Hep C Discussion Forum

Linuxter · Guru

RE: Insurance Companies!

Tig · Admin

Thank you for your opinion and post Dave. However someone feels about discussions on politics and religion is certainly up to them and we do our best to keep the discussions to a mild roar.

You are free to move your previous post to the rant and rave section and your thoughts are duly noted. I just wanted to add that I feel it was fine here where the conversation was started, only because we have over the years since Obamacare was enacted, seen it impact people quite differently than it has worked for you. We have also on occasion seen it benefit certain individuals. I hope to see that become more common sometime in the future. That is my opinion.

The subject of this thread is Living with Hep C and dealing with access to or the difficulty in receiving care is all part of that.

Linuxter · Guru

Edit: Post Deleted and can now be found Here (A more appropriate location, IMO, for rants for or against the ACA)

Dave

-- Edited by Linuxter on Thursday 21st of January 2016 05:14:03 AM

Tig · Admin

I feel your pain and frustration Iris. I had a great plan, pre Obamacare. Lost my doctors, all of them, had my plan cancelled four times because of stinking changes. Every time they would improve a certain item on their already pathetic list of covered items, they'd cancel the plan and reissue it with lesser coverages. I have lost two doctors already in 2016, because the doctors didn't like all of the required paperwork the BCBS HMO requires. It's a disability policy and I have pre existing conditions. The trick with Obamacare is they can't deny you coverage for pre existing conditions as long as you're with the same carrier. Try a new carrier or even a doctor with your current carrier and they don't have to accept new patients. It's BS, pure and simple... I'll never quit fighting the unfairness of this system.

That's my two cents.

Iris Dragonfly · Guru

Why do we have to go to such extremes to get results.

I might have to try it, ever since Obama care, my insurance has been a mess, between the Satate (the provider) and the Insurer (company who shall remain namless) they can't figure out what the other is doing.

Have been dealing with this since Feb of 2015...I was covered through county but not state or visa-versa. Then I was covered but my husband was not and the only income was his...how does that work? They lost payments... sent back payments ...didn't appy payments. I went to court, it was supposed to be resolved, but now some how the first of the year I was cancelled. Went to insurance company to file complaint and when they tried to make it better they made it worse. Just got off ghe phone with the Insurance co. and the State provider, who are saying oops we had a glitch....arrrrrgh. I have literally clocked in over 50 hours or more on the phone between these two entities that cant shoot information right over in thjs fabulous effing computer age.???..everything takes 2 weeks or 14 days and then they got it wrong. I need a lawyer but can't afford that. I just had a ton of blood work the other day and 2 appts this month already, if they don't fix this I'm screwed. After 2 hours on the phone right nowI made a payment with the Insurer for my reinstated plan with the State...now lets see if the can get it right this time.

In the end I was only insured for 3 months last year because of this mess, and now I will be penalized for not having insurance... >evil <

So ya I get the frustration...

Tig · Admin

I like the way you think too, Jimmy! I can hear you ROAR!!

JimmyK · Guru

Greetings Xtra.

The battle must begin in your Heart and Soul. No room for anger at this point.

Who is your Insurance Carrier?

Do you know how to create a You Tube Video? Make one, let it go viral and send them the link.

I did that years ago when I got one of those Ronco Rotisseries and it broke the first month of use. They refused outright to provide any sort of relief whatsoever.

Made a video, sent a link to the address of Ron Popeil's personal home along with a letter that simply said "The Video will be removed when you make this right and not one moment before."

LOL the dude spends all sorts of $$$ on infomercials and he did not want he negative publicity. One of the "Regional Directors" called me personally and arranged for next day shipment guaranteed arrival by 10:30 am if I would take the video down. I responded with the fact that it should take me ten minutes to unpack the new thing, plug it in and test that it works. So I agreed to take the video down at 10:40 AM.

Shoot I even scored a set of stupid Knives, some gloves and a certificate of unconditional no questions asked warranty for 5 years!

LOL good product, still have it and makes a great chicken! LOL

Use your mind and not your anger. wink

Y'all will do fine.

JimmyK

Tig · Admin

Great advice Stormy! I like the way you think... We are our own best advocate, no question about that.

Stormy · Veteran Member

I don't know if this works, might be worth a try......

So, your doctor ordered a test or treatment and your insurance company denied it. That is a typical cost saving method.

OK, here is what you do.

1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/ Privacy Officer" (By federal law they have to have one).

2. Then ask them for the NAMES as well as CREDENTIALS of every person accessing your record to make the decision of denial. By law you have the right to that information.

3. They will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at criteria words, making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely that it is made by a board certified doctor in that specialty and they do not want you to know this.

4. Any refusal should be reported to the U.S. Office of civil rights ( OCR.gov ) as a HIPAA violation

Tig · Admin

Hi, another thing I want you to put some thought into is this, when (if) you receive a second denial from your insurance company, you need to contact the manufacturer of the drug protocol your doctor recommends. I put together a list of payment assistance programs, which include the manufacturers assistance programs. Gilead used to pay for the medication when patients had been denied twice by their insurance carriers. They had some qualification criteria, but it was pretty straightforward and many approvals were given. Then they decided that the insurance companies were screwing with them and taking advantage of their generosity and suspended the program. However, it has been some time between that action and today, they may have changed some of those requirements and restrictions again. It would be worth a call to these organizations and explain your situation. It's another option for you to consider that may work in your favor.

http://hepcfriends.activeboard.com/t56904226/payment-assistance-programs/

xtra · Veteran Member

I talked to the insurance company. Then I talked to the Dr's office. The Dr's office said I received an encouraging response from the clerk. The Dr's office said they would submit the insurance claim but the Dr's insurance person said it would be denied, most likely. Once I have a denial in my hand, then I can either negotiate with the insurance or go to the State about this. I think it is a stall. I don't believe that in 7 months, the claim won't be denied for some other reason and I have to wait another Xmonths so I am becoming proactive early, thanks to Tig and Dharmabum.

If a Dr states that he is giving me the medication on the day I am in his office, then we go to the front desk and the receptionist states the insurance says no, then the insurance company is practicing medicine. That is my take.

Thanks, at least I know how to go forward, politely and firmly.

I guess I am borderline 2/3. That is not too bad for almost 50 years of this disease. I was really worried about cirrhosis. Still am but so far, not so far.

Now I am a Dragon Slayer Warrior also! It took 2 months just to get Dr's appointments and test results. .58 and active 3, not too bad.

dharmabum · Senior Member

Hi there xtra. I am so sorry to hear this story. Or any story involving a denial of benefits.

My method was not to leave my doctor's staff fully responsible for acquiring my meds (Harvoni).

I always felt that I needed to be involved as an interested party in all phases of my treatment and ultimately cure.

Before even picking up the phone I used to make a pot of coffee, get my paper and pencil ready and remind myself that my staying calm was the only way to get through the two hour grind of getting to the top of the food chain at the insurance company.

When I finally got through to my state's Attorney General, I got some action - and fast. Meds arrived next day. I kid you not. If you need a break, watch this hilarious treat...

http://ipsite.org/3bjk

(shortened the URL-Tig) Hilarious Joann!

-- Edited by Tig56 on Friday 8th of January 2016 12:23:41 AM

Tig · Admin

Hello,

Here is a link to the current Fibrosure/Fibrotest blood marker description that will show you the different interpretive scales addressing fibrosis. Generally speaking, we see the Metavir scale referenced here in the US most often. You will see that your result (.58) on the Metavir scale places you in the F2 fibrosis category, nearing F3. That's a moderately high level, but not near cirrhosis (F4) yet. The time frame of progression isn't easy to predict because it's based on so many variables. The Activity scores (inflammation) are also affected by so many different things, it's difficult to put your finger on any one thing that may be responsible, aside from simply having CHC. Immune system function, diet, medication, years infected, etc., can all impact activity. Healthy diet and understanding what causes affect these issues are your best means to monitor and help control it. We typically see the inflammatory scores reduce quickly once SVR is achieved. The fibrosis stage takes time to regress if it's going to, but the recent studies and research are showing positive results in that direction.

https://en.m.wikipedia.org/wiki/FibroTest

xtra · Veteran Member

What I don't understand is the cost of arterial bypass and stents can cost $100,000+. My aunt, between the age of 95 and 102 had two heart surgeries that cost over $200,000 dollars. I cannot count the number of stents in this neighborhood alone, all costing $100,000 +/- yet the cost of treating Hep C is cited as why it is not treated promptly. I don't understand that at all.

xtra · Veteran Member

Tig Thanks! With severe activity, it seems logical to get this stopped at F3 and not wait 7 months.

I have the test results. The FibroSure is .58 and the activity is 3 (severe).

Since we have to doctor ourselves, what I really need to know is what is making the activity severe? I can only identify Aspertame in gum I used to quit smoking or a 5 day dose of Ciprofloxin another Dr. prescribed within 30 days of that test.

That is the only two substances I can identify as I make all my own food from scratch and don't take any medications/over counter/herbal. So what beside the virus could be causing the sudden increase in activity?

I didn't make it almost 50 years with this disease with that level of activity. This must be something new. I know the AST went from 72 to 149 in that one month between the initial blood test and the specialist retest.

-- Edited by xtra on Thursday 7th of January 2016 04:28:54 PM

Tig · Admin

Who told you that completing your HBV vaccination was required to qualify for HCV treatment? Being vaccinated for A and B is recommended for all of us with HCV, but I have never heard of treatment being delayed because of it. I would appeal that decision and contact your state insurance commissioner. Something smells funny to me! Get your doctor to help you if possible. He should able to contact the medical officer or whomever made that insane decision, often someone you don't have easy access to. The doctors can better explain the seriousness of the situation with their decision maker and hopefully get them to reconsider.

xtra · Veteran Member

The tests have been done. The doctor has to post them online. I have sent a request. He said if #1 was a normal liver and #4 was Cirrhosis, I am #3. He was concerned about some of the results showing a degree of inflammation. He wanted to prescribe the drugs today and get this done but the stinking insurance companies, I have to wait 7 months! He thinks the disease is advanced enough to warrant 12 weeks of treatment rather than 8.

This disease is not linear. If I have anything else that requires medication, then I am SOL because many drugs for heart disease and other age related conditions cannot be given to people with liver disease. It is so aggravating!

Would it help if I called the insurance company? Is it possible to get a waiver for their stupid, pinch purse, mean-spirited, inane and aggravating rules? This rule has to be done before I get to the next rule. And that will mean more waiting. How long does it take to get treatment?

What other group of patients have to wait? Do they make diabetics wait 7 months or cancer patients or people with broken legs? This is ridiculous! My doctor said his receptionist was often so frustrated he was afraid she might quit. She has to hassle with insurance companies and they impossibly obtuse, rude and uncaring to his office staff

-- Edited by xtra on Thursday 7th of January 2016 04:28:58 AM

Linuxter · Guru

Hi xtra,

I understand your frustration, it takes a while to get through all the testing and preliminary stages, I know, I'm waiting on approval right now.

Wait until you get your lab results before making any judgments, not to worry, this disease progresses at an extremely slow pace.

Just be sure you aren't drinking any alcohol or exposing yourself to any toxins, eat well and drink lots of water and low cal juices (lemon juice is very good).

When you get you Fibrosis score and Viral Load, put it in your signature line so others know when they are responding to your posts.

You'll be fine, try not to worry ... I've had HCV for over 40 years and any damage progresses at a VERY slow rate.

Wishing you well,

Linux

p.s. I'm curious, you say "I have severe fibrosis, although I don't have the test scores yet. I am very close to cirrhosis", how do you know this without having the test results?

-- Edited by Linuxter on Thursday 7th of January 2016 02:55:14 AM

xtra · Veteran Member

I had all the test done which costs my insurance company a bundle. All test must be done within 90 days of submission. I have severe fibrosis, although I don't have the test scores yet. I am very close to cirrhosis, the doctor wants to start Harvoni immediately BUT my insurance will not give me the drugs for seven months while I am being inoculated for Hepatitis B! Now, all those tests will have to be redone in seven months.and I might cross the line into Cirrhosis which could cost the insurance company $$$.

I don't understand this. The doctor doesn't understand this and It Makes Me Furious!

What can I do? Any suggestions?

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