Guest guest Posted April 1, 2008 Report Share Posted April 1, 2008 What I go through every month with Anthem is the qualification, " your co-pay amount may change, but we will notify you " . As it is now, I am still qualified as " self-injectable " despite my doctor's protestations. But, there is always a possibility that Anthem will eventually stop the pharmacy expense for Xolair. I know that Blue Cross considered Xolair a medical expense only, but Anthem over-ruled them when I first started. Thus, I can still get it as a pharmacy expense. Eventually, I would hope that a ruling body will jump in, with enough people complaining, that the drug is prohibitively expensive under the medical expense part of drug insurance. The " black box " warning by the FDA didn't preclude self-injection, just counseled against it. So, if any insurance company uses the warning as a justification to force injections in a doctor's office and thereby make it a medical expense, then that insurance company would seem to be using this as a way to recover more money from the patient. --- In , " ronaldcrpntr " <cowtrail@...> wrote: > > I do not want to precipitate a self fulfilling prophecy, but... > > I just received a letter stating that Blue Cross of California will now be Anthem Blue Cross. It > also states, " rest assured " we will continue with your excellent services, you do not have to > do anything. > > I am an advocate of " 's Law " , LOL, and was wondering if anybody has had dealings > with these people, if I should just stop worrying, or if I need to prepare for a fight for my 3 > year ongoing prescription to Xolair. > > Ron > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2008 Report Share Posted April 5, 2008 Ron, I have been on Xolair for just over 3 1/2 years. It was approved with no trouble through Humana, and Aetna. We recently switched to BCBS of Illinois and they have continuously denied my application for coverage on Xolair. I received my final denial today. What they did was " cherry pick " my medical record for reasons they denied my coverage. I have contacted an attorney and he said I have an excellent case. I can't discuss the specifics of the case because BCBS probably reads this message board but I will be happy to help you if Anthem denies your coverage. In fact, I will be happy to help anyone if they have insurance problems. I will fight this battle until I win. If the mod's don't mind you can email me directly if you need assistance in the event they deny you. Funny thing, I've been doing research on litigation cases against Health Insurance companies and BCBS was at the top of the list. United Health Care is second but they don't even come close to the amount of times BCBS gets sued. It's very, very sad. You may not have the problem I'm having because you are switching from one BCBS to another so best of luck and feel free to contact me if you need help. ronaldcrpntr <cowtrail@...> wrote: I do not want to precipitate a self fulfilling prophecy, but... I just received a letter stating that Blue Cross of California will now be Anthem Blue Cross. It also states, " rest assured " we will continue with your excellent services, you do not have to do anything. I am an advocate of " 's Law " , LOL, and was wondering if anybody has had dealings with these people, if I should just stop worrying, or if I need to prepare for a fight for my 3 year ongoing prescription to Xolair. Ron --------------------------------- You rock. That's why Blockbuster's offering you one month of Blockbuster Total Access, No Cost. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2008 Report Share Posted April 5, 2008 Thank you for your support, this is the wonderful thing about this group. I have also been following the stories about BCBS " cherry picking " and then dropping people. They are getting hammered for it both legally and in the press. The fact that they would base their decisions on the expense of the drug/treatment is very disconcerting. As you point out this is not an isolated case but a " company policy " . I also hope that since I'm going BCBS to BCBS I will not be singled out, but I do feel sorry for those that are victims of their greed. If I have future problems I will most certainly take you up on your offer. Ron On Apr 4, 2008, at 9:05 PM, McLaughlin wrote: > Ron, > > I have been on Xolair for just over 3 1/2 years. It was approved > with no trouble through Humana, and Aetna. We recently switched to > BCBS of Illinois and they have continuously denied my application > for coverage on Xolair. I received my final denial today. What they > did was " cherry pick " my medical record for reasons they denied my > coverage. I have contacted an attorney and he said I have an > excellent case. I can't discuss the specifics of the case because > BCBS probably reads this message board but I will be happy to help > you if Anthem denies your coverage. In fact, I will be happy to help > anyone if they have insurance problems. I will fight this battle > until I win. If the mod's don't mind you can email me directly if > you need assistance in the event they deny you. > > Funny thing, I've been doing research on litigation cases against > Health Insurance companies and BCBS was at the top of the list. > United Health Care is second but they don't even come close to the > amount of times BCBS gets sued. It's very, very sad. > > You may not have the problem I'm having because you are switching > from one BCBS to another so best of luck and feel free to contact me > if you need help. > > > > ronaldcrpntr <cowtrail@...> wrote: I do not want to precipitate > a self fulfilling prophecy, but... > > I just received a letter stating that Blue Cross of California will > now be Anthem Blue Cross. It > also states, " rest assured " we will continue with your excellent > services, you do not have to > do anything. > > I am an advocate of " 's Law " , LOL, and was wondering if > anybody has had dealings > with these people, if I should just stop worrying, or if I need to > prepare for a fight for my 3 > year ongoing prescription to Xolair. > > Ron > > > > > > --------------------------------- > You rock. That's why Blockbuster's offering you one month of > Blockbuster Total Access, No Cost. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2008 Report Share Posted April 5, 2008 , I can't believe that they are treating you this way. No one else on this board is being abused like this. It is a shame you have to resort to getting a lawyer just to breathe. My BCBS coverage is COMPLETELY the opposite of yours. See next post....... Quote Link to comment Share on other sites More sharing options...
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