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Author Topic: Insurance companies that deny medications to patients.  (Read 1978 times)

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Offline justpoz

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Insurance companies that deny medications to patients.
« on: February 07, 2013, 08:59:37 PM »
I would like to make the community aware that there are sweeping changes coming in the health care fields as it relates to insurance coverage and medications.

This is a serious problem because it requires that you prove that you need to take a particular medication, insurance companies are "micro managing medications" which they feel are not appropriate, effectively bypassing your doctors orders, this kind of behavior is a direct result of the Affordable Care Act, part of which is designed to reduce the cost of insurance and prescription medications.

I was informed today that my medications, that have resulted in a quality of life that is far better than I was experiencing when I first started treatment (Atripla) I am enrolled in a scientific study that produces a trophile, study every 90 days and there is an indication that this medication has improved my health and my ability to function outside the home.

What I find disturbing here is that there is no legal reasoning in cutting off this medication, since the insurance company is not entitled to my medical records, (wait for it)

They actually have no knowledge of my medical condition, nor are they entitled to that information.

This should be something that everyone should be concerned with simply because this is a direct conflict between my insurance company and the HIPPA rules and regulations which should protect the patients right to privacy.

In order for me to obtain these medications, I will have to pay full price for the medication or prove to the insurance company that I need to take this medication.

The procedure is that you have to appeal the decision to exclude coverage for this and several other drugs, the cost of which are not that great when comparing with other drugs that are much more expensive.

  In order to appeal the decision you have to appear before a legal administrative court, your doctor has to prepare a legal statement and prepare to appear in court.

So what is happening here is that insurance companies are interfering with a doctors treatment under the auspices of the Affordable Care Act, this is what happens when you write laws that do not take into account those patients that both need and have a right to privacy.

Imagine what might happen if you were to have to fight for other types of medications that work well for you and produce little or no side effects, improve your ability to function and give you a better quality of life.

What is this really?

Political Correctness gone Insane.

Yes, there are some that abuse this drug, college kids and others, however that does not entitle an insurance company to withdraw a drug from coverage because it is politically incorrect.

They have asked that I take a different drug, but I have no idea what a different drug would react with my medical regime, I know what this drug will do and I have medical evidence that supports its use along with the trophile assay, that defines how well my current medications are performing.

I feel that if we all continue to ignore the very obvious political implications that is currently progressing, with regard to medications that are abused by a relatively small group of our society then it will only be a matter of time before all medications will be controlled by insurance companies and pharmaceutical corporations.

So in order to obtain my medications I now have to Prove, that I medically benefit from taking this drug, which means that I have to appear in a public setting and disclose my HIV status to total strangers.

This not only wrong but should not even be a part of my life, I have far more serious things to worry about than this ignorance.

You might think that this is an isolated case or that my quality of life does not require this drug however I would ask anyone to walk a mile in my shoes before judging me.

Insurance companies have no right to know my medical conditions.

If you are also effected by the reduction of drugs available as a covered prescription in your insurance coverage I would encourage you to fight it, because today its this drug, tomorrow it might be something else.

If we allow insurance companies to challenge our quality of medical treatment, I assure you that it will only be a matter of time before they force you to take cheaper medications, with more side effects.  This has far reaching implications, simply because when an insurance company goes too far in regulating medications, (which they have no authority to do) then they could eventually force you to take medications that might one day shorten your life span.

We all know that we have no guarantee, not like the population that has no serious medical condition, we know this yet for the most part we sit back and we take this abuse.

I refuse to be forced to disclose my medical condition in a public setting so that I can prove that I have a medical need for this medication.

Please be aware of how the Affordable Care Act, could significantly effect your life in 2014.

If you are not well versed in how this law changes everything you need to get Aware.


diag 08  vl 60,000 cd4 360
started atripla, 708
could not afford cost of meds.
stopped atripla 808 started atripla 109  vl 90,000 cd4 250 | 209 vl undect, cd4 275

Changed meds Truvada 200-300
Isentress 400 | 0312  vl und  cd4 550
snip
1212  vl und  cd4 625
0113  vl und  cd4 675
12/13 vl und  cd4 720

Feb 2014, insurance blue cross blue shield, increases co-pay from 120.00 to 970.00, tier 5, 33 percent of retail prices.

Cannot obtain any patient assistance, the AFA is a serious threat to patients with HIV. 

Unable to afford to purchase medications.
tired of fighting to stay alive.

March 4, 2014, VL, 161,000 cd4 400
Terrified but helpless to do anything about it.

Offline leatherman

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Re: Insurance companies that deny medications to patients.
« Reply #1 on: February 07, 2013, 11:00:26 PM »
I feel bad that you're having such a bad time with your insurance and meds right now. Hopefully things will work out soon  ;)

However, am I right in understanding that it's not your HIV meds that are being affected but some secondary medication that is not necessarily HIV-related? Is this other drug, since you mentioned it can be abused, something like a more regulated narcotic? Would like explain why the insurance company is scrutinizing it more?

Insurance companies have no right to know my medical conditions.
but doesn't an insurance company already know what your medical condition is simply by looking at the medications, tests, and type of doctor that they are paying for? It isn't hard for the local pharmacist to know a person has HIV when they are filling prescriptions for antiretrovirals, so I'm sure the insurance company, with access to even more information about your health care, is able to put 2 and 2 together.

(heck, when I was having lab work done through the local hospital even all the nice ladies in admissions knew I had HIV as soon as they had to type in the code for the HIV viral load test. You'd be amazed how many people connected to your health care can easily deduce what your medical condition is.)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline justpoz

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  • AFA equals Death for HIV patients.
    • Poz information
Re: Insurance companies that deny medications to patients.
« Reply #2 on: February 08, 2013, 11:17:08 AM »
 Thanks for your reply, as you know any drug can be abused, they are even abusing hiv meds in many places in African nations, but yes, the drug is used to treat Parkinson's, however it can significantly improve some of the CNS problems that are just now beginning to be recognized as issues resulting from the use of HIV medications.

  When I was taking Atripla, there were a certain sub set of side effects, the same is true of insentress, truvada, as well you might have some idea of side effects that create problems for you are someone you know.

The drug is not that expensive however insurance companies now want you to prove that you need to take a certain medication.

Keep in mind that these people are behind the desk, personal who actually cannot guess your medical condition because of HIPPA does somewhat protect your privacy, by denying that information to those who do not have a need to see it.

My main HIV medications are obtained through a different insurance provider so no they do not know.

I would prefer to keep it that way, as an aside I have obtained an attorney and we are going to fight this as a violation of HIPPA privacy requirements.

WE will win too, I just wanted to let people know that what you think you know about the Affordable Care Act, is all about to change.

 
diag 08  vl 60,000 cd4 360
started atripla, 708
could not afford cost of meds.
stopped atripla 808 started atripla 109  vl 90,000 cd4 250 | 209 vl undect, cd4 275

Changed meds Truvada 200-300
Isentress 400 | 0312  vl und  cd4 550
snip
1212  vl und  cd4 625
0113  vl und  cd4 675
12/13 vl und  cd4 720

Feb 2014, insurance blue cross blue shield, increases co-pay from 120.00 to 970.00, tier 5, 33 percent of retail prices.

Cannot obtain any patient assistance, the AFA is a serious threat to patients with HIV. 

Unable to afford to purchase medications.
tired of fighting to stay alive.

March 4, 2014, VL, 161,000 cd4 400
Terrified but helpless to do anything about it.

Offline Jeff G

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Re: Insurance companies that deny medications to patients.
« Reply #3 on: February 08, 2013, 11:39:00 AM »
Justpoz , putting aside the issue of the affordable care act , I hope you do realize insurance company's have been setting limits and access to certain medications since for ever .

Its nothing new for insurance company's to require prior authorization for many prescription drugs , its been going on long before the affordable care act was enacted .

I'm not defending insurance company's , god knows I'm not but this isn't exactly breaking news you are reporting here .     

Offline mecch

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Re: Insurance companies that deny medications to patients.
« Reply #4 on: February 08, 2013, 03:52:26 PM »
WE will win too, I just wanted to let people know that what you think you know about the Affordable Care Act, is all about to change.

It seems you are not a fan of the Affordable Care Act, but is it possible not to throw the baby out with the bathwater?  Your gripe seems to be about abusive practices by insurance companies.  Perhaps its true that there are missteps in the Affordable Care Act but Isn't it also true that the intent is to eventually improve a big heaping mess of health care in the USA, and broaden access to everyone?  And keep insurance companies somewhat in check, as time goes on?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Ann

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Re: Insurance companies that deny medications to patients.
« Reply #5 on: February 09, 2013, 07:18:39 AM »
I agree with Jeff. It's not unusual for an insurance company to question paying for a drug, particularly when that drug is being prescribed "off-label".

Just in case you don't know, drugs are approved for use in specific illnesses or conditions. When they're prescribed to deal with something they've not been approved for, it's called "off-label" prescribing. Many drugs are effective in situations they've not been approved for and so many drugs are prescribed off-label.

I take something off-label myself and I'm quite sure if I still lived in the US, my insurance company would probably be giving me grief over it. If you do not have Parkinson's but yet are taking a drug only approved for use in Parkinson's, then you're taking it off-label and that's why you're running into trouble with your insurance company.

Insurance companies have been doing this for a long, long time. Do I think it's right? No. I think it's positively criminal. If a doctor prescribes something for me off-label and it works, then I do not feel an insurance company should have the right to take it away from me.

This particular situation is one you can't blame on Obama.
« Last Edit: February 09, 2013, 07:24:12 AM by Ann »
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline bocker3

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  • Posts: 3,358
  • You gotta enjoy life......
Re: Insurance companies that deny medications to patients.
« Reply #6 on: February 14, 2013, 07:51:05 AM »
While I am open to being wrong -- I believe that a Health Insurance company does have a right to your medical records.  They get it when doctors send in their charges -- they use specific codes that identify diagnosis -- so, I think your rant about them not having a right to your records is incorrect.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline MitchMiller

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Re: Insurance companies that deny medications to patients.
« Reply #7 on: February 17, 2013, 02:56:08 AM »
If you're talking about selegiline, I've been taking it for ten years, self-prescribed, to ward off dementia.  Studies demonstrated patients with dementia did not progress when on selegiline, although they also didn't get better.  You can get it from an overseas pharmacy for very cheap without a prescription, so you don't need to go through your insurance company.  I split the 5mg pill in three parts and take it six days/week.  Not sure if that might help you out.

Offline vaboi

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Re: Insurance companies that deny medications to patients.
« Reply #8 on: February 22, 2013, 02:58:21 AM »
I have to side with the insurance companies and the Affordable Care Act on this one.  Anyone who provides insurance, in my opinion, has the right to your medical records, if nothing else, in order to minimize fraud and abuse of the coverage.  I'd think that is what you are signing and agreeing to when you sign up for the policy.  If you do not agree to the terms and want to keep your conditions totally private, then you are perfectly welcome to pay out of pocket for your own prescriptions and medical expenses.  You do not HAVE to get medical insurance.  But if you do, there are terms you have to agree to.  It's just like car insurance.  State Farm isn't going to pay for a new bumper unless they can first inspect your car to see if the one on there is actually damaged.  lol   Same with health insurance.  The provider needs to know and confirm your conditions before paying for your drugs.  It's as simple as that.   And btw, if you live in the US, once you test positive, you are likely put in your state's database as having hiv, so your privacy is lost the moment that happens anyway.  So I don't know what your real problem is.   Do you think you really think you are going to see these attorneys or the judge again outside of the hearing where you need to testify or something?  lol  And if so.. who cares?  I'm sure they hear about all kinds of medical conditions day in and day out..

 


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