Guest guest Posted September 23, 2007 Report Share Posted September 23, 2007 Oh man. I am so sorry to hear that. Talk about unfair and stressful. I hope you find the energy to fight this. We are all rooting for you! Get a sneak peak at messages with a handy reading pane with All new Mail: http://mrd.mail./try_beta?.intl=ca Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2007 Report Share Posted September 23, 2007 > > Oh man. I am so sorry to hear that. Talk about unfair and stressful. I hope you find the energy to fight this. We are all rooting for you! > > > > Yes, this is not right. If it were me, I would consult a good lawyer. Doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2007 Report Share Posted September 23, 2007 Things like this are so infuriating. I had to contact my local State Senator, after which I was approved, (they just happened to find " additional information " which allowed them to approve it). On Sep 23, 2007, at 11:39 AM, uca79iii wrote: > > > > > Oh man. I am so sorry to hear that. Talk about unfair and stressful. > I hope you find the energy to fight this. We are all rooting for you! > > > > > > > > > > Yes, this is not right. If it were me, I would consult a good lawyer. > > Doug > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 23, 2007 Report Share Posted September 23, 2007 I'd like to say this is unbelievable, but unfortunately this stuff is happening all the time these days. Have you seen 's movie Sicko? If not, see it - you'll find you have lots of company. Not that that helps you out right now. Have you already exhausted your insurance company's internal appeal process? If not, it's worth a try. Often the initial review is just done by a primary care physician rather than, in your case, an allergist or pulmonologist. Once the decision is appealed, it should go to an appropriate specialist. When you request an appeal, tell them that you're reporting your case to the state insurance commissioner and then do it right away. In Florida, at least, just telling the insurer that you're doing that often prompts a speedy reversal. It also can't hurt to tell them you're telling about your case - apparently that has also produced some quick reversals. His website, michaelmoore.com, also suggests calling your local TV stations about your story, if you're inclined to do something like that. I hope this gets resolved for you soon. Also, just so you know, when I was nearing the end of my COBRA period 8 years ago, I very accidently learned that there are insurance companies that provide post-COBRA coverage and they are not allowed to exclude anyone or any pre-existing conditions. AAA agents can help with this whether or not you are an AAA member and I would assume any other good agent should also be able to help. I don't know if this avenue still exists or is affordable any more. Fran --- In , " lurkitty117 " <scruffy@...> wrote: > > I am beyond angry. I am really beside myself. > > I am unemployed and have been paying COBRA insurance by cashing in my > retirement early - almost $1000/month. My insurer is Regence BC/BS of > Oregon. They require that I get prior authorization for Xolair every 6 > months. It's no bargain, either. They consider Xolair a medical > procedure, not a drug, and charge for it accordingly. I pay $800 per > dose up to the $2000 maximum out of pocket charge. > > I just got a letter saying that their physician consultant has > determined that they are unable to establish any ongoing health > benefits resulting from Xolair treatment. > > It means absolutely nothing to them that I am off of prednisone > completely, that my diabetes and blood pressure have improved, that I > have lost weight, that I can walk outside without having an asthma > attack, that I have not had an attack in the four years I have been on > the drug, that I use my rescue inhaler only once ot twice a week, that > my rescue inhaler is the only other asthma drug I use... > > This from a woman who was on daily prednisone, for whom they were > considering oxygen, who was being hospitalized on a yearly basis. > > This was the second request. My only option is an appeal to the state > insurance commission. I have no job, and I worry that I will not be > able to get any other kind of health insurance to cover me. > > I am tired of health insurance companies making obscene profits in > their ivory towers off of people's suffering. This isn't right. It's > as if they think that asthma just goes away on its own! Why do they > think that I suddenly got better? > > Right now, I don't know what I am going to do. I have to assess what > the right course of action is. I feel like these people are taking my > life away from me. > Quote Link to comment Share on other sites More sharing options...
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