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Post Info TOPIC: Life insurance increase denied - "history of Hepatitis C"


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RE: Life insurance increase denied - "history of Hepatitis C"
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I know of others that experienced the exact same thing with Metlife. They were denied for having the antibody show, which never goes away.
Enavigo3891 wrote:

I would love to get my hands on the underwriting guidelines for the company that provides Life Insurance through my employer. I currently have 2x my salary and last year (in anticipation of purchasing my home) I attempted to raise my life insurance amount. I completed the statement of health and the increase request was denied: "Our decision was based on a history of untreated Hepatitis C". That letter aggravated me as at that time, there really wasn't a viable "treatment" for GT2 (pre-FDA solvadi approval). Cut to this year - I treated, 12 weeks sovaldi and riba, and as of a few weeks ago I am SVR24. I again attempted to increase my rates this year under the theory that I was denied last year for not having been treated and now... well being treated! I completed this year's statement of health (after the SVR24 news) and I just received another denial: "Our decision was based on a history of Hepatitis C".

So last year was it really that it was untreated or was it just that I had it? And what "history" exactly? My history of zero evidence of cirrhosis? My history of never having elevated liver enzyme tests?

It's a slap in the face to do the right thing by treating and trying to do the right thing by protecting my family (by getting ENOUGH Life insurance) to be denied. Millions of American's have HepC and most don't even know it. Up to 75% of those in the US with HepC are unaware. I wonder how many people MetLife is insuring actually have HepC and neither they nor MetLife knows.

Well, off to write my "request for review" - feel free to share any good pointers for anyone who has had experience in this situation.

Happy holidays to everyone!




__________________

56 year old, Geno Type 1a, 2.1mm VL, F3 bridging fibrosis, diagnosed 02/2014, Started Harvoni 02/25 (8-12 wks) Cured date 04/03/15



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Dear Kristen,

What a beautiful and moving letter! Thank you for sharing! I am holding fingers crossed that people at MetLife will come to their senses.



__________________

Gen 1b, 33yo. Started 12wk Viekira Pak on 2/28/2015.

Baseline: VL=517K, AST=34, ALT=56.

Wk4: VL=<15, AST=16, ALT=14.

Wk8: VL=UND, AST=17, ALT=14.

Wk12: VL=UND, Fibroscan: 3.4kPa, F0.

--->Viekira Pak financial and nurse support<---



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Playing devil's advocate maybe insurance is denying on the basis that you merely have a sustained viral response rather than a cure, thinking that the drugs are so new it is impossible to know how long we will retain a SVR. Or, perhaps they're thinking that the Hep C could have done some damage yet to be seen, such as bone, nerve, liver damage that's unseen. Hep C does open us to a host of other diseases. However, you are so young and haven't had Hep C long enough for it to have really done any kind of serious damage. Just saying.

I wonder if you had cancer and it was brought into remission for 6 months if you would have been denied. It's kind of the same thing. Maybe?



__________________

UNDETECTED 5/4/15 - 16 weeks after EOT, 1st treatment - Sovaldi and Olysio, Geno 1a, 67 year old with compensated cirrhosis, over 40 years with HCV.



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Kristen,

Hopefully someone pulls their head out! And soon. Before my discovery of HCV, I never knew how ignorant and careless insurance companies could be. Your story and my experience infuriates me!! Please keep us posted and good luck.

-Rob



__________________

Age 33, Male. GT-1 for ten years. Diagnosed in March, 2014.

Treated with Sovaldi/Olysio: SVR 24 on February 16, 2015!

Tig


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Hi Kristen,

I don't understand the ignorance and complete lack of attention to the details you have provided! Might be time to discuss this with legal counsel. I'm in complete agreement, this simply cannot be allowed to stand unchallenged! I'm looking forward to hearing what the supervisor has to say. Can you record the call in your state without notifying the other party? I might consider it anyway if you can't, just for reference. I have seen some of your appeal work and don't think this will go well for MetLife. Keep us informed and good luck!

Tig



__________________

Tig

63 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 5+ years!

Hep C FAQ Lab Ref. Ranges HCV Resistance

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Hey everyone - so I received my response from MetLife. They maintain their denial for increased coverage; Reason: "Chronic Hepatitis C"

So of course I called them and spoke with someone who of course had no authority to answer any real questions. I asked how I was being denied for something I don't have. Her response: "So you're saying you don't have Hepatitis C?" UM .. HELLO! Did anyone even read the information I submitted?

I explained that I am cured. And that my doctor supplied to documentation that I am cured. I said, "Statistically, I'm at greater risk of dying in a car accident than from Hepatitis C so if you would have denied me for my statistical risk of dying in a car accident, well that would make more sense than you denying me because of Chronic Hepatitis C". She said she was reading further and said "oh yes, it appears our medical underwriters denied your request for increased coverage and also your claim that you do not have Hepatitis C."

WHHAATTT?

She confirmed that she just told me that the medical underwriters denied my "claim" that I don't have hepatitis C. I advised that I wanted additional information on the underwriting materials or procedures they use in these decisions as I am concerned that they are using outdated information. And I'm also concerned that they denied me for "Chronic Hepatitis C" because in essence, it's as wrong as if they denied me for having "Prostate Cancer" (being female of course). Her only response was that she can have a supervisor call me back in 24-48 hours. I said, "Please do. Good day."

I will not simply stand idle with this response. To be continued...



__________________

Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14 #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND



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Kristen,

Short and to the point- love it. Good luck!!

-Rob



__________________

Age 33, Male. GT-1 for ten years. Diagnosed in March, 2014.

Treated with Sovaldi/Olysio: SVR 24 on February 16, 2015!



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Kristen,

Well done on your letter and your doctor's letter. I agree it's safe to say that MetLife has many policy holders with HCV.

Good luck!



__________________

Miss B
56 years old. Genotype 1B, previous treatment with interferon 1994. StartedHarvoni 12/8/14. After 2 weeks, VL dropped from over 4 million to 496. At 4 weeks, undetected, but at 8 weeks, <15 mL (detected), at 12 weeks/EOT UND!

Tig


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Hi Kristen,

Outstanding! You worded that perfectly and supported your position with historical and professional documentation from all corners of the field. I can't help but believe that if anyone with two brain cells left, that is familiar with the newest information regarding HCV, reads your appeal, it should be accepted. I wish you the best of luck! I think I'm going to keep your contact info handy if I ever need help writing an appeal (for anything!).

Tig



__________________

Tig

63 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 5+ years!

Hep C FAQ Lab Ref. Ranges HCV Resistance

Signature Line Set Up/Abbreviations Payment Assistance



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Hi Kristen,

That's an amazing letter! Well done.



__________________

Me: 62 yr. old female, GT 1b, fibroscan 4.5; VL 650,975 as of 2/4/14;started Harvoni 3/6/15; SVR


Hubby: 59 yrs.; GT1b; fibroscan 25-cirrhotic; S/O for 12 weeks started tx 3/20/14; SVR56; fibroscan done 7-7-15 = 8.5



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Hey everyone... thanks for the replies. So good to see some familiar names! I finally got in touch with my doctor about the denial for increased life insurance. Turns out they never reached out to him this time. So he sent me a letter for me to send them and I have responded to them regarding their reason for declination. Tim, I may go the route of suggesting an exclusion for HepC directly however I'd like to see what they say to my response.

I attached a copy of the letter I'm sending to MetLife as well as a copy of the letter I got from my doctor. I can't tell you how many times I've read it! I think I may even frame it! biggrin

Will keep everyone posted.

It's funny, before treatment I was perfectly content in living my little life keeping the big dragon my little secret. Now that I've fought through treatment and reached SVR24 I just want to fight. Fight for everyone. Fight to kill the stigma. Grrr.



Attachments
Forum copy.pdf (165.4 kb)
__________________

Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14 #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND



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Back when hubby was with the union we applied for life insurance...I was denied due to my hep c, he got his insurance, but later medi-cal took it away. Basically you can own nothing to recieve services, he also had another policy that his mom took out on him in the 60's. Medi-cal took that too, well ...you had to cash them out so you are totally broke before they will help.evileyeWhy is the system so messed up? We still don't have any life insurance, and now that were on social security, I'm not sure we'll ever be able to afford it.

By the way...good to see you guys, biggrinIris



__________________

in the silence of the woods, you will not be alone- Chief Seattle

60 years on planet, Female, diagnosed 1978 as non-a non-b, VL 8mill+, Fibro f-1f-2, Genotype 1a, treatment nave....UNTIL 7-01-18 !!!! started Harvoni 12 weeks. :)

4 weeks=UND, 8 weeks=UND, 12 weeks=UND (EOT= 09-23-2018)



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1st this is a really strong message to all that HEP C is a killer, not to be disheartening but insurance is a poker game, you bet against yourself the insurance co. bets with you......but if you are dealt a hand of 7 card stud and show 3 of a kind...you think the insurance co is not gonna fold? It's a bad bet with poor odds and they don't take those bets.

That is why a person should buy incremental life policies that are cheap when you are healthy because most can't dump you if you are in prior to health issues.

Or the newest thing (abiet old) is start your own insurance fund, or what they used to call a savings acct.



__________________

53yr M 1a acq 12/83 cirr pre tx MELD 17 tx nv diag 1/29/12 tx S/O 3/5/14 trans list.

EOT 5/28/14 UND 6/12/14 SVR 8/29/14 MELD 14 dx HCC 9/5/2014 tumor ablation 9/24/14

In the 10K lakes State It's not about us but those around us.



Guru

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Hello Kristen,

I'm wondering if your insurance company would consent to writing an exclusionary clause for the Hepatitis C, but allow an increase in coverage for other circumstances?

__________________

"hrsetrdr"=Tim

Treatment halted on Aug.8,2012 due to vision problem. 6 month post tx labs

Aug.2013 SVR

Be strong when you are weak, brave when you are scared, and humble when you are victorious.
- Unknown



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Hey Kristen!

Long time, no see. I hope you're doing well and thanks again for helping me through my HCV discovery depression. I'll be watching this thread to see how this turns out for you. This is one area that concerns me greatly and now that we are both SVR, we shouldn't be in any higher risk category than any other healthy person.

Sorry you're going through this, it makes my blood boil! Anyhow, I hope everything else is going well for you.

Merry Christmas!

-Rob



__________________

Age 33, Male. GT-1 for ten years. Diagnosed in March, 2014.

Treated with Sovaldi/Olysio: SVR 24 on February 16, 2015!

Tig


Admin

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Hi Kristen,

Nice to see you again! You went through hell just getting treatment approved and now this! I would call this a "crock"! You have met your obligation many times over and I think you simply have to prove them wrong and I remember your ability to write powerful supporting letters. Be sure to get your doctor, and nurses to write letters in your behalf. Your doctor should certainly be able to assist you in writing an appeal letter. The new AASLD 2014 guidelines and the new SVR statistics are well in your favor. I wonder if the underwriters are relying on old guidelines and the disqualifying criteria from last year or even earlier. They certainly are using outdated material! You have a lot going for you, and it's going to require spelling it out to them. SVR, excellent liver health and condition, lab work to prove it and your youth are in your favor!

If you can think of anything you need assistance finding, let us know. I know we'll do whatever we can to get you past this obstacle. Good luck!

Tig



__________________

Tig

63 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 5+ years!

Hep C FAQ Lab Ref. Ranges HCV Resistance

Signature Line Set Up/Abbreviations Payment Assistance



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I would love to get my hands on the underwriting guidelines for the company that provides Life Insurance through my employer. I currently have 2x my salary and last year (in anticipation of purchasing my home) I attempted to raise my life insurance amount. I completed the statement of health and the increase request was denied: "Our decision was based on a history of untreated Hepatitis C". That letter aggravated me as at that time, there really wasn't a viable "treatment" for GT2 (pre-FDA solvadi approval). Cut to this year - I treated, 12 weeks sovaldi and riba, and as of a few weeks ago I am SVR24. I again attempted to increase my rates this year under the theory that I was denied last year for not having been treated and now... well being treated! I completed this year's statement of health (after the SVR24 news) and I just received another denial: "Our decision was based on a history of Hepatitis C".

So last year was it really that it was untreated or was it just that I had it? And what "history" exactly? My history of zero evidence of cirrhosis? My history of never having elevated liver enzyme tests?

It's a slap in the face to do the right thing by treating and trying to do the right thing by protecting my family (by getting ENOUGH Life insurance) to be denied. Millions of American's have HepC and most don't even know it. Up to 75% of those in the US with HepC are unaware. I wonder how many people MetLife is insuring actually have HepC and neither they nor MetLife knows.

Well, off to write my "request for review" - feel free to share any good pointers for anyone who has had experience in this situation.

Happy holidays to everyone!



__________________

Born HepC + in 1983 ... diagnosed @ age 13 ... GT2 ... 12 wks of Sovaldi/Riba from 2/11/14 to 5/5/14 #ribazombie

1/30/14 - Starting VL 1,922,967 * 3/11/14 - UND @ 4 wks * 7/29/14 - SVR12 * 11/6/14 - SVR24 * May 2015 - SVR52 * MAY 2016 - STILL UND * FEB 2018 - STILL UND

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