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Author Topic: Insurance Questions  (Read 10421 times)

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Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Insurance Questions
« on: September 30, 2014, 06:48:45 pm »
If you were denied hep C treatment and going through the approval process:
What is your insurance plan?
What state do you live in?

Thanks.
Lucinda
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline Barney

  • Member
  • Posts: 4
Re: Insurance Questions
« Reply #1 on: October 01, 2014, 12:51:26 pm »
Denied twice by UnitedHealthCare for Sovaldi/Olysio. Now I have to request an external review. Employer/carrier in Illinois, work/live in Oregon.

Thanks for picking up the ball on this!

Offline hlthy8

  • Member
  • Posts: 12
  • Eat Well
Re: Insurance Questions
« Reply #2 on: October 06, 2014, 02:13:05 pm »
I live in s. california.
I was denied twice by Anthem blue cross and once by Healthnet for off label O/S combo. I was a prior nonresponder to interferon and ribo.
I was denied because I had a level 2 Metavir score and they require a score of 3.
I went through a specialty pharmacy that advocated for me and I am now on the combo. I qualified for 100% assistance through them.

Offline johnsshutts

  • Member
  • Posts: 97
Re: Insurance Questions
« Reply #3 on: October 18, 2014, 03:28:22 am »
I called accredo with express scripts yesterday afternoon and I was told that my harvoni was denied. I was told that my paperwork stated that I do not have hep c and that I did not have a liver biopsy., crazy! I called my doctor's office and they were aware that it was denied. They told me they are going to appeal it. They said they would work on it Monday. I was told it could take up to 14 days to appeal it. I called GEHA, my health insurance and they were not able to help me. I told them you have all my paperwork stating I have hep c and I had a liver biopsy. You paid to have all of this done! I was on prior treatment for 14 months, over 10 years ago with peg and co-peg.  I called Accredo again, they are a speciality clinic for express scripts and I asked for the approval dept. I was told that my paperwork is still being processed for harvoni. I am thinking that I am getting the run around with accredo because harvoni is very expensive. Home delivery is $87,898.21 for a 84 day supply. I pay $5 with my co-pay coupon. I think they are trying to push Gilead to lower the price. I was on the phone for over 3 hours yesterday evening trying to straighten all of this out. I can't understand what is calling on. I was so confused over this. Each person I would talk to would give me a different story! I was so excited, and now I am really bummed out. I don't no how long they are going to stall this, and when and if it will get approved! I have the second largest health insurance company, GEHA, with the federal government. I will keep you all posted.

Offline johnsshutts

  • Member
  • Posts: 97
Re: Insurance Questions
« Reply #4 on: October 18, 2014, 04:37:51 am »
Doing a lot of research on why my harvoni was denied. Now I think I know why I was getting the run around on the phone for over 3 hours!

http://www.fiercepharma.com/story/pricey-hep-c-drugs-beware-express-scripts-plans-showdown/2013-12-11
 
 This website is interesting. It states: Pricey hep C drugs, beware: Express Scripts plans a showdown. Now I think I know why my harvoni was denied!

 


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