April 28, 2012 at 6:00 pm #60364mlepp0416Participant
The first thing that you have to do is get a copy of the insurance denial letter. Most insurance companies also will send a courtsey denial letter to the patient as well.
You physician can ask for a peer to peer review with the regional medical director of your insurance company. Once that happens, many times the insurance company will then authorize the medication.
You can also appeal the denial, but your doctor or your doctor’s physician will/should know how to appeal the denial of the medication.
I would advise you to obtain a copy of the denial letter, speak to your doctor or your doctors assistant and request them to appeal the denial or to ask for a peer to peer review. Your insurance company should also have a Medical Intake Team that may be responsible for denying the medication.
You can also call your insurance company and ask why it was denied and what you or your doctor have to do to appeal the denial.
Let me know if you have any further questions.
MargaretApril 28, 2012 at 7:43 am #60363marionsModerator
Jtoro…Taline is great and is quite familiar with insurance issues.
Are you adding Boost or something of that sort to your diet?
Also, Marijuana is known for its medicinal purposes. It may help you with pain control and with stimulating the taste buds. We are in California after all!
Margaret, our insurance advisor is a great resource in re: to insurance questions. Don’t know whether she is able to respond at this time; because she is dealing with a few medical issues herself. Others may chime in and offer their advice.
Good luck and please keep us posted.
MarionApril 28, 2012 at 6:57 am #60362jtoroMember
Marion, he suggested I talk to Taline, his PA about what the rejection letter said. I don’t think Dr. Lenz has the time to handle these. I will talk with Taline on Monday, just wasn’t sure if there’s a specific way to appeal it.
Yes, I do have pain, but am on a 25 Fentanyl patch and take 1-2 dilaudids each day for breakthrough pain. My main problem is trying to gain weight. I have started megase and hopefully that will help.
JtoroApril 27, 2012 at 7:17 pm #60361marionsModerator
Jtoro….Have you spoken to Dr. Lenz about the appeal?
Often times it is the physician handling the appeal.
I am thrilled that you present with stable disease. Pain is also under control?
MarionApril 27, 2012 at 3:53 pm #6720jtoroMember
Since diagnosis I was on Gemzar, xeloda, and nexavar for 17 months until it stated progressing. Dr. Lenz then moved me to fulfox in October. At the last appointment everything was stable, but he wanted to get Avastin approved to add it now or later. The insurance declined Avastin right away.. Now what? I want to appeal to my insurance company. I have seen some older posts about getting Avastin approved, but nothing recently. I want to get on this appeal quickly.
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