Fair Hearing

[Joe NM]

I sat in on a Fair Hearing with a client today...It was dismissed because it wasn't requested within 30 days of the appeal denial. We argued to the judge that the insurance company never sent out a letter or a fax either to the client or to the doctor's office, and I had to actually call and wait on hold for an hour just to get their department, where somebody told me it had been denied. We requested the Fair Hearing a couple weeks later. The insurance company also said it was an "Expedited Appeal" so they didn't have to send notice of their decision to the doctor's office. We had the appeal letter right in front of us and I was the one who faxed it in, it wasn't marked as Expedited! And her consent form specifically said that the decision should be sent to the doctor's office! The judge didn't listen and dismissed the case. While my client was crying and yelling at her, the judge told us to have a nice day and hung up.

[Joe NM]

We're requesting a Peer to Peer call with the insurance company's medical director, hopefully that goes somewhere! In the meantime I'm looking for genotype 3 clinical trials, but so far clinicaltrials.gov is only showing one that she'd qualify for but it's two states away!

I'm thinking she could put in an application to Support Path for Prior Authorization and Appeals Support? Does anyone have any experience with this? Will they help put pressure on the insurance company?

Is there ANY group that helps call up insurance companies and put pressure on them? AAAAHHH so angry right now. This client has daily vomiting episodes and can barely stay awake due to HCV symptoms, lost her job, lost her boyfriend, lost her house all due to these symptoms. But she's only F2 so they won't cover her.

[lporterrn]

Bless you for your kind heart. Some thoughts - perhaps contact NVHR, Project Inform, Help4-Hep, or www.hepatitisc.pafcareline.org Also, Treatment Action Group (they are litigating)

if you PM me, I can put you in contact with specific individuals.

[Onefluover]

Sorry to hear all that. Similar situations for me. And two to three states away as well but I will do it if they except me. From the phone number below they will tell you that they have several new Geno 3 studies opening later this year. I don't know where the test centers will be located as they seem to vary depending on the test but if its hundreds of miles away then it is still worth figuring out how to travel there every week. If I had no other option at all I would sleep in a shelter or my car or a park bench if I had to in order to have a shot at being cured.


AbbVie Inc.
Study Management Associate
Clinical Program Development (HCV)

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