best to everyone.
I, too, have Anthem Blue Cross. Been waiting for a year like this one. From the time my doctor received lab work and specialty pharmacy called was 9 days. 1st attempt. So the tide is turning.
-
Just a reminder...CEO's of insurance companies (yes the same ones that deny us a cure)...are some of the most over paid in American business...the one from my insurance company makes 66 million annually. I ask; and it is a fair question...how is that right? Truly, if they were doing their job...the real job...the job they should ethically do...well, I guess they would not be worth that kind of money. Why? Because then god forbid, they would be doing the "right" thing.
-
It's disgusting. We've all been given a very wide angle view of just what's going on in this country with our healthcare. Something is very, very wrong, just not sure how it will get fixed. FT
-
Now that people are getting approved, as they should be, the CEOs' salaries will not go down, but our premiums will go up.
Maybe a lot.
CM
-
So here's another component of this wacky system we're in here in the US: State IMR tells ins. to pay up on Friday; doctor is notified; they contact ins or whoever to start process for me to get these lifesaving drugs on Tuesday (due to Pres. holiday);I'm told I'll be called by specialty pharmacy by end of week. Someone from an affiliate of the pharmacy calls Tuesday, says Harvoni has been approved and this takes "several days to process" and I should be getting a call by Friday. No call so I call Fri. a.m. Am told they don't have a prescription. I call MD and first pharmacy caller to advise of rx problem; call again in late afternoon....... "still being processed, we now have the rx, but call the specialty pharmacy directly before they close". Do that; they obviously had not touched my application, but did so while on the phone with me, but again said it "takes a few days" to process and verify everything by MD and insurance. "Probably" by Monday afternoon I should get a call re: delivery. I verbalized how long this rx has taken to get approved and can I do anything to expedite...... answer is "no", but we can overnight the rx to you if needed once everything is verified. SO -- looks like I will have my hands on this medication hopefully Tuesday, 10 days after the insurance co. called to tell me it was approved. I have read others had similar long processes to get their miracle pills on this forum.
Now, WHY is this process so convoluted?????? All this repeated paperwork by multiple people in multiple offices adds exorbitantly to healthcare costs! This is the first time I've had to deal with a specialty drug, and I am not impressed by the system at all. Grateful I'm eventually going to get it, but the system seems extremely inefficient. And, I won't be surprised if everyone's ins. premiums go up, to boot. I guess this is a way to have multiple jobs for multiple people..... FT
-
Damn!
All I can say on this "G" rated venue.
When I got my approval letter from the IMR, I scanned it and sent it to my insurance company and immediately called them. They started this "Yes, we got the IMR decision and when we review it, we will make a decision..." That's when I went ballistic on the poor lady...Basically, I said I fought you for two years. I won. I want my medicine now. No need to review #*£¥. Call the pharmacy now or I might go "postal" on all of you...
The package was here the next day.
Good Luck!
Happy for you.
You fought them and won.
Good as cured!
CM
-
Coach, trust me, I'm trying very hard not to go postal on them until I get my hands on these drugs!! You unfortunately had to fight twice as long as me, so if I'd been going thru this for that long, I am SURE I would have been yelling into the phone! It's going to happen --- I didn't know that for the past 11 months --- and I'm just trying to "stay calm and carry on" until I take this first pill this week. But, you know, all this added stress and anxiety does not help us at all; I could tell this specialty pharmacy person wasn't going to move any faster on this, just another day at work, don't rush me, I'll get to it when I can, probably by Monday. I will be calling them Monday if I don't hear by noonish. It's been a very unimpressive experience thus far. Just have to focus now on getting that SVR and keeping it!! BTW, how are you doing with your labs, aren't you due soon for your final ones? FT
-
April 4th is the magic day. I may be more concerned about it as it gets closer, but I feel really good about it. I cleared in 4 weeks on the generics and did 8 on the factory meds. If it's back, I will do 12 weeks of sof and dac. You can import that from Medochem for $650.00 now.
Good luck again!!
Let us know when you take the first pill.
I had a dull headache for three days. That's it. Starting feeling better, really better, after day 12 or so.
CM
-
Now, WHY is this process so convoluted?????? All this repeated paperwork by multiple people in multiple offices adds exorbitantly to healthcare costs!
Is that a trick question, FT? ;) I'll throw out a guess - because it's a revenue generating machine instead of a healthcare system?
What made the cover of Time magazine - the "$1,000 pill" or the "66 Million Dollar a Year CEO"? The cure, not the criminal, of course!
Why is the national dialogue "can we afford it?" and not "can we afford THEM?" ???
-
Else, no it wasn't a trick question, I'm just in disbelief at how convoluted this whole process has been! (LOL) You are absolutely right, it's a revenue producing system with lots and lots of hands in it. I just want to get my hands on a bottle of Harvoni! I should know sometime tomorrow when that highly anticipated moment will be. I'll announce it when it happens!
And CM, 4/4 is just around the corner! FT
-
I'm going thru the same thing...I have public aide insurance. How do I go about talking to the state. Do I call just call my insurance company. It's blue cross community through public aide...thanks
-
Hi,
Has your insurance denied coverage? If so, have you appealed the denial? If so, ask your insurance company if there is a higher level appeal. If they say there is not, tell them you demand an independent medical review of their decision. The have to grant that under federal law. I don't know if they have to tell you about it if you don't ask.
The IMR will find in your favor.
Coach Mike
-
Kristen84, sorry to hear you hare having to go thru this, too, but you've found a great resource here on this forum for lots of information and support. Coach gave good info to you (as he always does!); after my insurance denied me twice, once for the original script and then after one appeal, my doctor told me the next step was filing a claim with my state's insurance commission. So -- you will first have to appeal the decision to your insurance company, but if they just keep on saying "NO", then ask your doctor about the state for help. Or, as Coach recommends, ask the insurance. I was so disgusted with my insurance that I didn't ask them anything else, just filed the application with the state ---- and WON!
I just found out the Harvoni will be delivered to my door tomorrow morning -- I think I'm still in shock! Kristen, Let us know how it goes, OK? We're all in this fight together!! FutureThinker
-
Thank u so much I just saw my specialist for first time yesterday and my viral level is only 799,000.IDK genotype yet til end of week. But I've only had hep c for 1 1/2 years. Found out for sure in October :( I was crushed. I have insurance through public aide and my prescription book says it covers sovaldi
-
But my specialist says it only covers those meds if it's bad. That's bull shot. Thank u guys I need the support and will keep in touch . :)
-
Kristen 84, you've entered this HCV arena at a very exciting time, with several drugs now available and more in the pipeline, and soon. Your doctor is your best bet at determining when to start treatment, so ask him every question you can think of to help with that decision. Your genotype will have a lot to do with the treatment option.
Keep us posted as you learn more, and good luck!! FT
-
Happy for you FT!
For Kristen, insurance denial is not an issue, although I am a firm believer in making them cover the medicine needed to treat this scandalized disease. Right now, you have some options. Generic, I mean clinically tried and tested, generic tx can be in your hands in 4-5 days for as little as $860.
Keep us posted.
Great news FT, I feel better each and everyday.
More so because of stories like yours.
CM
-
Once I realized I wasn't going to faint or anything after taking my first Harvoni this a.m., I've been smiles all day!! I think a weight has been lifted off my shoulders, now that I am finally on my way to SVR. Felt very good all day, and certainly drank lots of H2O as all have recommended. It's a much better place to be in than where I was, fighting with the insurance, fearful, angry, frustrated, etc......... just so grateful to be in this new place. FT
-
Thank u everyone for the feedback...it's so wonderful to be able to talk to people who are fighting this battle as well...it gives me so much more hope!!! I found out yesterday that my insurance covers harvoni even. And they said I don't have to wait to get approval for it til damage is already starting to occur. Great news!! He said it just has to go through a "specialty pharmacy" I'm so relieved....I'm still waiting on my bloodwork from Monday to come back...my specialist ordered the lab for them to check my levels , liver enzymes test,and genotype. I'm curious to know which type I have . I'm so grateful and thankful for this forum. Now I don't feel so alone...we will continue to fight this battle together!!! God bless you all!!!!
-
HaHaHa :) :) :)
I am so happy for you!
Things are changing!!
CM
-
Things are looking up I even start a new job today:) I've been trying to find work for a year now!!
-
Buy a Lotto ticket!
M
-
I know right!!! Lol I better do it while good things are happening!! I'm so broke I don't even have money to buy one. Hb u buy one and I'll pick numbers for u lol
-
I've also been without cable for a few years now and ordered a package thru at&t and it'll be hooked up tomorrow!! Yayyyy I can watch TV now!! My kids will be thrilled lol
-
Wow Kristen! This really is your year! 8)
-
Kristen, SO, SO, SO happy for you!!!!!!!!!!!!! What a quick change in your life, just like that!! Yes, the tide really is turning w/ treatment coverage for HCV, thank God, and I believe the "class of 2016" is gonna be a big one!! YEAH!!!!!!! Let us know when you board the Harvoni Train --- or whatever train your doctor sends you to. Again, so happy for you! FT