Re: Re: BCBS Denied my Xolair

February 24, 2008

I'm definitely going to fight it. I will hire an attorney if I have to. The

medical benefit is as clear as day. It's not the perfect medication and I've

had some trouble areas but it's been working for me 90% of the time. There was

a time I went from not being able to climb a flight of stairs without being

winded to being able to job 4 miles in an hour. I don't have that kind of wind

anymore but I can easily run up a flight of stairs and the only other asthma med

I take is Advair. I rarely use my rescue inhaler. W/O the Xolair I use it 4-6x

per day and take prednisone periodically.

instdesgn1 <instdesgn1@...> wrote: This is

totally an insane outrage and I would really fight it.

I also have BCBS or at least a sub-company of BCBS. Ok, it's through

a different organization (i.e., not medicare or anything of that

sort) and the insurance pays all but $45 of my Xolair every month.

I guess that's part of my point. Because BCBS is paying all or most

of Xolair for patients with BCBS because it is known to work then it

seems that that could be held up as evidence.

From reading my policy one time quite a while back ... there is a

procedure or process or chain of command that can be followed to ask

for re-evaluation of the decision and from what I've heard quite

often, if reasonable evidence is provided, the decision can be

reversed. Most people do not follow up as it is a hassle and a bit

drawn out. They're really trying to wear you down and you need an

advocate. Glad your doc is working on this for you.

Pardon my vernacular here but, I would make a big stink out of it.

This is beyond absurd.

>

> I got a nice dose of the flu even though I had my shot.

Fortunately, Xolair has kept my lungs in check. I have a very

unproductive cough but my breathing is well.

>

> Get this.....BCBS denied my application for Xolair claiming there

is no evidence of a " medical benefit. " BCBS is just the devil. I

had these guys a few years ago and they deny at every turn. I was in

the hospital for 4 days back in 2000 and they would only pay for 3.

They claimed the 4th day wasn't necessary and my doctor should have

discharged me earlier. Like I actually had a say-so in that matter.

Had I left in 3 days they wouldn't have paid a dime because I'd be

leaving against medical advice.

>

> BCBS is in for a battle. I will take this to capital hill if I

have to. My Doc's office is working with the Xolair Rep and going

after BCBS. I can't see how they can deny this but they sure are

trying.

>

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February 24, 2008

I'm no lawyer, but it sounds like to me you have a case.

McLaughlin <gmclaughlin1000@...> wrote: I'm definitely going

to fight it. I will hire an attorney if I have to. The medical benefit is as

clear as day. It's not the perfect medication and I've had some trouble areas

but it's been working for me 90% of the time. There was a time I went from not

being able to climb a flight of stairs without being winded to being able to job

4 miles in an hour. I don't have that kind of wind anymore but I can easily run

up a flight of stairs and the only other asthma med I take is Advair. I rarely

use my rescue inhaler. W/O the Xolair I use it 4-6x per day and take prednisone

periodically.

instdesgn1 <instdesgn1@...> wrote: This is totally an insane outrage and I

would really fight it.