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Author Topic: New disgnosis and insurance denial.  (Read 8019 times)

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Offline Allison

  • Newbie
  • Posts: 1
New disgnosis and insurance denial.
« on: September 11, 2015, 03:50:34 pm »
Hello everyone.
 I have been diagnosed two years ago with prenatal care. I was in complete denial and shock. I was sent to a GI doctor who scared me half to death. He went on about how awful the treatments were and that I may have to quit my job because I'm a healthcare provider as well. After that conversation it took me months to work up the courage to go back to the specialist. I went back after I was done breastfeeding, but decided to switch providers.
My new GI specialist was very encouraging and understanding. He told me not to beat myself over this. He told me that he had over 20 patients that were cured with Harvoni. I went home super excited, but after being denied by the insurance I got very depressed. I am not sick enough they said. There is no damage to the liver, yet...
I was hoping to go through the treatment and maybe get pregnant again, but my treatment is now on the back burner until insurance decides if I am sick enough.
Is it worth fighting the insurance company? The doctors office didn't seemed to be very optimistic.

Offline byebyeC

  • Member
  • Posts: 286
Re: New disgnosis and insurance denial.
« Reply #1 on: September 23, 2015, 02:52:47 am »
Hi Allison,

I'm sorry to hear of what you've gone through. It can feel like a devastating diagnosis. Truly though, it's not. I've raised two wonderful boys to manhood with hepc. You can stay quite healthy for quite a long time before things start cropping up. I'm talking 20, 30 years post infection.

It'd help responders if you'd fill out a signature line on your profile. Like what's under mine. Viral load, when diagnosed, what's been rx'd and denied. What your fibrosis level is if you have one, and what your genotype is.

A lot can ride on what kind of insurance you have as well, so include as much as you feel comfortable sharing about that. If you're covered by Express Scripts, they're now covering everyone in all stages of hepc for Viekira Pak alone or with ribavirin. I'm on week 3 of that tx right now and it's not bad at all. You could definitely carry on being a mom and working on this tx. You might just need some work restrictions so you don't get too winded, if you develop anemia that is.

Appealing is worth the trouble. Many are becoming covered after going through 2 appeals through their insurance then on to the outside of the insurance company 3rd appeal and getting approved at that stage. You'll have to be your own strongest advocate.

There are also clinical trials for the next gen meds going on.https://clinicaltrials.gov/ct2/results?term=hepatitis+c&Search=Search

Additionally, depending on insurance, you could potentially get help from the drug company's themselves, check out Gilead's and Abbie's websites. I believe Gilead's help is called support path and Abbvies, is called proceed. There's also another organization that'll fight legally for you to get your meds and some have gotten them for free through that. But, I can't remember the name. If you search the "on treatment" area and look through the threads with "denied" in the headers, you'll find what I'm talking about.

You'll get your tx if you fight for it. If your doc won't fight with you, change docs if possible.

Good luck and God bless,
GT 1a
Diagnosed 1980
Treatment naive
12 wk Viekira Pak Riba Started 9/7/15
Pre-treatment labs were ast 42 alt 33 vl 7,162,(eyes are light yellow now)
*Latest alt 19 ast 23! Yay! VL <15 detected

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: New disgnosis and insurance denial.
« Reply #2 on: September 23, 2015, 11:08:13 am »
Yes - fight like heck. Most people are denied, but many are winning on the 2nd, 3rd, or 4th round. Here's one resource: http://www.hepatitisc.pafcareline.org/ Others may be found at: http://www.hepmag.com/articles/2512_20506.shtml
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: New disgnosis and insurance denial.
« Reply #3 on: November 15, 2015, 08:50:08 am »
You can access treatment in Australia. The plane ticket will be your largest expense. Check out fixhepc.com.
Good Luck!
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24


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