Re: Re Xolair Coverage, Denials

[Guest guest]

My prior health insurance company in Colorado (who I use to work for) denied my

renewal prescription for Xolair last year -- reason - physician did not provide

medical records as requested. This is quite interesting since verbally I was

told the name of the nurse who faxed them by a pharmacy manager at the insurance

company and the doctor's office confirmed they sent them.

We know the reason is cost. We were having issues with my former employer,

the insurance company, not paying for certain codes and my doctors office was

ready to seek legal action and were making complaints to the Insurance

Commissioner. I never will work for an insurance company again.

I am now back home in Missouri working for a small business. I have a $1000

deductable which applys to Xolair -- copays for other drugs and office visits.

Balancing work, life, and Xolair in Bush America is quite expensive. We have

had enough problems fighting this disease. Why do we have to fight for our

right to care and prove its working to their standards and not the patients or

the doctors?

For my review, yes I have improved dramatically with Xolair. I barely take

Advair - reduced the dosage to one time a day. Have had no need for predisone

or antibiotics for infections. I still need to take Zyrtec for hives and

Flonase. Increased my breathing capacity to 85% from 72%. I don't look like a

sickly pale ghost all the time. I can concentrate better and speak better. And

I have more energy to fight the insurance companies. (How hard is that -- they

don't need all our medical records. Just a simple two minute conversation with

our doctor if needed or a simple questionaire)

Good luck! let us know how we can help. I beleive this week is Asthma week

in Congress -- let's all make sure we call our Senators and Congress men and

women. and let them know of our challenges.

pyle456 <coachmac@...> wrote:

,

It would not surprise me if insurance companies are trying to mine

the internet for information on their patience, particularly using

services like myspace. None of that information is protected under

HIPAA, so they are free to search at will.

I think something that all of us need to take into account is that

Xolair cannot bind to ALL of our IgE and that we are continually

making new, unbound IgE so our symptoms may recur at any time. This

does not mean Xolair isn't working, simply that our systems are

manufacturing new IgE which is just waiting for an allergen to get to

it before Xolair does!

Please keep us posted on the good fight!

Addy

Group co-owner

> > > We're on the state employees health plan, which is

> with

> > BCBS of NC.

> > > They no longer have an " indemnity " plan - now there are three

> > different

> > > PPO type plans, with $$copays and such dependent on the

amount

> of

> > > premium you pay.

> > >

> > > Knock on wood there have been no issues with my Xolair

coverage.

> I

> > > expect this may due to the fact that we are in a plan that

> covers

> > tens

> > > of thousands of people (if not hundreds of thousands), and

the

> > state is

> > > able to negotiate really good coverage for even the most

> expensive

> > > drugs and procedures. I pay the same monthly copay that I pay

> for

> > my

> > > blood pressure medicine - $50. (and I get 6 vials of Xolair

> every

> > > month!)

> > >

> > > Absolutely anyone who is denied Xolair by their insurance

> company

> > > should fight it all the way.

> > >

> > >

> > >

> > >

> > >

> > >

> > > ---------------------------------

> > > You rock. That's why Blockbuster's offering you one month of

> > Blockbuster Total Access, No Cost.

> > >

> > >

[Guest guest]

My case is very similar to your. I went from using my rescue inhaler 4-8x per

day to once per month. I used to throw them away because they would expire. I

tried going down to advair 250 but I couldn't do it; instead, I found I was

forgetting to take my advair 2x per day because I was feeling so well. I

estimate I was taking it 3x every 2 days, or 1.5x per day. Now I had to go off

the X and I'm no prednisone after being off the shot for 6 days. And BCBS says

it doesn't work! LOL

Webber <melwebber22@...> wrote: My

prior health insurance company in Colorado (who I use to work for) denied my

renewal prescription for Xolair last year -- reason - physician did not provide

medical records as requested. This is quite interesting since verbally I was

told the name of the nurse who faxed them by a pharmacy manager at the insurance

company and the doctor's office confirmed they sent them.

We know the reason is cost. We were having issues with my former employer,

the insurance company, not paying for certain codes and my doctors office was

ready to seek legal action and were making complaints to the Insurance

Commissioner. I never will work for an insurance company again.

I am now back home in Missouri working for a small business. I have a $1000

deductable which applys to Xolair -- copays for other drugs and office visits.

Balancing work, life, and Xolair in Bush America is quite expensive. We have

had enough problems fighting this disease. Why do we have to fight for our

right to care and prove its working to their standards and not the patients or

the doctors?

For my review, yes I have improved dramatically with Xolair. I barely take

Advair - reduced the dosage to one time a day. Have had no need for predisone

or antibiotics for infections. I still need to take Zyrtec for hives and

Flonase. Increased my breathing capacity to 85% from 72%. I don't look like a

sickly pale ghost all the time. I can concentrate better and speak better. And

I have more energy to fight the insurance companies. (How hard is that -- they

don't need all our medical records. Just a simple two minute conversation with

our doctor if needed or a simple questionaire)

Good luck! let us know how we can help. I beleive this week is Asthma week

in Congress -- let's all make sure we call our Senators and Congress men and

women. and let them know of our challenges.

pyle456 <coachmac@...> wrote:

,

It would not surprise me if insurance companies are trying to mine

the internet for information on their patience, particularly using

services like myspace. None of that information is protected under

HIPAA, so they are free to search at will.

I think something that all of us need to take into account is that

Xolair cannot bind to ALL of our IgE and that we are continually

making new, unbound IgE so our symptoms may recur at any time. This

does not mean Xolair isn't working, simply that our systems are

manufacturing new IgE which is just waiting for an allergen to get to

it before Xolair does!

Please keep us posted on the good fight!

Addy

Group co-owner

> > > We're on the state employees health plan, which is

> with

> > BCBS of NC.

> > > They no longer have an " indemnity " plan - now there are three

> > different

> > > PPO type plans, with $$copays and such dependent on the

amount

> of

> > > premium you pay.

> > >

> > > Knock on wood there have been no issues with my Xolair

coverage.

> I

> > > expect this may due to the fact that we are in a plan that

> covers

> > tens

> > > of thousands of people (if not hundreds of thousands), and

the

> > state is

> > > able to negotiate really good coverage for even the most

> expensive

> > > drugs and procedures. I pay the same monthly copay that I pay

> for

> > my

> > > blood pressure medicine - $50. (and I get 6 vials of Xolair

> every

> > > month!)

> > >

> > > Absolutely anyone who is denied Xolair by their insurance

> company

> > > should fight it all the way.

> > >

> > >

> > >

> > >

> > >

> > >

> > > ---------------------------------

> > > You rock. That's why Blockbuster's offering you one month of

> > Blockbuster Total Access, No Cost.

> > >

> > >