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Hep C Discussion Forum -> On Treatment -> Insurance problem
Post Info TOPIC: Insurance problem
Katie


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RE: Insurance problem
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I had very bad experience of appoval from my insurance company for the meds. Everything was so stressful. First I was told by insurance company to contact with some foundation for assistance, I was denied because of my income. In order to have my insurance company pay for meds I had to be denied for assistance by the foundation. Based on the denial, the insurance company had a meeting for an approval for meds. By the time I was approved for meds I lost my job, no more insurance. I was panic and worried. I was waiting for getting a new job to have insurance pay for meds. It didn't happen. No body told me that I could have free meds if I am uninsured. I happened to call Pegays to ask for assistance and learned that they assist uninsured patients. My boyfriend searched for Incivek and found out that Vertex assist free meds for uninsured patients too.  

Thanks God that I lost my job, everything turned out much simplier than having insurance. All meds are free of charge from Pegasys and Veter (Incivek). Meds shipments were so fast without any problem. For refill I just have to call Pegasys, shipments are always on time by UPS. Vertex shipped through FedEx (for Incivek) always one day earlier than they informed me. Vertex even followed up with me for refill, I didn't have to call them for refill. I didn't have order at specialy pharmacy. 

My boyfriend said "you really need to lose your job in order to have treatment". It really is. 

I am blessed to lose my job in order to have meds and good service. 

Katie



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news


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Phil,

As usual I agree with you. From years of association, I know my medical and prescription coverage is good, but they are cantankerous. Any excuse to delay, write letters, call on the phone, send emails, and they will do that rather than buy the drugs. But during this treatment, in each and every case, the meds have come on time, and the pharmacy calls me a week ahead to ask where and how to ship. I know for a fact this is due to the technical excellence at my doctor's office. It is not in fact due to the friendliness, or efficiency for that matter, of the insurance company. I just thank my lucky stars that I fell in with such a good medical practice, who found a great specialty pharmacy, and also that I found such a wonderful bunch of friends in this forum.

Alan



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Geno 1A  Started Pegasys/Ribavirin/Incivek Nov. 20, 2011 .  Completed July 28, 2012 (36 weeks). For a treatment history, see:  https://jshare.johnshopkins.edu/xythoswfs/webview/_xy-9921874_1

SVR on January 14, 2013!!
Phil G


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In my case, I feel the blame (and not that it matters) is mostly with my doctor's office. The specialty pharmacy is efficient, and if all the approvals are in place from the insurance company and prescriptions up to date from the doctor's office, it ships without a hitch in a day. The insurance company appears to follow the published and manufacturer guidelines. I have been able to look at their policy bulletins, and they pretty much follow the recommendations. In this case, the 12 week VL labs are a go/no-go decision. They want to see it. The doctor has to send it. It seems that the insurance approvals, etc. expire cause they have not received the required information from the doctor, and it can only come from them, not me. All I can do is stay informed, light the fire, and keep it burning. But the blame also falls on me. If I don't like it, I can change doctor's, but at 17 weeks down out of 28 and undetected at all check points, I'm not willing to do that. Anyway, doctor's appt tomorrow morning. Hopefully, we can work out some other issues. Thanks for letting me vent here. Calms me down, and just maybe I can go in tomorrow without acting out my scripted emotional rant.



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Geno 1A, VL 1.9 mm, SOT 12/2/11 - Pegintron/Ribavirin/Victrelis, UND since wk 8, EOT 6/15/12 (28 wks), SVR 11/30/12
Isiscat2011


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moptop68 wrote:

i will never know why the US didnt go for the same health system as the uk

That can be answered in two words.  Corporate greed.  It has brought our health care system to its knees.  But, don't get me started. no



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
thathillkid


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This is someone who was stranded by insurance companies after 6 mos. of treatment. No one told me about Victrellis being a complicated restart medication after a lull (5 days) in taking it. My insurance spontaneously and quite decisively refused to pay the bill for Interferon, Victrellis and ribovirin. My treatment professionals said that since my viral load was undetectable and my treatment was very hard systemically, that I should go with what I got. If my viral load shows back, I can begin to worry again. For the past 6 months I have had an "undetectable" reading for my viral load. Insurance companies are your garden variety *******s. They care about one thing and it doesn't come close to looking out for our asses. There is hope and blessings beyond what you are told are facts. Because insurance companies choose the path of ploitical correctness and social incorrectness, i.e., "**** the little guy, remeber there are forces beyond those encountered that have more say about your future than anyone plodding around on this planet. Have faith!
Praying for all brothers and sisters inflicted with this ****
Peace,
ted

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Often, seeing the truth is harder, than believing the lie!
moptop68


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i will never know why the US didnt go for the same health system as the uk,iv been paying out £40 of my wage since i started work at 16 and you dont notice it, i mean you never have to pay anything more for treatments or thyroid meds or ops. i dont get it you payout for insurance dont you. tx here if free because we pay that bit of money and i cant imagine having to worry about money while on tx,christ thats bad enough. my meds came to my door every month i didnt have to do a thing apart from take a phone call. i do feel for you guys. scrips arnt free but still.

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Phil G


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Update from 3/21 post: Got my Vic shipment this morning. I was on my last days supply, tomorrow I would have started the day with nada. Too close! But apparently the doctor' office has finally satisfied the needs of the insurance company, and they have approved both the Peg and Vic for another 6 months. Hopefully, this is over, but I will continue to re-order at least 2 weeks early.



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Geno 1A, VL 1.9 mm, SOT 12/2/11 - Pegintron/Ribavirin/Victrelis, UND since wk 8, EOT 6/15/12 (28 wks), SVR 11/30/12
news


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I'm not sure if it is my insurance company (Medco through Hopkins Employer Health Programs - EHP) or my excellent doctor and CRNP, but I just renewed for a sixth box of pegasys and a change of therapy on the ribavirin and nobody batted an eye. The delivery, in a styrofoam chest with ice packs, will arrive for me to sign on Wednesday morning of next week. The prescription insurance outfit argues about most of the normal stuff, and beats us up about transferring it all to their inhouse mail-order pharmacy, but my HCV meds are "no contest - just send 'em", from a specialty pharmacy in northern Virginia, hand delivered by a uniformed messenger. Once again I feel almost guilty for having it so easy.

Alan



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Geno 1A  Started Pegasys/Ribavirin/Incivek Nov. 20, 2011 .  Completed July 28, 2012 (36 weeks). For a treatment history, see:  https://jshare.johnshopkins.edu/xythoswfs/webview/_xy-9921874_1

SVR on January 14, 2013!!
Shep


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The other night --I finally got a really good night's sleep and had this scary dream about monsters chasing me, friends and family. Well you could have thought it's about fighting the dragon but I think it was insurance companies.

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Diagnosed 1996 genotype 1b VL alot tx starting 12/23/11 Victrelis UND week 8!!! 28 weeks of tx

Completed tx 7/6/12--still UND!!!!
rcorange


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Insurance issues are the last thing you should have to worry about at this point.  My insurance company made me get my first shipment from one specialty pharmacy and all subsequent shipments had to come from a second pharmacy.  Yeah, that made things easy.  Then, at week 20 the pharmacy switched my pegasys from regular syringes to the pro-click.  My Dr was not happy because he didn't order the pro-click and I hadn't been trained on how to use it.  Just venting.



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Genotype 1B, started treatment 10/7/11.
Shep


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It sure was a scare--I have learned my lesson! How are you?

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Diagnosed 1996 genotype 1b VL alot tx starting 12/23/11 Victrelis UND week 8!!! 28 weeks of tx

Completed tx 7/6/12--still UND!!!!
jrc209


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shep- i always ordered mine (victrelis) 2 weeks early that way i never ran out, had one scare and that was enough for mesmile



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Geno 1 A Started Tx 8-3-11, Viral Load  21.2 Million,  4 Week Lead of Soc ,9-1-11 <43 On Soc alone started victrelis 9-3 ,8 week pcr vL und.Week 12 Vl Und, Did Week 24 PCR Results UND @ Week 24!!! 1-11-12,End Of Tx 2-15-2012 !!
Shep


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Must be insurance companies motto--just say no! I thought that was suppose to be for illegal drugs. So hope everyone will re-order meds with plenty of time for the insurance company to exercise their power trip and save yourself less stress!

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Diagnosed 1996 genotype 1b VL alot tx starting 12/23/11 Victrelis UND week 8!!! 28 weeks of tx

Completed tx 7/6/12--still UND!!!!
Phil G


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Called the pharmacy yesterday to reorder Victrelis. Seemed to go OK and gave me a Friday ship date. They just called and said it was not approved, won't ship, and needs a new pre-cert. Why am I not surprised? Anyway, in doctor's hands now, and they have come thru in the past. Think I got over a week left.

My experience grows, and not all of it good, but I am not reinventing anything. Somebody else has already been there, done that, and I get to react a little more sanely, day by day. THX.



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Geno 1A, VL 1.9 mm, SOT 12/2/11 - Pegintron/Ribavirin/Victrelis, UND since wk 8, EOT 6/15/12 (28 wks), SVR 11/30/12
Anna Christie


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Shep glad u got the meds on the way. You handled it. Hugs



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Phil G


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Glad it worked out and hope it continues to. The relief is near instantaneous and so very big. Now, you would think that after all those calls to so many people, THEY finally understand and will never do it again! 



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Geno 1A, VL 1.9 mm, SOT 12/2/11 - Pegintron/Ribavirin/Victrelis, UND since wk 8, EOT 6/15/12 (28 wks), SVR 11/30/12
Shep


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Insurance update--I hate insurance companies!!! After many phone calls--thanks Phil---I finally got through to eveyone that I was almost out of meds and they will arrive like the cavalary on Friday. They were going to ship tomorrow but the Victrelis people did not make their delivery to the pharmacy today. It was amazing though--as soon as I knew they were being shipped my 3 day headache started fading.

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Diagnosed 1996 genotype 1b VL alot tx starting 12/23/11 Victrelis UND week 8!!! 28 weeks of tx

Completed tx 7/6/12--still UND!!!!
Shep


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Thanks all--this is so frustrating. I know the pharmacy has been talking to my nurse and they said it will take a couple of days. I guess I learned my lesson & will start the re-ordering process much earlier.

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Diagnosed 1996 genotype 1b VL alot tx starting 12/23/11 Victrelis UND week 8!!! 28 weeks of tx

Completed tx 7/6/12--still UND!!!!
krowdog


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Hi Shep,

I don't know why it has to be so difficult either. I had that problem too.  In my case the authorization ran out at week 16 for my Pegasys (Which is always used at least 24 weeks)

I was told the auth. was not for a time length, but up to a certain $ worth, depending on the particular insurance.

I bugged the *&#! out of my doctor's assistant, got re-authorized before my last week ran out.

Keep on 'em!

Brad

 



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(Geno 1a, Incivek Triple Tx, 6 month post TX - 9/20/2012 = SVR!!!)
Anna Christie


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Shep,I had the speciality pharmacy do that to me at 12 weeks reorder of Peg. They required a new prescription. I got pissed and irritated but it all worked out. I was so glad when I got to the point where I had all the meds I needed til the end of TX and did not have to mess with such bs. When a person is on this stuff dealing with MD and pharmacies and insurance companies is very stressful. I always started really early when reordering so if anything went wrong I had time to make what seemed like a million phone calls about it. Hugs 



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Phil G


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I feel your pain cause I've been there and still am. It seems like just about every other time I go to order meds, the prescription has expired, need to do another pre-cert, or flat out denied. And once the Peg/Riba gets straightened out for one more ship, the Vic has a problem. Last time, I had one more day of Vic before I got it. I am just a grunt talking to other grunts that can't do anything. I even sent in an urgent appeal once, declared not urgent, and the decision date would be after I'm out. It takes the doctor's office to get anything done. So, my job is to order as early as I can, so that I can alert the doctor's office ASAP if there are problems. So far, they have come thru every time and I haven't missed any meds, but the stress is so high, much less the rage.

To be honest, I don't know how much of this is the insurance co (Aetna) or the doctor's office not supplying the necesary info or responding to requests.



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Geno 1A, VL 1.9 mm, SOT 12/2/11 - Pegintron/Ribavirin/Victrelis, UND since wk 8, EOT 6/15/12 (28 wks), SVR 11/30/12
kmiller


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So sorry to hear this. I hate ins. I hope that this will be resolved as soon as possible. I'll be praying for you.

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Shep


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This is probably more of a rant BUT... went to re-order meds & the speciality pharmacy is oops insurance company wants prior authorization. HUH??? didn't we do that??? Isn't the tx for 28 weeks & why at week 12 would they need authorization again?? I am out of meds at the end of the week and really worried. I was UND at week 8 but need to continue til week 28 to stay that way. The stress of this is making me anxious & crabby.

I just don't get why everything has to be so difficult

Shep



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Diagnosed 1996 genotype 1b VL alot tx starting 12/23/11 Victrelis UND week 8!!! 28 weeks of tx

Completed tx 7/6/12--still UND!!!!
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