Re: /Chris 2nd treatment Ins

[Guest guest]

Hi ,

The hospital I work for is self insured, meaning they pay an

insurance company to manage things but the monies come out the

hospitals pocket.

did his first treatment of 48 weeks in 2003 completing in

early 2004. He was virus free within 6 weeks of starting treatment.

He maintained that until treatment was done. Within six weeks after

completing the 1st treatment he was positive again. At that time we

were going to a GI specialist the best in the area. We were told that

there really was no other options. No point to retreat. this was a

slow progressing disease usually, and to just wait until something

else came down the treatment pipeline. No follow up done or

suggested.

In early 2006 began feeling not right and we went back to the

GI specialist. He was ho hum about his concerns, but said we could

do a biopsy to check. That was done and s disease had

progressed very rapidly and now the GI specialist was recommending 72

weeks of treatment. We were in a bad spot and insurance was changing

from his insurance to mine. We didn't want to start treatment and

have to stop so we waited until the change was effective and he

started treatment in early 2007.

We became very frustrated with the GI doc and ended up getting

referred to a hepatitis specialist who was now in our area.

has

not done well and needed procrit and the GI guy was reluctant to

start it because of the new black box warning. Geesh you weigh the

side effects vs the benefits. My background is in Peds and have many

resources to draw on for medical sense of what is going on. One of

our pediatric hemonc docs said that in his world you give the right

dose at the right time and treat the side effects to get the best

outcomes. He even wrote a letter to the insurance company to get

to big referral center,because the big center would be an out

of pocket expense. This was before we were aware of the hepatitis doc

in our own network.

The Hepatitis doc agreed to the 72 weeks. Started him on procrit. We

got

close to the 48 week mark and my insurance said that 72 weeks of

treatment was investigaional and experimental. Wouldn't pay for

more. The docs fought them but eventually it became clear they

wouldn't pay for anymore treatment. I am the only one working and

there's no way we can pay for it out of pocket. I also make too much

money for financial assistance. We did get some samples for a few

weeks. Treatment was stopped at 52 weeks. MIcahel was positive again

at 4 weeks after treatment stopped.

The hepatitis doc started requesting treatment for a different kind

of treatment, daily injections with ribo for 72 weeks. Initially the

same kind of denial. When we thought it was done and no hope we got

a letter from my insurance (remember self insured)so it was signed by

head of HR and the Medical director for the health system. They were

not budging on the language but were making an exception to policy

and approving the treatment for the full 72 weeks. OUr doc would not

restart it unless that was the agreement.

So was off treatment about 2 months and restarted it again.

I feel strongly that this is why he has struggled so with the last

treatment. Not enough time to recoup before restarting.

Not sure if this helps but that's how it played out.

Thanks

Chris

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