Ins. Co.

Question

Was supposed to start TX on May 7 and Aetna is still refusing to pay for 2 of the 3 drugs holding up the show. It is just making me more depressed before I even start. Worried about how depressed the TX is going to make me. I hate all this waiting and uncertainty, it just makes it all worse.

flcyclist · Accepted Answer

Is your insurance through Aetna handled through your or spouses employer, an insurance broker or a local insurance agent?  If so, use them.  I have Aetna which used Aetna specialty phamacies for the med, so I guess each state and type of plan my differ with how this is handled.  I wouldn't give up trying to call Aetna to speak with a supervisor.  Be polite, but persistant.  In my opinion, getting an attorney at this point will delay things even further and be very costly with little outcome.   Don't get too frustated, since this isn't terribly uncommon.

Prepycp · Answer

Started TX today. Thanks for all the help.Let the party begin.

Dee1956 · Answer

oops sorry I only read the question.  I had the same problem again 3 months in when the doctors office got the Pegasys approved but wrote scrip for Pegintron, the docs office told me they were the same thing, that was fun

Dee1956 · Answer

Hi I had the same problem.  The doctors office needs to send Aetna some additional paperwork, once they do you will be approved.
It is very frustrating as no one explains how things are supposed to go.
I am sure it will work out.  
Good luck

Prepycp · Answer

I will be using incivek. Thanks again and I will keep posting. I'm sure I will be asking a lot more as time goes on.

1swimmer · Answer

Yeah, good news! The ducks are lining up. Wishing you the best on tx.

BoceprevirGal · Answer

Hey, great news!  We all have to fight, to get our meds, and I'm glad you persevered.
   I will be looking forward to hearing how your Treatment will be going.
Are you going with the Incivek, or the Victrelis? Both PI's have shown good results, good luck~

Prepycp · Answer

I finally got approval from Aetna for the 3 meds.  Got my boss and our ins. broker involved and that made the differance. Thanks to all for the advice. I will be starting TX on June 4th. The co-pays are going to be covered between the Hep. center and the pharmacy. I got lucky with that at least. So now I guess the journey begins. Will be in touch.

flcyclist · Answer

"I wonder what the co-pays are going to be."
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Your co-pays will depend on your specific plan and level of prescription coverage.  I'd suspect the one med they aren't question is Ribaviron since it is the least expensive.  Interferon is consider a tier 4 injectable and I'm not sure which PI you're planninig on, but both are very expensive.  Your Aetna representative should be able to tell you exactly what your monthly out of pocket cost will be and you employer should be able to give you an estimate.  Good luck.

Prepycp · Answer

Thank you all again. My ins. Is from my employer and does go through a broker. My employer is contacting him tomorrow and going to lay it on him. See what happens then. I'm in NJ. If they are denying payment now, if they do approve I wonder what the co-pays are going to be. Let's see what tomorrow brings. Thanks again

1swimmer · Answer

Hi there, don't get discouraged! I think it's all part of the big test. The hardest part of tx for me was all the preliminary stuff I needed to do. The to-do list seemed endless. Soon you will be taking the meds. I found I was worrying too much about sx. Take each step as it comes. You'll make it. I just started week 7 and I'm doing ok. I come to this forum to learn.
Wishing you the best,
C

debbiemac40 · Answer

Sorry to hear about your delay.  I have no insurance and its taking me 7 months to finally get some financial aid for treatment.  So I know its very frustrating for you.  Dont give up..  This forum has really helped me when I didnt think I could take anymore.  Just someone who understands how we feel helps I think.,   Good luck to you.

Prepycp · Answer

Thanks to all you replied. My doctor, myself and Prime Aid, the pharmacy handling my meds have been all going back and forth with Aetna and all we get is "it's still under review". They have not answerd our emails and refused to let us speak to a supervisor saying that they are all too busy.At times they are outright rude. I think it may be time for a lawyer.Don't need this stress at tis point. Makes me wonder what the furture is going to be like.

flcyclist · Answer

As Hector stated, you should be communicating with your treating doctor and Aetna to find out what the holdup is.  Sometimes there are gaps in communication between the doctors and the insco, so sometimes you have to be proactive in step in.  I have Aetna and didn't have a problem with initial approval, but had a few problems with the 3 month authorizations to continue.  It does cause a lot of stress when things don't go smoothly.  Good luck getting started.

HectorSF · Answer

First, you should talk to your treating doctor and have someone in his office that deals with the insurance companies contact Aetna and find out what the problem is and correct it. This is not uncommon and I am sure they have previous experience with this issue.

Secondly, if you have a history of clinical depression you should be treated with an anti-depressant BEFORE starting treatment. Treatment can cause depression in certain patients especially those with a history of clinical depression.


Good luck.

Hector

nygirl7 · Answer

Sorry iPad to extend...not coextend

nygirl7 · Answer

I have Aetna. They would not pay for me coextend treatment but said they'd pay for a transplant. Go figure.

Ins. Co.

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