My BCBS saga continues....

[Guest guest]

Got news today that BCBS of Illinois has officially denied my application for

Xolair and it is now in the appeals process.

I had a very lengthy conversation today that probably caused my blood pressure

to spike above 200. My doctor wrote them a letter and notified them, in no

uncertain terms, that I have severe asthma and I MUST stay on Xolair. Their

response you wonder? " No documentation from the treating physician of sustained

clinical control of stable asthma on Xolair. " Huh?

At any rate....I wrote them a letter to let them know I am contacting an

attorney and taking this to the Illinois State Insurance Commissioner's Office

if I am denied at the appeals level. In addition, I may pursue this through the

newspaper and television media if I have to. I'll let you know if I'm going to

be on TV.

I'll keep everyone posted on how this develops and if anyone needs help on the

application/denial/appeals process I will be more than happy to share my

experience.

On a good note, I have 1 shot left at the doc's office and I should be able to

get the shots covered thru either Xpansions or SPOC until the BCBS issue is

resolved. I'm calling them tomorrow.

Stay well everyone!

---------------------------------

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[Guest guest]

>

> Got news today that BCBS of Illinois has officially denied my

application for Xolair and it is now in the appeals process.

>

> I had a very lengthy conversation today that probably caused my

blood pressure to spike above 200. My doctor wrote them a letter and

notified them, in no uncertain terms, that I have severe asthma and I

MUST stay on Xolair. Their response you wonder? " No documentation

from the treating physician of sustained clinical control of stable

asthma on Xolair. " Huh?

>

> At any rate....I wrote them a letter to let them know I am

contacting an attorney and taking this to the Illinois State Insurance

Commissioner's Office if I am denied at the appeals level. In

addition, I may pursue this through the newspaper and television media

if I have to. I'll let you know if I'm going to be on TV.

>

> I'll keep everyone posted on how this develops and if anyone needs

help on the application/denial/appeals process I will be more than

happy to share my experience.

>

> On a good note, I have 1 shot left at the doc's office and I should

be able to get the shots covered thru either Xpansions or SPOC until

the BCBS issue is resolved. I'm calling them tomorrow.

>

> Stay well everyone!

>

,

That really stinks big time. I have no clue as to why YOUR BCBS will

not cover it. I don't understand why one BCBS will cover it and

another won't.

I have BCBS out of Pennsylvania and have never had one problem getting

approved or getting my shots to the doctors office on time. In 2003

when I first started Xolair I was shocked when I was approved

instantly. My doctor himself made the initial phone call and that was

that.

I changed to a different BCBS plan though Pennsylvania this January

and had to re-submit to be covered. Once again, not one problem

whatsoever and my xolair was waiting for me at the Doctors office as

usual.

I just got an explanation of benefits in the mail yesterdaty informing

me that my BCBS just paid Medmark Specialty Pharmacy $2129.24 for one

month of Xolair.

I wonder if there was some way you could get another BCBS to tell them

why they ARE covering it? If they won't listen to your doctor, maybe

they will listen to one of their colleagues.

One excuse I have heard insurance companies say that really steams me

is this: " Prednsione should be enough for your condition. " grrrrrr.

You take EVIL CANDY long enough and that insurance company will really

see the claims pile up for the long term side effects.

Xpansions and SPOC will be able to help. I am glad you are getting in

contact with them.

Doug

Group founder

On Xolair since September 2003

[Guest guest]

It puzzles me as well because both Humana and Aetna approved it right away. My

Doc told me there is a six step process of trying other medications you have to

go through and I did that so I qualify in that regard. My IgE levels qualify

and I have documented clinical evidence that Xolair has made an incredible

impact on my life.

If they deny here I believe I have an extremely strong case. I will be calling

an attorney who will go to the state and I'm also going to ask him if I sue BCBS

for pain and suffering if I have to go to the hospital when it otherwise could

have been avoided. I know these companies have deep pockets and they are hard

to sue but heck, what if I die?

I remember the time before I started Xolair....I'd be lying down in bed

experiencing asthma symptoms wondering if this was the " big one. " I use to put

the phone right next to my bed so I could call 911 as fast as possible.

I tried approaching them nicely, on a humane level hoping I could appeal to

their sense of humanity but apparently they aren't human. They are concerned

about dollars and cents and that's it. So today, I just went off on them.

After I hung up the phone I'm guessing my blood pressure was about 200/150. I'm

was steaming. I'm ready to fight!!

uca79iii <bme1979@...> wrote:

>

> Got news today that BCBS of Illinois has officially denied my

application for Xolair and it is now in the appeals process.

>

> I had a very lengthy conversation today that probably caused my

blood pressure to spike above 200. My doctor wrote them a letter and

notified them, in no uncertain terms, that I have severe asthma and I

MUST stay on Xolair. Their response you wonder? " No documentation

from the treating physician of sustained clinical control of stable

asthma on Xolair. " Huh?

>

> At any rate....I wrote them a letter to let them know I am

contacting an attorney and taking this to the Illinois State Insurance

Commissioner's Office if I am denied at the appeals level. In

addition, I may pursue this through the newspaper and television media

if I have to. I'll let you know if I'm going to be on TV.

>

> I'll keep everyone posted on how this develops and if anyone needs

help on the application/denial/appeals process I will be more than

happy to share my experience.

>

> On a good note, I have 1 shot left at the doc's office and I should

be able to get the shots covered thru either Xpansions or SPOC until

the BCBS issue is resolved. I'm calling them tomorrow.

>

> Stay well everyone!

>

,

That really stinks big time. I have no clue as to why YOUR BCBS will

not cover it. I don't understand why one BCBS will cover it and

another won't.

I have BCBS out of Pennsylvania and have never had one problem getting

approved or getting my shots to the doctors office on time. In 2003

when I first started Xolair I was shocked when I was approved

instantly. My doctor himself made the initial phone call and that was

that.

I changed to a different BCBS plan though Pennsylvania this January

and had to re-submit to be covered. Once again, not one problem

whatsoever and my xolair was waiting for me at the Doctors office as

usual.

I just got an explanation of benefits in the mail yesterdaty informing

me that my BCBS just paid Medmark Specialty Pharmacy $2129.24 for one

month of Xolair.

I wonder if there was some way you could get another BCBS to tell them

why they ARE covering it? If they won't listen to your doctor, maybe

they will listen to one of their colleagues.

One excuse I have heard insurance companies say that really steams me

is this: " Prednsione should be enough for your condition. " grrrrrr.

You take EVIL CANDY long enough and that insurance company will really

see the claims pile up for the long term side effects.

Xpansions and SPOC will be able to help. I am glad you are getting in

contact with them.

Doug

Group founder

On Xolair since September 2003

---------------------------------

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