Friday, October 09, 2009

My Insurance Company Has Denied Further Coverage Of Interferon

I've been on interferon for 6 months.  My physician submitted a prescription renewal to continue treatment for another 6 months but my insurance company denied it for clinical reasons.  I can't determine from the customer agent what the clinical reason is.  The medication costs $500 per week.  Maybe that is the clinical reason.

I need to take my shot today but I have no medication, it isn't approved yet and if it is approved it will be a few days before it arrives.  I wonder if a gap in the treatment will be a problem.

Sure, we don't need no stinking health care reform.  This is working well for me.

9 comments:

Mike aka MonolithTMA said...

And they say health care reform will create problems like this. The problems are already here! This is the kind of BS they want to stop!

I hope they approve it for you, Joe. I had some medicine get denied several years ago, fortunately I had an alternative, only slightly less effective, medicine I could take.

Can you imagine any other business model where we would actually pay them to deny us service?

Joe said...

Only the insurance industry, as far as I know, and not just health insurance. Look what they did (or didn't) do in New Orleans following Katrina.

Homeowner policies typically pay for wind and rain damage, but not for flood damage. At issue in many of these lawsuits is whether hurricane-fueled storm surges are covered by these policies.

Government-issued policies insured against flood damage, but most homeowners had private insurance, which lacked flood coverage. In the Katrina-hit region, only about one-third of homes and one-fourth of businesses carried the federal policy. Those homeowners can recover up to $250,000 in damage to the property and $100,000 for its contents. But that's not close to adequate when your house has been relocated on top of your detached garaage.

The insurance company Nationwide Mutual was sued by homeowners but a federal court found for the insurance company. Which is a good thing, if the insurance companies fail financially trying to pay for Katrina damage where would we go to get future insurance coverage?!?!?!

Mike aka MonolithTMA said...

I just warms the cockles of my heart to know that the CEO of UnitedHealth is getting $57,000 Per Hour.

Mike aka MonolithTMA said...

"It just warms" not "I just warms"

brian said...

Sorry to hear this Joe. Unfortunately, it's not unusual.

Joe said...

The reason I was just given is that the results of my lab tests no longer indicate a need for treatment, in the opinion of the insurance company. I have hepatitis C. There is no test that can confirm the total absence of the virus. Once the level is lower than the detectable level, the test result is "undetectable below XXX/liter" but it does not guarantee that the virus has been eliminated. This is my third full treatment for hep C. The virus rebounded within two months after the previous treatments. So, my doctor wants to extend the treatment as is the protocol in cases such as mine.

But the insurance company is going to take advantage of the "undetectable result" to save money.

The issue is greed. It's always greed.

Mike aka MonolithTMA said...

The insurance companies could save tons of money if they were more supportive of preventative medicine and treatments like the one prescribed for you which is essentially tying up loose ends. It's going to cost them tons more if your hep C rebounds. Greedy morons.

brian said...

This is why we need doctors making decisions instead of bureaucrats. Short-sightedness.

Kansas Bob said...

Ditto Mike - "The problems are already here!".. stories like yours Joe reminds me about movies like "The Rainmaker".. stinking insurance companies routinely deny coverage in their quest for megabucks profits.

I hope you can find a way to get the Interferon Joe.