Need approval from Insurance for Solvadi/ribo..scared need advice

[will I?]

Hi all just found the forum today its great..everyone is like me, fighting for something...anyhow ive had hep c for 5 years its done some high damage to my liver..5 months ago I went to get treatment from infect disease doc..i have Medicaid united health community plan...TERRIBLE they are... first they denied my approval because they said I never tried interferon/ribo combo....Doctor appealed because im on allot of psych meds history of severe depression anxiety post tram stresss etc.  They denied again and wanted a HCV Fibrosure blood test done AND a Urine drug screening...I gave them that (im in recovery since 09 from iv drug use clean and sober) So i see my doc and ask for the results of the hcv fibrosure and fibrosis score is 0.84 and stage is Cirrohsis Necroinflamm activity is 0.94 which is the worst Grade Severe activity.. So Insurance turned me down again...
All the while im fatigued my urines are Dark colored and high traces of bilirubin in urine (this is goin back months and im still goin through it) Very active hep C right now its doin damage. So the Doc orders a pelvic cti scan to see if i have cirrhosis....it comes back that i have mild fatty infiltration of liver..with liver disease with No Focal Mass. Ty God.
So im still waiting for approval...they Now want history of urines that show ive been clean for over 6 months..Which im on methadone legally and have the paperwork so im gonna turn that in and see what reason they come up with next LOL
most recent blood work is alpha 2 macros or AST 517 and my ALT is 277 iu/l
hep c viral count is 6.1 million iu/ml ...hep c genotype 3 and  idk what this is but hcv log10 is 6.786 log10 iu/ml

Any help or advice is great..am i curable or is this real bad? TY all GOd Bless too

[mario555]

I just read your post and I would agree you need treatment asap! You've already done the heavy lifting in quitting your past behaviour. You're in luck because there has never been a better time to have Hep C! New medications are coming out every year and the price of older medication is going down as the new ones start up! You should be able to get some kind of medication if you keep pushing your insurance and request help from Gilead with the co-payments.
You'll find all kinds of people here who have had trouble with insurance and you should be able to get some tricks and procedures to get an approval.  So, good luck!

[will I?]

tx man.. yeah are my numbers that dangerous? cuz the doctor has just waved me away like well we just wait now. I don't understand how my fibrosure test tells me I have cirrhosis staging and sever necroinflam activity. But the doc says from the pelvic cti scan that since my liver is normal size its not cirrhosis and not too worry? LOL  I don't get it

OK any help would be great...so do I goto gilead website?

[sunrise]

Hi Will
      That is so right what Mario said. Is their another doc around that can help you? Big reason I did not want Medicaid is that the companies helped me within 4 to 5 weeks I got approval. I would think tbere os an advocate around that would help you. Try to drink alot of water for your system. Eat low sodium foods and lower your sugar intake. Lots of veggies and fresh fruits also. If you smoke, Stop! Check Connies site (life beyond hepatitis c) she is great and can lead you to find help. Im so sorry to hear about this.  You need treatment right away....Best wishes.....sunrise

[will I?]

thx the irony of it all.. I don't smoke don't drink..im on and off on a good diet..but man my urine very dark and smells like chicken soup..anyway im 37 years old too very young
Im gonna start my good diet back up today and drink lots of water. ty
Although my doc after reviewing everything and told me we are waiting had said none of this. crazy eh.
my main doc referred me after finding the bilirubin and ketones in my urine to a ureologist..I haven't made appt.. I mean what for ? I need treatment not a ureologist so they can get there buddy doc a apt from me and can gouge my insurance more.
frustrated so much. get these hot flashes throughout the day where I break out in sweats and it drips off me I cant move for like 2 minutes till it passes. It feels so disgusting and uncomfortable. My biggest fear is that they wont treat me because my liver is already bad and my numbers are too bad.. idk I have paranoia thoughts because of my psych history I am on allot of meds now too, abilify 20mg, prozack 40mg, visterol 5 pills a day for anxiety, remeron 20 mg at night for sleep. and methadone 60 mg oral dose daily. God help me

[will I?]

they prolly see me as an x junky and put me on the back burner. I understand.
but I have been in recovery 5years..if u consider methadone maintenance recovery..its a fine line..i have restrained from illicit drugs for 5 years

[sunrise]

Try not to get down on yourself.  Be positive. the kind of doctor you want to see is a gastroenterologist. a physician that is understanding about addiction. aand has a lot of experience with hepatitis C. That is why I'm leading you to Connie's site as she has a lot of connections to the right type of physican  that you need to see.we all have our problems will don't think  that you're the only one. a lot of people here have had problems with drugs and also anxiety as myself I have anxiety. I have a great doctor who really was intense on finding me medication that is what you need best of luck... Sunrise

[will I?]

ok I have had a gastro doc soo..she said I need to get treatment and shes the one who read the pelvic scan I had from whom the infectios disease doc ordered it. she said since liver is normal size that its not cirrhosis just mild fatty infiltration of the liver with no focal mass
She dismissed me too.. so its now upto my infectious disease doc to get my appeals to be a success. Like I said im getting the next step now they asked which is a year of no illicit drug use proof. (I think the insurance didn't think I had this but I DO) see at the methadone clinic they check out urines weekly for illicit drugs. I have no illicit drugs since late 09, BUT BUT im sure the insurance knows im on methadone and may be setting me up for failure because the urines will have methadone in them. So I don't know how they will react to that.

[sunrise]

As long as its prescribed they shouldn't be bias, but then again its insurance. You will get treatment dont worry so much. Just take care of your liver. There is a great supplement milk thistle just cannot uae it while on treatment. It really helps the liver. Too bad you cant wean yourself pff the methadone. Its hard on the liver .

[will I?]

yeah fingers crossed..tx for support all. glad to know theres others here like me. I worked the 12 step program and know about support and he helps allot.. without it Id don't know where id be.

[Rubye]

I'm on Medicare with Medicaid as a supplement and it depends on which state you live in. My state's criteria for treatment is not only cirrhosis but also a secondary condition. For me, I have cirrhosis with neuropathy and so was approved.

Btw, you can have cirrhosis with a normal size liver. I do anyway. Your liver gets smaller when the cirrhosis becomes really bad but at the beginning it can still be the same size. I don't know why they told you that.

60 mg is a healthy dose of methadone so maybe that has a lot to do with it. Legal or not, you are still using a lot of drugs and methadone is worse for your body than the heroin was. With that being said, I wish you luck because treatment is very hard to obtain with Medicaid unless you are very ill. For the most part.

[will I?]

its weird the doc after reading the fibrosure didn't say much ..then he ordered a pelvic cat scan where they inject dye in me that came back and just said mild fatty infiltration of liver no focal mass.. he said well no focal mass that's good and left. so he didn't seem concerned.
So if you or I get treatment and rid the body of hep C what then becomes of our Cirrohsis? We can never drink alcohol again I guess, (I don't drink just curious) do we still have to walk on egg shells so to speak.

Lastly I asked my doc about methadone and he said it has little to no effect on the liver. this is infectious disease doc so where did u hear its really bad? Many people told me its fine on the liver. The doctor emphasized 1 point...DO NOT DRINK ALCOHOL! that's it

[sunrise]

Will,
      All drugs filter thru the liver. That being said, you have a few floating thru your system. Alcohol is def the worst. You say ypu don't drink so amen to that. If you think your doc is the one. Then go with what they say.  They are the pros. Yeah if you have cirrhosis then you should never drink again. Cirrhosis is scarring of the liver where not much gets filtered and will poison you and unless you get a   liver transplant can destroy your other organs. That is what i do know about hep c. Good luck...