Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 , know that you are in our thoughts and prayers as you battle a big insurance company. How has our country let the insurance companies tell us when we need medical help and when we don't! But our overall system is still better than in most other countries. I am sorry you are having this battle. Adah McLaughlin <gmclaughlin1000@...> wrote: 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. Adah Voigt <asthmatic50@...> wrote: So many people I have talked to have had a different version of the flu even though they got a shot. However, they are people who are in contact with the public daily. The flu went through the school where my daughter teaches, but she stayed well--used clorox wipes and antibacterial gel in her classroom (she is an asthmatic, too, but her allergy shots have really helped.) I agree that the xolair helps, too, somehow--maybe keeping the sinusitis under control helps. I know some in this group still have severe trouble with sinus infections, but I believe the xolair has helped keep me well. Don't know where Texas is listed in the " flu " arena. Carpenter <cowtrail@...> wrote: Speaking of the flu. I have been very concerned with all the news reporting that this year's flu shots are not as effective as they should be. They said that only a maximum of 40% of the people who get shots this year will be helped, as opposed to at least 70% in other years. With washing hands, Xolair (I'm convinced Xolair helps and allows me to keep my strength up), and limiting my " people contact " I'm hoping to make it through the season. It seems everywhere I go people are coughing, sneezing, and not feeling well. Oklahoma is listed as a problem Flu State. On Feb 22, 2008, at 1:59 PM, Adah Voigt wrote: > I am very blessed. I have not had the flu or even a respiratory > infection. Praise God! I have had some minor sob from time to time > because of all of the pollutants in the air, but overall I have felt > pretty good. > > I didn't realize it had been that long since anyone posted! > > Have a great day--wish all of you could enjoy our cool, sunny day, > here in South Texas! > > Adah > > > uca79iii <bme1979@...> wrote: > No one has posted since Feb. 15. I am just seeing if the group is > broken or something LOL. > > Hope all are well > > Doug > Group founder > > --------------------------------- > Looking for last minute shopping deals? Find them fast with > Search. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 Thanks Adah. The medical system is broken in so many ways. This is one example. How can an insurance company deny paying for a medication that clearly works? It's very puzzling but I've been expecting this. I've never had a good experience with this insurance carrier. Adah Voigt <asthmatic50@...> wrote: , know that you are in our thoughts and prayers as you battle a big insurance company. How has our country let the insurance companies tell us when we need medical help and when we don't! But our overall system is still better than in most other countries. I am sorry you are having this battle. Adah McLaughlin <gmclaughlin1000@...> wrote: 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. Adah Voigt <asthmatic50@...> wrote: So many people I have talked to have had a different version of the flu even though they got a shot. However, they are people who are in contact with the public daily. The flu went through the school where my daughter teaches, but she stayed well--used clorox wipes and antibacterial gel in her classroom (she is an asthmatic, too, but her allergy shots have really helped.) I agree that the xolair helps, too, somehow--maybe keeping the sinusitis under control helps. I know some in this group still have severe trouble with sinus infections, but I believe the xolair has helped keep me well. Don't know where Texas is listed in the " flu " arena. Carpenter <cowtrail@...> wrote: Speaking of the flu. I have been very concerned with all the news reporting that this year's flu shots are not as effective as they should be. They said that only a maximum of 40% of the people who get shots this year will be helped, as opposed to at least 70% in other years. With washing hands, Xolair (I'm convinced Xolair helps and allows me to keep my strength up), and limiting my " people contact " I'm hoping to make it through the season. It seems everywhere I go people are coughing, sneezing, and not feeling well. Oklahoma is listed as a problem Flu State. On Feb 22, 2008, at 1:59 PM, Adah Voigt wrote: > I am very blessed. I have not had the flu or even a respiratory > infection. Praise God! I have had some minor sob from time to time > because of all of the pollutants in the air, but overall I have felt > pretty good. > > I didn't realize it had been that long since anyone posted! > > Have a great day--wish all of you could enjoy our cool, sunny day, > here in South Texas! > > Adah > > > uca79iii <bme1979@...> wrote: > No one has posted since Feb. 15. I am just seeing if the group is > broken or something LOL. > > Hope all are well > > Doug > Group founder > > --------------------------------- > Looking for last minute shopping deals? Find them fast with > Search. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 They aren't denying it because it clearly works, they are denying it because it is expensive! BUT, if you ended up in the ICU for a week because you suffered anaphalaxia, as a result of not being on Xolair, they'd be stuck with a $40K bill. (Sadly ...been there done that.) Which is why I keep suggesting the SPOC program when people say they have been denied or are having problems getting approved. --- McLaughlin <gmclaughlin1000@...> wrote: > Thanks Adah. The medical system is broken in so > many ways. This is one example. How can an > insurance company deny paying for a medication that > clearly works? It's very puzzling but I've been > expecting this. I've never had a good experience > with this insurance carrier. > > Adah Voigt <asthmatic50@...> wrote: > , know that you are in our > thoughts and prayers as you battle a big insurance > company. How has our country let the insurance > companies tell us when we need medical help and when > we don't! But our overall system is still better > than in most other countries. I am sorry you are > having this battle. > > Adah > > McLaughlin <gmclaughlin1000@...> wrote: > > 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. > > Adah Voigt <asthmatic50@...> wrote: So many > people I have talked to have had a different version > of the flu even though they got a shot. However, > they are people who are in contact with the public > daily. The flu went through the school where my > daughter teaches, but she stayed well--used clorox > wipes and antibacterial gel in her classroom (she is > an asthmatic, too, but her allergy shots have really > helped.) I agree that the xolair helps, too, > somehow--maybe keeping the sinusitis under control > helps. I know some in this group still have severe > trouble with sinus infections, but I believe the > xolair has helped keep me well. > > Don't know where Texas is listed in the " flu " > arena. > > Carpenter <cowtrail@...> wrote: > Speaking of the flu. I have been very concerned > with all the news > reporting that this year's flu shots are not as > effective as they > should be. They said that only a maximum of 40% of > the people who get > shots this year will be helped, as opposed to at > least 70% in other > years. With washing hands, Xolair (I'm convinced > Xolair helps and > allows me to keep my strength up), and limiting my > " people contact " > I'm hoping to make it through the season. It seems > everywhere I go > people are coughing, sneezing, and not feeling > well. Oklahoma is > listed as a problem Flu State. > > On Feb 22, 2008, at 1:59 PM, Adah Voigt wrote: > > > I am very blessed. I have not had the flu or even > a respiratory > > infection. Praise God! I have had some minor sob > from time to time > > because of all of the pollutants in the air, but > overall I have felt > > pretty good. > > > > I didn't realize it had been that long since > anyone posted! > > > > Have a great day--wish all of you could enjoy our > cool, sunny day, > > here in South Texas! > > > > Adah > > > > > > uca79iii <bme1979@...> wrote: > > No one has posted since Feb. 15. I am just seeing > if the group is > > broken or something LOL. > > > > Hope all are well > > > > Doug > > Group founder > > > > --------------------------------- > > Looking for last minute shopping deals? Find them > fast with > > Search. > > > > [Non-text portions of this message have been > removed] > > > > > > > > [Non-text portions of this message have been > removed] > > --------------------------------- > Be a better friend, newshound, and know-it-all with > Mobile. Try it now. > > [Non-text portions of this message have been > removed] > > --------------------------------- > Never miss a thing. Make your homepage. > > [Non-text portions of this message have been > removed] > > --------------------------------- > Be a better friend, newshound, and know-it-all with > Mobile. Try it now. > > [Non-text portions of this message have been > removed] > > > > > > > --------------------------------- > Looking for last minute shopping deals? Find them > fast with Search. > > [Non-text portions of this message have been > removed] > > ________________________________________________________________________________\ ____ Be a better friend, newshound, and know-it-all with Mobile. Try it now. http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 Could we say it is all about money and greed, and not really caring about the consumer who needs the services of the insurance company that they (the consumer) has paid for? McLaughlin <gmclaughlin1000@...> wrote: Thanks Adah. The medical system is broken in so many ways. This is one example. How can an insurance company deny paying for a medication that clearly works? It's very puzzling but I've been expecting this. I've never had a good experience with this insurance carrier. Adah Voigt <asthmatic50@...> wrote: , know that you are in our thoughts and prayers as you battle a big insurance company. How has our country let the insurance companies tell us when we need medical help and when we don't! But our overall system is still better than in most other countries. I am sorry you are having this battle. Adah McLaughlin <gmclaughlin1000@...> wrote: 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. Adah Voigt <asthmatic50@...> wrote: So many people I have talked to have had a different version of the flu even though they got a shot. However, they are people who are in contact with the public daily. The flu went through the school where my daughter teaches, but she stayed well--used clorox wipes and antibacterial gel in her classroom (she is an asthmatic, too, but her allergy shots have really helped.) I agree that the xolair helps, too, somehow--maybe keeping the sinusitis under control helps. I know some in this group still have severe trouble with sinus infections, but I believe the xolair has helped keep me well. Don't know where Texas is listed in the " flu " arena. Carpenter <cowtrail@...> wrote: Speaking of the flu. I have been very concerned with all the news reporting that this year's flu shots are not as effective as they should be. They said that only a maximum of 40% of the people who get shots this year will be helped, as opposed to at least 70% in other years. With washing hands, Xolair (I'm convinced Xolair helps and allows me to keep my strength up), and limiting my " people contact " I'm hoping to make it through the season. It seems everywhere I go people are coughing, sneezing, and not feeling well. Oklahoma is listed as a problem Flu State. On Feb 22, 2008, at 1:59 PM, Adah Voigt wrote: > I am very blessed. I have not had the flu or even a respiratory > infection. Praise God! I have had some minor sob from time to time > because of all of the pollutants in the air, but overall I have felt > pretty good. > > I didn't realize it had been that long since anyone posted! > > Have a great day--wish all of you could enjoy our cool, sunny day, > here in South Texas! > > Adah > > > uca79iii <bme1979@...> wrote: > No one has posted since Feb. 15. I am just seeing if the group is > broken or something LOL. > > Hope all are well > > Doug > Group founder > > --------------------------------- > Looking for last minute shopping deals? Find them fast with > Search. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 That's exactly what it is. They just don't want to pay $12,000+ per year. Adah Voigt <asthmatic50@...> wrote: Could we say it is all about money and greed, and not really caring about the consumer who needs the services of the insurance company that they (the consumer) has paid for? McLaughlin <gmclaughlin1000@...> wrote: Thanks Adah. The medical system is broken in so many ways. This is one example. How can an insurance company deny paying for a medication that clearly works? It's very puzzling but I've been expecting this. I've never had a good experience with this insurance carrier. Adah Voigt <asthmatic50@...> wrote: , know that you are in our thoughts and prayers as you battle a big insurance company. How has our country let the insurance companies tell us when we need medical help and when we don't! But our overall system is still better than in most other countries. I am sorry you are having this battle. Adah McLaughlin <gmclaughlin1000@...> wrote: 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. Adah Voigt <asthmatic50@...> wrote: So many people I have talked to have had a different version of the flu even though they got a shot. However, they are people who are in contact with the public daily. The flu went through the school where my daughter teaches, but she stayed well--used clorox wipes and antibacterial gel in her classroom (she is an asthmatic, too, but her allergy shots have really helped.) I agree that the xolair helps, too, somehow--maybe keeping the sinusitis under control helps. I know some in this group still have severe trouble with sinus infections, but I believe the xolair has helped keep me well. Don't know where Texas is listed in the " flu " arena. Carpenter <cowtrail@...> wrote: Speaking of the flu. I have been very concerned with all the news reporting that this year's flu shots are not as effective as they should be. They said that only a maximum of 40% of the people who get shots this year will be helped, as opposed to at least 70% in other years. With washing hands, Xolair (I'm convinced Xolair helps and allows me to keep my strength up), and limiting my " people contact " I'm hoping to make it through the season. It seems everywhere I go people are coughing, sneezing, and not feeling well. Oklahoma is listed as a problem Flu State. On Feb 22, 2008, at 1:59 PM, Adah Voigt wrote: > I am very blessed. I have not had the flu or even a respiratory > infection. Praise God! I have had some minor sob from time to time > because of all of the pollutants in the air, but overall I have felt > pretty good. > > I didn't realize it had been that long since anyone posted! > > Have a great day--wish all of you could enjoy our cool, sunny day, > here in South Texas! > > Adah > > > uca79iii <bme1979@...> wrote: > No one has posted since Feb. 15. I am just seeing if the group is > broken or something LOL. > > Hope all are well > > Doug > Group founder > > --------------------------------- > Looking for last minute shopping deals? Find them fast with > Search. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 23, 2008 Report Share Posted February 23, 2008 I don't mean to defend insurance comapnies, but not only is it $12,000 a year, but it is likely $12,000 a year for as long as you are subscriber which may mean more like $24,000 or even $60,000 if you stay with the same carrier for five years. > > That's exactly what it is. They just don't want to pay $12,000+ per year. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2008 Report Share Posted February 24, 2008 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. > Quote Link to comment Share on other sites More sharing options...
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