Hep C Discussion Forum

Members Login
Username 
 
Password 
    Remember Me  
Chatbox
Please log in to join the chat!
Hep C Discussion Forum -> General Discussion -> AASLD on Retreatment
Post Info TOPIC: AASLD on Retreatment
Isiscat2011


Guru

Status: Offline
Posts: 1724
Date:
RE: AASLD on Retreatment
Permalink  
 

The bad faith claim is the important one because it is generally handled on a contingent fee basis (no atty fees up front) and the potential damages are much greater.  That would be handled by a law firm that practices in the area of Tort Law and more specifically in the area of insurance law and bad faith claims.  

The same firm would handle the breach of contract claim.  A breach of contract action alone wouldn't be sufficient because you would probably have to pay atty fees and costs up front and your damages would be very limited.  You may or may not be able to even recover atty fees depending on your policy and state law.  The litigation could cost as much as the tx if the insurance company wanted to make things difficult.

You would probably need to exhaust your appeal remedies first--your policy should spell that out.  Also, state laws vary so there is no single answer to these questions.

I wouldn't wait to talk with a lawyer in your area  if the doc-to-doc call isn't successful.  If you can find a sympathetic lawyer a letter to the insurance company might change their position.  Again, I don't think this is going to be necessary, and if you were not cirrhotic I wouldn't even be thinking about it at this point. 

 



__________________

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


Guru

Status: Offline
Posts: 1782
Date:
Permalink  
 

Interesting topic, holding BCBS to the fire. What kind of law firm handles that kind of case?

I have thought about it, breach of contract. What actually has to happen to get to that point? Another rejection at the appeal process. or something beyond that?

Hopefully the changes needed won't take to long.

matt 

 



__________________

"And in the end, the love you take is equal to the love you make"

61 year old Geno type A1, F4 Cirrhotic, started 24 weeks on Harvoni 12-17-14 ,EOT-5 week = UND, 8-31-15 =UND , SVR-24 Baby YES! 
Isiscat2011


Guru

Status: Offline
Posts: 1724
Date:
Permalink  
 

Gilead/FDA need to update its Harvoni label and the AASLD need to update their guidelines soon.  That would be the fastest and easiest way to resolve the retreatment issue at least for priority 1 patients. 

I probably should not bring this up but I was just thinking about what a great case you would have for a bad faith and breach of contract lawsuit against BCBS.  Not only do you have cirrhosis, and therefore require Urgent treatment, but Dr. Lawitz was your treating physician.  He could be an expert witness AND a fact witness.  That will never happen because BCBS is going to approve but you would be the perfect plaintiff to get the lawsuits rolling. God forbid you became sicker while they denied tx.  The punitive damages would be LARGE.   That is why they will approve your treatment sooner rather than later.



-- Edited by Isiscat2011 on Sunday 16th of November 2014 04:52:47 PM

__________________

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


Guru

Status: Offline
Posts: 1782
Date:
Permalink  
 

Hey Isiscat

Thanks for this post / resource about DAA relapser re-treatment. The Doctors and clinical trial study sites that see the results of there own patients that go through re-treatment are the cutting edge and should have a big voice for all that are seeking appeals and to substantiate there basis for re-treatment.

Example, when I received my denial and there rational I emailed my other Doctor from the TLI (Dr. Lawitz) and I wrote "It seems to me that the basis or criteria they are using for denial is flawed"

he wrote back "Wow that is crazy..very flawed as harvoni is indicated for protease failures as studied in ION 2. Agreed there are studies retreating DAA failure pts that show success with harvoni!  You are correct! "  

Its highly likely that in 3 to 6 months there will be a lot more support for re-treatment, so again we wait, "All Things in Time"

matt



__________________

"And in the end, the love you take is equal to the love you make"

61 year old Geno type A1, F4 Cirrhotic, started 24 weeks on Harvoni 12-17-14 ,EOT-5 week = UND, 8-31-15 =UND , SVR-24 Baby YES! 
Isiscat2011


Guru

Status: Offline
Posts: 1724
Date:
Permalink  
 

DAA retreatment is a recurring topic here and for those who are interested, in addition to the study results that are slowly surfacing, there is language in the AASLD guidelines that provides support for retreatement.  The guidelines clearly state that retreatment should be considered and the decision left to the discretion of the physician: 

 

A small number of patients in whom an initial antiviral treatment failed have achieved SVR when treated with the same drugs for a longer duration, or when treated with alternative antiviral regimens. (Lawitz, 2014) Thus, patients in whom treatment has failed to achieve an SVR should be considered for treatment when alternative antiviral regimens are available. Advice from a physician experienced in HCV treatment may be beneficial when considering retreatment after antiviral therapy failure.

Patients in whom antiviral therapy failed to achieve an SVR may harbor viruses that are resistant to 1 or more of the antivirals at the time of virologic "breakthrough."..... Subsequent retreatment with combination antivirals, particularly regimens containing antiviral drugs that have a high barrier to resistance, such as nonstructural protein 5B nucleotide polymerase inhibitors (eg, sofosbuvir), may overcome the presence of resistance to 1 or more antivirals. 

http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-are-treatment-or-have

 



__________________

Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Page 1 of 1  sorted by
 
Quick Reply

Please log in to post quick replies.
Hep C Discussion Forum -> General Discussion -> AASLD on Retreatment
Legal Disclaimer:

THIS FORUM, IT'S OWNERS, ADMINISTRATORS, MODERATORS AND MEMBERS DO NOT AT ANY TIME GIVE MEDICAL ADVICE AND IN ALL CASES REFER ANYONE HERE TO SEEK APPROPRIATE MEDICAL ADVICE FROM THEIR DOCTOR.