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Author Topic: What is the Insurance Review / Appeals Process for Harvoni?  (Read 4877 times)

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Offline Roger

  • Member
  • Posts: 171
What is the Insurance Review / Appeals Process for Harvoni?
« on: November 13, 2014, 08:50:14 pm »
I finally crossed the line, into Stage 3 - so now my Hepatologist submitted my case to my insurance company (yesterday), asking for authorization for Harvoni.

I asked him what "the process" is, but he really couldn't explain it, as he really doesn't deal with insurance - someone else does.  I talked with those folks and since they are dealing with so many "numbers & variables", they don't keep track of it.

Since it involves me, directly, I would love to know how long it takes for the insurance company to give Harvoni the "go" or the "no".  Is it days or weeks?

Does my doc have to followup with them, or do they let his office know automatically?

How about the appeals process, if it comes to that?... What can be said that he has not already said in round 1?    Does the appeal take very long for a go or no?

I've always been pretty optimistic, but do struggle with the realities of BIG insurance wanting to collect our dollars and not disperse them.

I did plenty of pushing and legwork for my doc, to date, to get this thing moving faster than normally, but from this point I am in the dark.

What will this process look like?

Thanks!
Genotype 1a
2006 - Dx
2009 Biopsy      - Stage 2
2013 FibroScan - Stage 2
2014 FibroSure - Stage 3

Started Harvoni 11.21.2014 Viral Load - 313,593
12.26.2014 - UND (at 5 weeks)
At 8 Weeks - UND
EOT 02/12/15 - UND
12 Week EOT Blood Work - UND

Offline lporterrn

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  • Posts: 1,982
  • LucindaPorterRN
    • LucindaPorterRN
Re: What is the Insurance Review / Appeals Process for Harvoni?
« Reply #1 on: November 14, 2014, 07:38:21 pm »
I'll let others weigh in on this, but here is a resource that will help with the co-pay and if you get stuck or denied: http://www.mysupportpath.com/
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
http://blogs.hepmag.com/lucindakporter/

Offline Roger

  • Member
  • Posts: 171
Re: What is the Insurance Review / Appeals Process for Harvoni?
« Reply #2 on: November 14, 2014, 07:58:22 pm »
Thanks Lucinda,
I'm just getting use to the way this board work, so I posted this same answer to you via a different topic that I started.

I'm on Gilead, and they contacted my insurance company a week or so ago,
and primed the pump.  My doc was suppose to send my file to the insurance
yesterday, but I received a note from them today telling me that they have
not actually sent it yet!  She said it should take 6 - 8 weeks to be denied, then appeal and finally get the drugs...

Eight weeks!

I am scrambling for health reasons and because I have to get onto Medicare very soon and would like this underway prior to that date!
Genotype 1a
2006 - Dx
2009 Biopsy      - Stage 2
2013 FibroScan - Stage 2
2014 FibroSure - Stage 3

Started Harvoni 11.21.2014 Viral Load - 313,593
12.26.2014 - UND (at 5 weeks)
At 8 Weeks - UND
EOT 02/12/15 - UND
12 Week EOT Blood Work - UND

 


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