You will get this treatment!! You will be SVR!! Keep that chin up & keep that faith.Everyone is behind you with lots of support. this forum is the very very best. they got me throuhj ALOT!! Believe me! lol But I got there & u will too..

Best Wishes

Peace out

Taz

Fantastic News, Stormy!

Support Path will move fast and they helped me in a big way as my insurance failed me and painfully drug me through the mud for a few weeks.

You will notice the Gilead efficiency in short time and will get a definite answer sooner than later. It's great to see you started the process. Keep us  posted. My fingers are crossed for you.

-Rob

Hi Stormy,

Thats great news! Gilead has helped a lot of our members obtain treatment when their own insurance carriers have failed them. I'm encouraged to hear they have asked for your paperwork. It shouldn't take long for them to look it over and advise you of their decision. 

I know this all seems like a lot of hoops to jump through, but trust me it's worth the effort. Let us know what you find out and good luck! Hang in there...

Tig

Just faxed over my portion of Gilead support path intake form to Acaria Health.  I believe I meet all the requirements. And so, more waiting. It has been over a year of waiting, though seems so trivial compared to others.

Stormy

Hi Stormy,

i'm sorry to hear about your denials but this is the course of action many insurance carriers have followed. I can only guess that your doctor has seen the same course of action with others in his/her practice and perhaps knows that many carriers have responded favorably after the second appeal. Does he want to appeal a third time? I do suggest you contact Gileads Support  Path and request their assistance on this. They require two denials before getting involved. At least that has been their recent history with people here. I'm sure there will be responses from members that have received help from them. I would make sure that your doctor is advised of the fact that you are going to try that. They will need to work in concert with each other to exchange treatment information anyway. If you don't have their number you can find it through the link in my signature. Please let us know how this progresses And if you need any information, don't hesitate to ask. Good luck...

Tig

I just received my second denial from Anthem for Harvoni.  My Dr's office told me my next step was to contact Acaria Health. Of course my call went to voice mail and the contact person is out of the office for the day. I kinda thought I would be dealing with support path at this junction. Any thoughts on why I need to call this person at Acaria.? 

Thank you

Stormy

LOL @Groupergetter. That truly was a great song!

Hi Stormy, wishing you well.  Most here know the frustrations and anguish trying to get the high dollar Harvoni or Sovaldi.  It's almost as thought the insurance co's and pharmacy's take joy in seeing people suffer. Some are sympathetic and patient, while others seemingly could care less.   It is easy to become frustrated and lose sight of the prize.  Sometimes it's hard, but when dealing with the insurance and pharmacies, stay composed, keep your cool.  Always take the high road, don't allow them to bring you down to their level.  This will work out.  Remember you are your own best advocate.  Learn the specific requirements of your insurance company.   Make sure all the necessary supporting documentation is submitted with the prior auth request.  If denied understand the appeals process.  Follow through in doing what you need to do to get your meds.  Keep the faith and don't give up hope.

While you're at it Stormy..........bring back that suuuuny day.  :)

Rob, 

Thank you for your encouraging words, yours and everyone elses. It helps.

Stormy

Hi Stormy,

You will get there with time. These insurance companies are trying anything they can to delay coverage and avoid paying. Just remember that criteria is rapidly changing. With the new treatments available, prices are dropping and guidelines are being rewritten to improve patient accessibility. 

Support Path is awesome to work with and upon your next insurance denial, Support Path will work quick to attempt qualification for assistance.

Hang in there, your time is coming.

-Rob

I already have my first denial and an appeal was filed. Last Friday I received a call from Anthem saying they would call within 72 hrs. with results of an emergency appeal.  Saturday they called again saying I did not meet the criteria for an emergency appeal and it might be another 30 days for a decision. And just try to get a little clarity from them. I've never dealt with any insurance issues, sure seems complicated. So, I went ahead and contacted support path....Wow what a difference. I talked with a person who was compassionate, assuring and informative.  She gave me hope. I just know I'll get there, eventually.

Thank you, mallani, for your help.  I may have the other hep b panel results at home. I do remember my doc telling me to get the vaccine last winter. 

I feel a bit helpless trying to get information from my doctors office.  I have panic attacks at office visits. But am determined to be more pro active.

Wonder if panic attacks are associated with the hep?

Hi Stormy,

You really need to know whether you're Genotype 1a, or 1b.

A non-reactive Hepatitis B Surface Antigen only means that you don't have active Hepatitis B as present. The Hep B panel should also include the Hepatitis B surface antibody (usually just called HBsAb) and the Hepatitis B core antibody (HBcAb). You need all three to decide whether you need a Hep B vaccination.

Your appeal is not being helped by the fact you don't know your Fibrosis stage. It seems only the F3's and worse are getting approvals from some companies. You should insist on a Fibroscan or biopsy to get this vital information. Best of luck.

I received a copy of my lab work. I am Genotype 1

HCVQPCR

Hepatitis C Qnt by PCR IntUnit/ml      3,300,000

Hepatitis C Qnt by PCR Log                 6.5

Heoatitis C RNA Qnt by PCR Interp       Detected

HBVSRAgflx

Hepatitis B Surface Antigen           Non Reactive

ANA

ANA Anti Nuclear Antibody Screen      None Detected

TSH2

TSH Thyroid Stim

Hormone 2nd Generation      1.05  (in range)

 I am running into walls here. I don't really understand how sick I am. I have been denied Harvoni. The denial letter stated they needed more information.  So I have called my doctors office and talked with the person who does the appeals. I inquired about the additional testing and information that Anthem said was needed.  She was very short with me, to say the least. Said the additional information may not be needed and she was filing the appeal.  Also, since there were so many patients, 40 or 50, requiring requests and appeals, I was taking up her time when she could be doing the paper work. I asked if I should contact Support Path, her response was they won't even talk with me until all appeals are exhausted.

So, I just sit and wait?  

Thanks for for listening to my ramblings.

Also Stormy,

It also looks like a biopsy is in order. I would avoid the fibrosure due to frequent inaccuracies of that test. A Fibroscan is a better measurement of liver damage. But then again, a flawed fibrosure result might work to your advantage if it comes back with a higher score? The fibrosure is much less invasive too. Just a thought. Others will likely weigh in with more suggestions.

-Rob

Hi Stormy,

Sorry to hear about your denial. Keep appealing and have your doctor order you the Viral Titer test to show your current viral load along with submitting the required and recent blood work. Your doctor will also likely need to write a letter on your behalf explaining the "medical necessity" for treatment. 

Don't get too discouraged as these Insurance Companies will go to great lengths to not pay for treatment. Also, if you haven't already, apply for assistance from Support Path via your doctor's office.

Good Luck!

-Rob

I received my Harvoni denial letter today from Anthem. Reason--- medical necessity. Sounds like my doc didn't send in some information.  

They need:

The results of a test to confirm my infection (Quantitative HCV RNA)

Want to know if I am having problems from liver disease (Child-Pugh score)

Fibrosis stage by biopsy or FibroScan elastography.

Want to know other condition (either type 2 or 3 essential cryoglobulinemia with end -organ manifestations or significant glomerular kidney disease; or prior liver transplant).

Wondering what exactly my doc did send in, seems like a lot of criteria unmet.

Any thoughts? Not sure what some of this means. I have some work to do.

Hi Stormy.  I understand scared.  So was I.  I was just diagnosed 5 week ago.  It all moved so fast from there.  Blood tests and more blood tests.  Ultrasound and a fibrosure from my first GI visit.  Six days later I started Harvoni.  I am on day 8 now and it's going pretty well.  You can be scared.  But get your results and the people here can help you understand them.  Treatment is just around the corner. 

I think everyone is scared, at least at first. You are not alone, I agree with Matt that this is the best time for you to have found out. These new drugs are healing so many of us. Take it one step at a time, you will get through and you have found an excellent forum full of wonderful people to help you.

Take care ~ Roo

Thank you for the welcome.  I have requested my last blood test results. I remember asking why do the hep b vaccine if I already had hep b and was told I have the antibodies. Haven't yet done vaccine for either the hep a or b. Scared.... I'm just scared.

Hello Stormy

Welcome to the forum you have found a good place. Great to hear from you and thanks for filling in your history. You certainly have picked the best time to seek treatment, in that the regime is quite a bit easy that it has been. You are wise to find out your Geno. type  and LFT (Liver Function Test) lab results it can explain a lot for you. Sounds like your doctor thinks your GT1 because he is talking Harvoni.

If you have questions just asked the forum or use the search engine.

We hope you get your ticket punched for the Harvoni treatment train soon.

matt

Hi and welcome Stormy.

You need to find out whether you have active HepB, or just the antibodies.

We can't give much advice without blood test results. These belong to you, so you can request a copy.

Basic things like HepC genotype, Viral Load and LFT's are all basic information. The Ultrasound report would be useful.

I'm not sure how your doctor can say 'you have no cirrhosis' except by doing tests like Fibroscan or liver biopsy.

If you can get some results, we can give you some advice. Cheers.

At age 19, I was infected with hep, I think it was of the B type. Was hospitalized and released in a few days. Never given any information about the disease. Thought I was over it.  Fast forward 45 years. Took a pilates class and couldn't handle it, my body revolted, BP spiked, had panic attacks, went to a doc.(first time in many years). He ordered blood tests and an ultrasound. Found out I still had hep b and now hep c. Sent me to a gastro doc last January. Gastro doc told me to get a hepB and hepA vaccine, ran a different blood test and told me to wait til the end of this year for a new drug. Saw him again a month ago and he told me about Harvoni. Said it might take a month for approval.  I never saw any of the number results from the blood work or details of the ultrasound. I don't know my genotype. I think I recall the doc saying I had no cirrhosis but don't wager on that. Now I'm just trying to process it all. It has taken me over a month of lurking here to post my intro. I have no expertise to offer, just a fellow human on the same path as many here.