Now we begin the dreaded fight with the insurance company to keep Steve's medicines. His shots are once a week, he's well past the hellish side effects we dealt with for nearly 2 months (taking 800 mg of ibroprofen and still raging 104 degree fevers or more, total lack of energy, flu like symptoms and aches, good chuck of his immune system down the drain (still deals with a weakened immune system),and emotional/hormonal swings that were less than pleasant for either of us), showing marked improvement on controlled for now lesion expansion, and for the most part more good/decent days than bad. Now we will start the fight to keep that shot because insurance has cut a deal with a new drug company for a new drug that is out to fight MS. I'm all for anything that can make strides in this area but the insurance company has to remember that it's passed FDA tests but has not been in patient use for a long period of time like his current medicine so in turn we don't know what the true effects will be.
We also face the financial issue. Right now we fought hard to get into a copay program that will offset his current medicine significantly. Insurances see MS meds as "alternative therapy" and pay a much lower amount on them than they do other meds. For 12 needles (3 mo supply) AFTER insurance it's $3,000. Without the copay program we'd never be able to swing that. The new medicine right now is $54,000 a year with some insurance companies coverage so scanty that MS patients are paying $1,100 a MONTH for the meds. If your insurance company will not work with the current copay programs or there are no copay programs then you pay straight out what the cost is. We cannot do that. If they refuse any coverage on Steve's current meds then we can still get them but at cost...nearly $5,000 for 3 months...which we cannot do. So that is one serious issue.
The second issue is the fact that it's a gut fear that now Steve is finally feeling decent and the shot is helping and now the rug could be pulled out from under him and he will possibly start over side effects etc.
We have filed our appeal and the drs office has filed one for us as well. The board can take up to 4 months since the med is not a pain killer (thus not considered urgent!!). In the meantime Steve has 2 1/2 mo worth of shots in the fridge. We don't know till refill time if they will allow him to have his shot or if he will have to wait for the appeal board. If this appeal fails then we can go to the second appeal. We will have one more recourse after that then the matter is done.
It's sad you pay into personal insurance, you work hard, you try to do what you need to do to stay feeling better (Steve exercises, has altered his diet, cut out alot of pop, watches what he does and how/when etc) and you cannot have the medicine that is actually doing something!!
Well meaning people have said "Oh get on disability". That does NOT solve this issue. It's a personal insurance issue for MS suffers. Cutting Steve entirely off my insurance and onto government issued insurance means he will still not get his shot. Our friend that has MS much more severely than Steve has to have Medicaid because of his staggering bills and he has been on the shot for 3 months already!!!
I wish some could see our medical bills we've payed and will pay. I wish for one minute those well meaning people, those ones that really have no clue to our daily lives and insurance companies could live the life and be the family of someone dealing with MS. It would be a whole nother story for sure!!
No comments:
Post a Comment