trying to get approved BCBS of nc

[outfitter01]

Hello everybody, I just registered because right now I do not even know where to start.  I have been very sick since my baby was born, apparently while I was pregnant hep c returned.  My baby is now 15 months. 

This has been a rollercoaster ride, they even told me I had lyme disease for while never tested positive for that though.  Now I just tested positive for Cryoglobulins.  Ultrasound showed coarse liver, tested positive of high ammonia, and crazily enough my lfts are suddenly in the normal range.
I feel worse than ever though.

Anyways the pain in my bones, chronic fatigue and brain fog have me a mess. 
My doctor prescribed Harvoni 2 weeks ago and I just found out my insurance has not received any request from the doctor.

Is this typical?  Does anyone have advice to give? I am really down about this not sure where to even begin.  Thanks

[Else]

Just getting going myself, outfitter, so I don't have much info to share.  But you have found a GREAT resource in this board. 

My two cents would be to start a "treatment notebook". (every visit, every email, every phone call, dated and with names).  You can fill in past info when you're up to it - no need for that today.
It'll be your back-up when the brain fog gets overwhelming. 

Where to begin?  Today, call your doctor's office and ask the date the request was sent and by whom.  Log this info in your notebook.  If it has not been sent, ask who will send it and when.  Log this info too.  Follow up that this has been done, etc.  Think of it as a daily to-do list.  Just one thing at a time, next thing on the list.

You've got a lot on your hands with a toddler!  Take it easy on yourself.

[Lynn K]

Hi outfitter and welcome

Congrats on the new little one.

So sorry to here your hep c is back.

When you said your hep c returned had you treated in the past and were clear on the virus? That is a very rare situation from what I understand.

What treatment did you do and how long ago? Do you know your Genotype? What is your viral load? Has the condition of your liver been checked like with a fibroscan?

Yes I agree totally with Else keep notes about who you speak with at least a first name. Unfortunately we sometimes need to be proactive in working to get treated I spent a lot of time on hold and making many phone calls. My doctor sent it in but seems to get lost at the insurance side. Some fax fell off the machine and was never uploaded to your file that kinda thing.

I have called the insurance and they say they are missing a document my doctors office had told me they had already sent. I asked them to fax it again to my doctor, then I check with my doctor to make sure they received it. Then when my doctor's office sends it back I called the insurance to make sure they received it.

Unfortunately, that is sometimes how we have to do it to get things done.

Best of luck to you and your family

[morning_glory]

@Outfitter01 - Welcome to the best forum for information, support & a good place to share your experiences! 

Be encouraged, you will find very helpful advice here. As, Else & Lynn K suggested, keep notes and records of 'everything'. (Get copies of everything) This is so important - As you start your journey in advocating for yourself, be patient, yet persistent.

If I am remembering correctly, I think your doctor needs to call your insurance company to do a 'Pre-Authorization' for the medicine. It is considered a specialty medication and there is a process to follow, with the insurance company.

We all have had good and bad days, dealing with insurance, doctors, etc. Please don't get too discouraged, through this process. Many here have traveled the road your taking and believe me there are bumps and pot holes along the way.

Most importantly, rest when you are able and take care of yourself!

Being a mom of a toddler, is a fulltime job. Try to pace yourself and get outside with your little one.

You are in our thoughts and prayers.

Blessings,
MG

[Mike]

Hi Outfitter,

Welcome to the forum!.

You need to stay on top of the treatment request and follow it through the process. I would start with a call to the doctor's office just to make sure it was sent in and were the script was fax'd to. Ask them to fax it again. Get the fax number.

Then call your insurance drug benefit provider and find out exactly where this type of script should be fax'd to and have them explain the approval process. Make sure the doctor fax'd it to the correct number.

Else, made a great suggestion and a notebook can be helpful. Write fax numbers down, log the time and date and the person you spoke with. Keep a running record. Don't give up.

Best wishes, Mike

[outfitter01]

You guys are great thanks so much for your positive feedback. I am new to this forum and learning how to navigate it, sorry for the delay in replying!

Lynn: I am genotype 1a, I was told I cleared it, I never treated it, and had no symptoms, lfts were totally normal.  I followed up for 6 months after I had my baby 10 years ago and was given the all clear.

In 2014 after having my daughter everything went haywire, I had horrible rashes, joint pain and mental confusion.  I went to the ER and they treated for lyme disease, I followed up with my doctor 4 days later and she did a full battery of tests, and I was positive for hep C, cryoglobulins, lfts were 5x the norm, and ammonia levels were high. F2 Fibroscan. negative for lyme 4 times!

Else and Mike great advise I cant believe I did not think of doing that my self! I will reread it before I make follow up calls tomorrow.

My current doctor seems to disregard my symptoms and just prescribed Harvoni, for which the insurance denied twice, I do not think she included this in the original request. Meanwhile a year later I am still a mess.  Thank God I found this site. I am thinking its time to find a new provider too one step at a time.

Yikes sorry for the long post

Any advice and success stories is very welcome

[outfitter01]

I just wanted to post that I was approved by BCBS of NC for harvoni 12 weeks upon my 2nd appeal.  I started taking the Harvoni 9 days agos and I feel loads better. 

[Mike]

Great news, Outfitter!

Congrats!

Mike

[Else]

Congratulations!  And how great that the medication is working so quickly!!!

[Rosie13]

Congrats Outfitter! You are definitely my uplifting message today .Will follow your progress as I am behind you a few papers it seems! I just got denied by BCBS this morning. They said my genotype (1b) wasn't properly documented. A nurse called that I have not met & told me she was filling in for my nurse who is on vacation. I supplied the proper document (which they should already have) again and didn't ask many questions. I had such a restless night last night. The side pain is getting me  sleepless & some may just be nerves about being left to hang as my numbers climb. The tumor marker rose this time .The nurse told me all my numbers will be normal after Harvoni & not to worry.  Just a blessing I found the support here. Celebrating another member on her way!