I can rant and rail about insurance and Medicaid denials of coverage for hepatitis C treatment, but I am trying to avoid blood pressure medications. Last week, I listened to an NVHR webinar of experts sharing their experiences trying to obtain prescription coverage for hepatitis C patients. My horror increased as I heard stories about denial after denial. One patient couldn’t get a lung transplant until her hep C was treated. Another went through such a horrendous nightmare of denials and appeals that an old anxiety problem kicked back in. There are many stories like this one, and here is a link to one.
One medical provider stated that her office devotes an average of 8 hours of staff time per patient to the process. By the way, that is UNPAID time; it is done because of compassion. Because this process is so time-consuming, some providers are forced to limit their practice to how many patients they can take, because if they spend all their time on fighting denials, they don’t have time to practice medicine. It’s a horrendous problem.
As grim as all this is, keep in mind that ranting is useless. It is painful and promotes powerlessness. Looking for solutions is a much better approach. When faced with denial for hepatitis C treatment coverage, what are some options? What are our choices so we don’t end up merely ranting? Here are some tips:
- Assume you will be denied. I know we are “supposed to think positively,” but denials are so common, that I think it is better to hope for the best, but prepare for the worst.
- When denied, skip the catastrophic thoughts. I hear people say, “My life is over,” and other similar thoughts, and it isn’t true. You are just beginning the process. My unscientific assessment is that the majority get treatment in the end. Save the catastrophic thoughts for later, after you’ve been denied a few times. A few times? Yes, you may be denied three times. Then your provider goes down the line with a peer-to-peer review, perhaps a grievance, and then may need to contact the pharmaceutical company and ask them to pay for the drug. And even after that, there may be other options from Patient Assistance programs.
- Expect the process to take a long time. A month is short; a few months is more typical. It is long enough to take up yoga or meditation.
- Be sure you can meet the requirements of your insurer. If your insurer won’t cover your treatment unless you pass alcohol and drug tests (which includes marijuana), either be sure you can pass it or tell your provider that you’d like to postpone the test. If you fail the screening test, you may not be eligible for treatment for 6 to 12 months. Also, I just heard of a case in Oregon of a patient who was denied treatment because of tobacco use. I have never heard of this before, and it is shocking. If you use tobacco, I am not suggesting that you lie about this, but you might want to think about this in advance in case this question comes up. Just saying...By the way, if you are wondering why I am not screaming my head off about this, remember that I am trying to stay off blood pressure medications.
- Get support. This process is grueling. Join a support group, such as Hep Forums.
- Supply your doctor with tools. If your doctor doesn’t know how to help you, give him or her resources. You can use these too. There are many excellent patient advocacy and assistance organizations. Here are my favorites:
HepMag.com’s Hepatitis Assistance Programs
Help4Hep 877-HELP-4-HEP (877-4357443)
- Consider a clinical trial. This bypasses the entire system since the study drug is supplied.
- Breathe in; breathe out.