Re: Pre-authorization required for anti-fungal ?

[Guest guest]

Barb,

I would be inclined to think that your doctor used an ICD code for your

symptoms that typically is not treated with anti-fungals. Hope they do the

trick for you.

Sharon

In a message dated 9/10/2009 4:45:26 P.M. Pacific Daylight Time,

kmtown2003@... writes:

ITS CALLED DENIAL!!! and I'm not talking insurance, but denial of any

fungal illness

From: barb1283 <_barb1283@..._ (mailto:barb1283@...) >

Subject: [] Pre-authorization required for anti-fungal ?

_@ic_ (mailto: )

Date: Thursday, September 10, 2009, 3:15 PM

Has anyone had to do this before? For my foot, non healing and swollen for

months, doctor going to try an antifungal, (antibiotics already tried) and

wrote an Rx for antifungal and pharmacy said it isn't ready because doctor

will need to call my insurance company for a " pre authorization " . I don't

even need to get pre-authorized for exensive MRIs and scans, etc. What is

up with that? Does anyone know why that is?

[Guest guest]

ITS CALLED DENIAL!!!  and I'm not talking insurance, but denial of any fungal

illness

From: barb1283 <barb1283@...>

Subject: [] Pre-authorization required for anti-fungal ?

Date: Thursday, September 10, 2009, 3:15 PM

 

Has anyone had to do this before? For my foot, non healing

and swollen for months, doctor going to try an antifungal, (antibiotics already

tried) and wrote an Rx for antifungal and pharmacy said it isn't ready because

doctor will need to call my insurance company for a " pre authorization " . I

don't even need to get pre-authorized for exensive MRIs and scans, etc. What is

up with that? Does anyone know why that is?

[Guest guest]

Could it be because you were on antibiotics, you cannit mix the 2,  however

thast would be a medical decision.  Strange

 

God Bless !!

dragonflymcs

Mayleen

________________________________

From: barb1283 <barb1283@...>

Sent: Thursday, September 10, 2009 7:15:19 PM

Subject: [] Pre-authorization required for anti-fungal ?

 

Has anyone had to do this before? For my foot, non healing and swollen for

months, doctor going to try an antifungal, (antibiotics already tried) and wrote

an Rx for antifungal and pharmacy said it isn't ready because doctor will need

to call my insurance company for a " pre authorization " .

[Guest guest]

That's what I'm thinking. They probably want to know if I have AIDS or

something! No end to the taboo around fungus. Can't get your house fixed,

can't get yourself fixed. No wonder it's hard to get a doctor to Rx it. I got

Difflucan once but that is for Candida mostly. My uncle was prescribed Lamasil

oral antifungal for a 'toe nail infection'. I thought that wasn't worth

possible liver damage for an elderly man, so I suggested he try vinegar instead,

which he has and said it seems to be working fine. They are okay with fungus on

the skin or nails apparently, an oral for that is overkill I think, but then

there probably since there is no taboo on skin fungal infections, you want to

get those expensive drugs out. There must be a huge clash giong on between

pharmaceuticals wanting to sell their antifungals and insurance companies

wanting to deny the existence of illness from fungus.

I wonder if they will deny it? I'll sue them if I lose the ability to walk and

I have something it would have helped. I haven't been able to walk for months

on swollen foot that won't heal.

>

> ITS CALLED DENIAL!!!  and I'm not talking insurance, but denial of any fungal

illness

[Guest guest]

No, not on any anti-microbials.

>

> Could it be because you were on antibiotics, you cannit mix the 2,  however

thast would be a medical decision.  Strange

>  

>

>

> God Bless !!

> dragonflymcs

> Mayleen

>

[Guest guest]

If you have a prescription, you can get many prescriptions at Walmart for $4.00.

http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

________________________________

From: barb1283 <barb1283@...>

Sent: Thursday, September 10, 2009 5:08:31 PM

Subject: [] Re: Pre-authorization required for anti-fungal ?

That's what I'm thinking. They probably want to know if I have AIDS or

something! No end to the taboo around fungus. Can't get your house fixed,

can't get yourself fixed. No wonder it's hard to get a doctor to Rx it. I got

Difflucan once but that is for Candida mostly. My uncle was prescribed Lamasil

oral antifungal for a 'toe nail infection'. I thought that wasn't worth

possible liver damage for an elderly man, so I suggested he try vinegar instead,

which he has and said it seems to be working fine. They are okay with fungus on

the skin or nails apparently, an oral for that is overkill I think, but then

there probably since there is no taboo on skin fungal infections, you want to

get those expensive drugs out. There must be a huge clash giong on between

pharmaceuticals wanting to sell their antifungals and insurance companies

wanting to deny the existence of illness from fungus.

I wonder if they will deny it? I'll sue them if I lose the ability to walk and

I have something it would have helped. I haven't been able to walk for months

on swollen foot that won't heal.

--- In , a Townsend <kmtown2003@ ...>

wrote:

>

> ITS CALLED DENIAL!!! and I'm not talking insurance, but denial of any fungal

illness

[Guest guest]

I talked to my insurance company today about the pre-authorization bit on

Sporonax. My doctors' office is closed today but trying to get an idea of how

long this is going to take, and they said they need to find out why my doctor is

prescribing it, the details of my health that he is treating with this.

No wonder antifungals are hard to get. I wonder what the justification for that

is. The side affects of antidepressants are worse and side affects of

rheumatoid arthritis medicine can kill you or make you very sick easily since

they diminish your immune system. On those, they say to call your doctor if you

get a cut or a cold!!!

>Has anyone had to do this before? For my foot, non healing and swollen for

months, doctor going to try an antifungal, (antibiotics already tried, and

because of my mold exposure at home) and wrote an Rx for antifungal and my

pharmacy said it isn't ready because doctor will need to call my insurance

company for a " pre authorization " . I've never needed to do that before. What's

up with that??

[Guest guest]

Barb,

I am not a medical doctor (or an EHS pro as would say), but I am a

mother of someone with ABPA and have been for many years. It is my

unlearned opinion that you need Sporonox. Difflucan won't cut it. Generic

itraconozol won't cut it.

The reason doctors are afraid to prescribe Sporonox is because they have

had it drilled into their heads that it is highly toxic to the liver. From

what I have witnessed, from what my daughter's physician who prescribes

Sporonox on a regular basis to immunocompromised patients and from what Dr.

Marinkovich told me, this is a complete falicy. You can also ask them over on

the aspergillis chatboard. Many of them have been on Sporonox for years

and have their livers checked regularly. I am not aware of any of them

experiencing liver toxicity from the medication.

There is a good chance that the blood work your doctor runs will not

provide any more evidence of what is causing your chronic inflammation. If it

were me, I would request an ombudsman from my insurance company and then I

would POLITELY push until they gave me the damn Sporonox!

I used to have to do this all the time with our insurer to obtain it.

Every six months like clockwork. Ironically, it wasn't because they did not

want to give my daughter Sporonox, they just did not want to give it to her

without also giving a steroid.

What is it they are telling you they need to see before they will pay for

your needed medication? Whatever it is, just go find some case study on

pubmed that supports Sporonox can be used as an anti-inflammatory for

suspected fungal conditions. Most likely they just need some documentation

that

supports Sporonox has been given before for your condition.

As far as your feet swelling with inflammation going up your leg, try this:

Wash your feet really well. Plain off any dead skin with one of those

foot razor thingies and clean under your nails as best possible. Soak your

feet in white vinegar for about 10 minutes. Sit out in the sun to let them

dry. Put on clean socks. Drink lots of water and take some over the

counter anti-histamine like Benedryl. Repeat the cleaning/soaking/sunning twice

a

day for three days.

I can't say for certain this will work for you, but it works for me

whenever I get moccasin foot, red heals and swelling in my legs. I am aware of

a

few other people this has worked for also. And...if it doesn't help to

relieve your symptoms, no harm as nothing I have suggested has any side

effects (unless you can't tolerate anti-histamines).

But again, to reiterate, I am not a medical doctor. This is just a

suggestion from one who has tried a home remedy that works for them. Your

problems sound much more severe than I have ever experienced. In the long run,

I

am of the uneducated opinion that you need to practice the above protocol

along with taking Sporonox.

From About.com:

Moccasin Type Athlete’s Foot

This type of athlete’s foot, also known as moccasin-type, is caused by

Trichophyton rubrum. This dermatophyte causes dry, scaling skin on the sole of

the foot. The scale is very fine, and silvery, and the skin underneath is

usually pink and tender. The hands may also be infected, although the usual

pattern of infection is two feet and one hand, or one foot and two hands.

This type of athlete’s foot is often seen in people with _eczema_

(http://dermatology.about.com/cs/eczemadermatitis/a/atopicderm.htm) or asthma.

It

is associated with _fungal nail infections_

(http://dermatology.about.com/cs/fungalinfections/a/Onychomycosis.htm) which

may lead to recurrent skin

infections.

Diagnosis of Athlete’s Foot

Athlete’s foot is diagnosed by clinical exam and performing a _KOH test_

(http://dermatology.about.com/cs/fungalinfections/g/koh.htm) . A positive

KOH test confirms the diagnosis, but a negative KOH test does not mean a

person does not have athlete’s foot. Fungal elements can be difficult to

isolate in interdigital and moccasin type athlete’s foot.

Treatment of Athlete’s Foot

Mild cases of athlete’s foot, especially interdigital toe web infections,

can be treated with topical antifungal creams or sprays such as

_tolnaftate_ (http://drugsaz.about.com/od/drugs/tolnaftate.htm) , or _lotrimin_

(http://drugsaz.about.com/od/drugs/lotrimin.htm) . Topical medications should

be

applied twice a day until the rash is completely resolved. More serious

infections and moccasin type athlete’s foot should be treated with oral

antifungal medications such as _terbinafine_

(http://drugsaz.about.com/od/drugs/terbinafine.htm) or _itraconazole_

(http://drugsaz.about.com/od/drugs/itraconazole.htm) for 2 to 6 months. All

oral antifungal medications can affect

the liver; therefore, blood tests should be performed monthly to evaluate

liver function.

Sharon K

[Guest guest]

I had trouble getting sporonax Dr. Johanning was telling me to get but he had

resigned or whatever two weeks after I saw him, and my local doctors were

afraid. Wonder if you soaked a little with vinegar. I use it alot on feet after

shower, rinse hair. YMMV.

[Guest guest]

, Re: trouble getting Sporonax approved by my insurance company:

It might be the expense. I didn't have any trouble getting Difflucan at one

time but I see one can get generic Difflucan at Walmart for $4 for a 30 day

supply, but calling them on Sporonax it is not on their $4 list and cost 235.00

for a 30 day supply about. Difflucan and nystatin were the only antifungals on

their $4 list. Sam's Club is a place to get Rx filled inexpensively and they

had similar high price. I wonder why it is so high. Usually after it's off

patent, and generics are out, the price comes way down.

Doesn't matter, this week doctor is having my blood tested for any systemic

infections and so we will know for sure. Whatever it comes back positive for,

if anything, my insurance will accept an antimicrobial for, so I will wait.

Just getting lots of rest until then. Rest is only thing that brings the foot

swelling down.

I finally found a doctor who is working with me a little and said if first blood

test comes back negative, we will do another one, until we figure this out, so

that is making me feel better all by itself. I've been on crutches since

February and sometime numbness is all the way up to my hip, with rash to one

side of my spinal column.

He said he may have to try more than once because they sometimes need to test

the blood in different ways to find different pathogens. Anyway, I have my

fingers crossed and hoping he finds something that can be fixed.

, you said your local doctors were afraid to prescribe sporonax. Do you

think the fear is of side affects or because it isn't called for in usual

protocol, or typical symptoms. I have no lung problems which I think has

confused doctors, but I believe now my exposure to microbials came through my

skin, which is a little more unusual, due to way I was exposed. I developed

very itchy skin, due to fiberglass insulation gettting down into house through

air leaks, cracked plaster, etc, that I itched into bloody sores, as hard as I

tried not to itch. Didn't know why I was itching. Anyway, new injury to skin a

year ago, I won't go into that but I think my skin has just 'had it', is all

scarred up from the two ordeals, and not able to get better and my doctor and I

feel I might have developed 'skin and connective tissue' disease/which I call

infection. The ball joint of my foot can't move much due to swelling. Anyway,

don't want to post much about it until I know but thanks. I'm not going to let

the Sporonax issue bother me. I will take care as best I can until I get blood

test. Thanks for everyone's information.

>

> I had trouble getting sporonax Dr. Johanning was telling me to get but he had

resigned or whatever two weeks after I saw him, and my local doctors were

afraid.

[Guest guest]

Lamisil is another antifungal that's on the Walmart $4 list. It's listed under

the generic name--Terbinafine.

_______________________________

From: barb1283 <barb1283@...>

Sent: Saturday, September 12, 2009 2:10:38 PM

Subject: [] Re: Pre-authorization required for anti-fungal ?

, Re: trouble getting Sporonax approved by my insurance company:

It might be the expense.

[Guest guest]

In a message dated 9/12/2009 7:19:06 P.M. Pacific Daylight Time,

barb1283@... writes:

Do you think reading at aspergillus site would help? I used to but seemed

to be all about lungs.

Yea. They are primarily about lungs. But they are also a wealth of

knowledge about anti-fungals. Seems to me you should be able to get

anti-fungals (Sporonox) for foot swelling. Everyone knows athletes foot is

fungal.

Look up " moccasin foot " in various places. I haven't looked at this for a

while, but the way I remember it, all places say oral anti-fungals for this

kind of athlete's foot.

Try the vinegar/cleaning/sunshine treatment on your feet. I swear it

always helps me with the deep soreness, throbbing and swelling that occurs. But

I have never been as bad off as you sound to be.

Again, no doctor but I hope this info helps.

Sharon K.

[Guest guest]

Thanks Sharon. It might help my skin. Of my foot, an MRI was done and shows

inflamation all around the joints of the ball of my foot but not arthritis and

edema/swelling in the marrow of my bones...never heard of that but nobody acted

like it was strange. They diagnosed repeatitive injury but that was back in

March and it hasn't gotten any better as it should have long time ago. I didn't

know there was a difference between name brand and generic so thanks for that

information. The brand name would be about 100.00 more a month without

insurance. My insurers were vague about why but basically said they need to

hear 'why' the doctor is prescribing it, if it fit into the parameters of

recommended usage of product.

I'm sure 'foot swelling' will not be listed.

Regarding fear of liver problems: I was scared to death to take Difflucan

because of this. I took it on a day I had off, early in the day so in case I

felt sick, I could do something about it, but nada. I started taking CSM but I

only take half a packette once a day because it's hard for me to get, but some

days I forgot. Anyway, I had no bad affects from Difflucan which my doctor

tried me on last month to see if it would help my skin or foot. It in fact had

many good affects, I slept better so I started to take it at bedtime. One day I

had a migraine which disappeared after I took it, which never happens, but it

didn't help my foot, so on to other things. Antibiotics were tried right away.

I had high counts of aspergillus and mucor when I had the multiple skin injuries

from attic insulation. I'm sure spores were in the 40 year old carpet until I

removed it last spring, so I thought something affective against what I have

been exposed to for so long. Anything to try, since nothing has helped yet.

Doctor is having the blood drawn from some place other than surface vien to do

test. Sending me to someone to do it. I was hoping it would show something but

I know these things can be difficult because it could be so many things and

different things need different tests to show up, so if wrong test is performed,

nada comes back even though pathogen is there. At least that is my

understanding. The doctor has to make a good 'call' on what should be tested

for, which can be difficult since so many symptoms can be the same for different

things. Oh well, appreciate the advice. it's so hard not to be off my feet for

so long.

Do you think reading at aspergillus site would help? I used to but seemed to be

all about lungs.

>

> Barb,

>

> I am not a medical doctor (or an EHS pro as would say), but I am a

> mother of someone with ABPA and have been for many years. It is my

> unlearned opinion that you need Sporonox. Difflucan won't cut it. Generic

> itraconozol won't cut it.

>

[Guest guest]

To get things going faster, after they draw the blood for my test next week, I

will probably just fill half the Rx at my own expense to get started. I've done

this before for another situation and gotten reimbursed later. The Rx entitles

me to the medicine, it just doesn't entitle my insurance company to pay for it,

so I could go ahead with treatment probably next week. I think it is written

for Itrazalone (sp?) but I can ask pharmacy to fill with Sporonax I'm sure. My

insurance may only be willing to pay the difference in that case, if it agrees

to pay for any of it.

>

Whatever it is, just go find some case study on

> pubmed that supports Sporonox can be used as an anti-inflammatory for

> suspected fungal conditions. Most likely they just need some documentation

that

> supports Sporonox has been given before for your condition.

>

[Guest guest]

Barb, I hope you get the info and medication you need this week. Remember a foot

infection can be related to diabetes (spell) also, and you have had yeast. You

know the sugar/yeast thing. Just a thought but I am sure you doctor has

considered that... You poor thing, I am sure you are tired of this. I did

Diflican in 2002 for 8 months and I did well on it. Ran out of insurance. But it

took a while to get that back then. Keep us updated.

>

> Thanks Sharon. It might help my skin. Of my foot, an MRI was done and shows

inflamation all around the joints of the ball of my foot

[Guest guest]

My doctor tested my sugar but I eat such a low carb/low sugar diet, I'm not sure

results would show my status very well. On the day I was to take a sugar

challenge test, I had my blood test after fasting, then I was to go to have a

meal and wait an hour and go back for another blood test. I ran into my cousin

on my way to lunch and she came with me. We went to the hospital cafeteria. I

ordered some meat, some rice, a vegetable and for the sugar, got dish of jello,

had water with it. Then I looked over at her plate. She had ordered a meal

heavy in carbs, with a coke or similar and a large piece of cake, at lunch! I

wondered if my sugar load was compared to people who eat more like her, so I

asked if I could have part of her cake. Doctor said test came out okay but I

didn't see results myself. I already eat like I have diabetes.

>

> Barb, I hope you get the info and medication you need this week. Remember a

foot infection can be related to diabetes (spell) also, and you have had yeast.

You know the sugar/yeast thing. Just a thought but I am sure you doctor has

considered that... You poor thing, I am sure you are tired of this. I did

Diflican in 2002 for 8 months and I did well on it. Ran out of insurance. But it

took a while to get that back then. Keep us updated.

[Guest guest]

Sharon, Thanks for description below of moccasin foot. I don't have rash on my

foot though. I have skin problem for over a year on lower legs and lower arms

from scratching, got insulation into skin that was dirty. Took dirty insulation

out and sealed up ways it got down here but skin continues with inflamation and

I think the inflamation traveled down into one foot, in the joint. Oh well,

doctor did not call for pre-auth. He gets fed up, but going for blood draw

Wednesday. I know not to expect much as I have been so disappointed so many

times but if nothing shows up, I will just pay for the Rx myself through the

cheapest source I can find.

This whole fungus coverup has ruined my life. No way of knowing if this is

fungus or not, but you can't even TRY it. Doctor will give you antibiotic, as a

trial, no problem and my foot doctor did try that but then that is it. They

ignore the other HUGE kingdom of pathogenic causes of health problems.

I cannot walk on foot since late February. You'd think it would be reasonable to

just try it.

I asked pharmacy about ICD code and they said insurance company is not asking

for an ICD code but a Pre-Auth.

>

> Barb,

>

> I am not a medical doctor (or an EHS pro as would say), but I am a

> mother of someone with ABPA and have been for many years. It is my

> unlearned opinion that you need Sporonox. Difflucan won't cut it. Generic

> itraconozol won't cut it.

>

[Guest guest]

I found this article about authorization :

.....Because she doesn’t have health insurance, Bell has borne the cost of her

treatment. But Marinkovich said an HMO that many of his patients belong to will

often deny coverage for a key aspect of his treatment, a relatively expensive

anti-fungal pill known as Sporanox. The veteran mold doctor is convinced that

the HMO’s refusal to authorize the treatment is motivated solely by corporate

greed, and has encouraged his patients to contest the treatment denials.

The dispute escalated last year when a malpractice complaint was filed against

Marinkovich with the California Medical Board. Although the board will not

disclose who submitted the complaint, Marinkovich believes it originated from

the same HMO that repeatedly denies its members reimbursement for his treatment.

As a result of the complaint, two months ago Marinkovich was required to attend

a meeting with a California Medical Board representative to defend his toxic

mold treatment practices. ......

 

http://www.imakenews.com/pureaircontrols/e_article000654692.cfm?x=b83PR5s,bvtvCt\

3

God Bless !!

dragonflymcs

Mayleen

[Guest guest]

Great find Mayleen!! This is the medicine my insurance has denied payment of

also.

>

> I found this article about authorization :

>

> ....Because she doesn’t have health insurance, Bell has borne the cost of

her treatment. But Marinkovich said an HMO that many of his patients belong to

will often deny coverage for a key aspect of his treatment, a relatively

expensive anti-fungal pill known as Sporanox. The veteran mold doctor is

convinced that the HMO’s refusal to authorize the treatment is motivated

solely by corporate greed, and has encouraged his patients to contest the

treatment denials.

[Guest guest]

My pleasure !! Now you know why, do not let them, go gettem  !!!!!!!!!!!

God Bless !!

Mayleen

________________________________

From: barb1283 <barb1283@...>

Great find Mayleen!! This is the medicine my insurance has denied payment of

also.

[Guest guest]

My doctor wrote Rx for Sporonax over a week ago and still nada. His office

called me this morning to tell me there will be a 25.00 charge to fill out a

pre-auth form for it. I said okay. Now pharmacy says they still haven't heard

from the doctor and his office is closed tomorrow, so it won't be now until next

week. The pharmaist said they called everyday about it, so I asked pharmacist

could I purchase just a half month Rx and he said yes but it will cost 9.00 a

pill. He then suggested why don't I ask the doctor to switch out the Rx for

Sporanox for Lamasil. He said he could sell me 90 day supply of Lamasil for

12.00. This just seems so weird, as if the drugs are interchangeable.

Everything to do with mold and fungus is such a nightmare. Every day think

maybe tomorrow will be the beginning of the end, and nothing is achieved.

I didn't even want to consider fungal cause because I know how unbelievably

difficult or impossible it is but I have tried 'wait and see', alternative

methods, and antibiotics and foot is still no good. Podiatrist diagnosed me

with RSD but I don't want to accept a diagnosis with no solution, without

looking for something that may be causing it. All I want to do is see if it

could be fungal so I can rule it out as possible cause, but you get no

satisfaction on this.

I think I got this for leaving my house for a year. While I was gone, house got

infested with fleas from a stray cat that got in, then I got all bitten up when

I returns, skin problems that lasted and lasted and then inflamation seems to

have gone down into my foot from my ankles. Wierd, or sad story I know, but

fleas would have been in my very old carpet and could have carried what ever was

in the carpet up onto my skin. At least that is what I am thinking.

I feel guilty for taken people time up with this but sometimes it helps to

" share " !!

>

[Guest guest]

This is crazy you have to wait so long. Doesn't this doctor have doctor on call.

If they wrote the prescription it should be filled. I have had RSD. Very painful

hand injury. Was in therapy for a year and 10 spinal injections. The thing with

RSD if it is not treated in first three months it can really get bad. But yours

sounds so fungal related. I know you must be disgusted. I would at least try to

soak in vinegar while these people drag on and on. I don't think it could hurt.

Some correct me if I am wrong. Lamisil I am a little afraid of cuz I heard some

people died when taking that. Hang in there Barb. ---

[Guest guest]

Thanks for your encouragement . Did you get over RSD?

>

> This is crazy you have to wait so long. Doesn't this doctor have doctor on

call. If they wrote the prescription it should be filled. I have had RSD. Very

painful hand injury. Was in therapy for a year and 10 spinal injections.

[Guest guest]

, should I soak whole body in vinegar, or feet? Diluted or straight? Thanks

>

I would at least try to soak in vinegar while these people drag on and on.

[Guest guest]

Do nit use apple cider vinager if exposed to mold.  It is a fermented food and

proliferates  feeds, the mold.  That is my undertsanding

 

 

God Bless !!

Mayleen

________________________________

From: ldelp84227 <ldelp84227@...>

Sent: Friday, September 18, 2009 7:48:25 AM

Subject: [] Re: Pre-authorization required for anti-fungal ?

 

This is crazy you have to wait so long.