Saturday, August 28, 2010

Indian on the Warpath to Change Discriminatory Health Insurance Restrictions
My fight to have my Benicar full dosage covered by my Medicare Part D plan (which is managed by United Healthcare) continues. It's been about 4 years that they've been stonwalling and dodging, and out and out refusing my various levels of appeal, and it took them an entire month to respond to my last appeal.

To put it mildly they have tried every possible trick in the book to stall me and my doctor and screw us around.

Those readers who have read my segments on the horrendous acts of many of the major name health insurance companies may remember that United Healthcare was one that had a track record of denying crucial claims.

Medicare made a huge mistake by privatizing their Part D which deals with medications for the elderly and disabled.

Well the letter I finally received from United Healthcare today had me on the warpath. The upshot of it was that I would have to start from scratch and have my doctor initiate the whole appeal process through United Healthcare again before going back to the point I'd reached after several years (which is the final appeal to an outside company called Maximus).

That ship has sailed and my doctor quit doing this on my behalf about a year ago because he was tired of being given the runaround and having them tell his staff they didn't receive his numerous faxes.

Then I received a phone message from United Healthcare (another department), called the woman back, a prepresentative who only identified herself as Ashley F. I read the letter to her and told her that the way they worded it made it sound as if my doctor didn't do what he was supposed to do and that they said he "cited that it was not FDA approved" for my disease, to make it appear as if he himself didn't support my staying on the drug at that dosage. They failed to say that my doctor had sent them alot of information supporting why I could not take the other drugs they had on their formulary, and that he actually sent them research supporting why this drug at this dosage is safe and effective for Sarcoidosis. They were trying to insist that he do this all over again!

Ashley F. then gave me another fax number directly to Maximus and said I should just send a letter to them telling them also that I'd already done all the appealing I could through Uinited Healthcare.

I am still recovering from the flu but will be doing that soon. Now that Carmella is stable I can start putting more time into this, and they'll find out that they have messed with the wrong patient because I don't give up!

The other night when I called the Medicare 800 number, the representative I spoke with checked over 15 other Part D plans and found that literally none of them covered 40 mg. of Benicar 3 times a day! If I can get this changed I think it will help many others too who are on cutting edge treatments that are off-label or new medications. The concept is very simply; if it helps, and it's safe, then the patient should be able to get it.

Why are conservatives griping about government intervention in healthcare, and not about big business sticking it's nose into it??? These are private companies that are denying people medications they badly need to relieve suffering, and often to stay alive for a full lifespan!

Since the time I started on this particular protocol the number of people benefitting with a variety of autoimmune diseases has multiplied about 4 times (and that's just what is counted on the official research site). There are many others quietly on the protocol through their own local physicians who are not part of the online research cohort, many of whom probably are running into the same problem. If they have a fair amount of money they can afford to buy the medication out of pocket, but if not they may have to resort to getting it from third world countries, or they may be unable to get it at all.

I just recently heard that one of the other protocol drugs, Zithromax has stopped being covered by my plan and by most of the others except those with the most expensive premiums.

Yes, they're perfectly willing to cover medications that will reactivate deadly infections and possibly kill me, and anti-cancer drugs that can totally dismantle my entire immune system and open me up to new and deadly infections, but they can't see fit to allow coverage of some simple antibiotics and a medication usually used to treat high blood pressure with a very low risk of side-effects to which I had none at all for 3 some years!

I guess they think that it's less expensive to pay for the doctor's appointments and tests that become necessary when my various organs start malfunctioning several times a year during an acute exascerbation than it would cost them to cover a few more Benicar a day to prevent that...Oh, I forgot...that would be Medicare itself covering all their consequences for not paying for my medication at therapeutic doses. I guess they figure they'll let that be the government's problem! They (meaning United Healthcare) don't pay for that part!

Luckily I have not had to be hospitalized, at least not yet, but I think the last one came pretty close to it. I just hate going to the ER and I probably should have when I had the cardiac and respiratory symptoms but to be honest I didn't have the energy to get out of bed for several weeks. Living alone I really didn't have somebody to go with me anyhow and bring me back home. It was hard enough to drag myself to the GP and the heart specialist via the medical transportation system that had to be set up with three days notice.

I can imagine how many others these insurance companies are making jump through these hoops, and although the National healthcare bill has passed, in its watered-down form it's hard to know how much, how completely, and how soon we'll be protected from such denial tactics.

I would love to speak before Congress about this and I may see if I can set that up. It's getting about time for me to write President Obama again. This seriously needs to be changed. If Maximus is a private company too then I will need all the clout behind me I can get.

1 comment:

Victoria said...

giving you the runaround is their way of getting you to give up. It is unfortunate that your Dr. will not stay in the fight. My daughter and I have had some major illnesses in the past few years. I have met some lousy Dr.s and some who are beyond wonderful.(one surgeon did NOT send me a bill for a surgery costing between $10-15,000, because I had no insurance and the hospital treated me shabbily). Pray for guidance and never give up. It won't be long before many Dr.s start rebelling; they are getting fed up as well. Every now and then you must take a breather---then get back in the fight.