Re: Re: problems with BCBS reauthorization

[Guest guest]

Addy good advice, we all need to band together and be each other's advocates.  I

do not think the insurance companies understand the therapy and ramifications

for discontinuing treatment. In fact, I worked for one and I know they don't.  

I think the industry needs to institute best practice guidelines for continued

treatment.   From my personal experience they are not and ignoring physician's

requests and documentation.  My suggestion, if anyone has to appeal their

preauth denial, they should get legal counsel involved who can pressure and

expedite the process.  I am luckily approved until January 2010 with my current

insurance carrier.  After being 3 weeks late for my monthly shot, I know I don't

want to live with out it.

 

Hope everyone has a healthy and happy Thanksgiving and I am very thankful for

Xolair.

 

 

 

Webber

303.513.5653

melwebber22@...

 

 

From: pyle456 <jamcculloch2@...>

Subject: [ ] Re: problems with BCBS reauthorization

Date: Tuesday, November 25, 2008, 6:26 PM

Marie,

Before your reauthorization period, you may want to write the medical

director for meds at Oxford and call his/her attention to

this " pattern. " Include a copy of the typed doctor's notes that were

submitted this go-round with your letter. Emphasize the fact that

the asthma piece is life=threatening, and so on. If you have a

friend who's a lawyer, you might want to ask him/her for

suggestions. Anyway, see if doing something pro-active in advance of

the reauthorization period may help.

I got my meds today, thank goodness. I am thankful you have yours

too. And you're right, anytime ONE of us fights, we are fighting for

all of us.

Addy

> >

> > Hello, all,

> >

> > A little over a month ago, my Xolair script was due for

> > reauthorization. Medco, BCBS of NC pharmacy provider, denied it

as

> > being non-medically necessary b/c I didn't have a qualifying IgE

> > score (despite the fact that I, of course, do). So I had to

> initiate

> > the appeals process. A couple of weeks ago, I faxed a letter to

> > my " appeals analyst, " after I got a letter giving me her name and

> > contact info. I detailed the problem AGAIN, blah, blah. Shortly

> > thereafter I had a terrible allergic episode requiring pred and

> > antibiotics. I'm still on pred. Tuesday I faxed her (after

> phoning,

> > she was out of the office that day), explaining that I was on

pred

> > and my symptoms were increasing and my condition deteriorating.

I

> > faxed again the next day, called yesterday, called again this

> morning

> > and said, " please let me know something by the end of the day. "

> >

> > Well, she called at 4:30pm and said she had gotten the medical

> > director to approve me to get a month's worth of Xolair until

they

> > figure out what the heck they are doing. (my words, of course).

I

> > called Accredo, they promised to call BCBS Monday am and get my

> drugs

> > shipped in time to arrive before the holiday.

> >

> > So, my recommendation is to squeak often, politely, and let them

> know

> > EXACTLY HOW MISERABLE YOU ARE.

> >

> > Addy

> >

> Sounds all too familiar. On July 24, 2008, I was due to renew my

> Xolair. The Insurance Company, Oxford, denied it, of course. " Not

> medically ncessary. " I appealed and they replied, " Need doctor's

> notes, " (they wait until you need you medicine!). This was the

second

> time they had done that to me (it was about a month of interruption

> the first time). But, ths time, when they recived the doctor's

notes,

> they replied (after 2 weeks!), " Doctor's notes illegible, " I too

> begged and pleaded that my condition was deteriorating, but no one

> cared.The doctor's assistant typed the notes and I waited another 2

> weeks. All total: 2 months had passed without Xolair. I have a

> secondary condition to asthma of extremely severe eczema, so I was

> doubley miserable! Well, I had enough. I filed a letter of

complaint

> against Oxford with the New Jersey Department of Banking and

> Insurance. Do I expect anything good to come of it. No. Oxford

> already notified me that they will review my file in another 6

months

> (3/09), so I'll be going through it again. But if they do, I will

> institute a law suit. My doctors are supportive, which is great.

I'm

> not a litigious person, but I feel I'll be fighting for all of us!

>

> Happy Thanksgiving.

>

> Marie Ruffolo

>