United Health are Denied Ibrance!

camul

I was mistaken in the process. FDA only approved it for first line treatment. I am 8th line w/chemo, and 12th line if you combine the chemo and blockers.
He just sent the 3rd appeal with an arvuement. But he is no longer optimistic. He would like me to sfart Gemzar, I told him I have chosen not to and gave.my rrasons. He agrees, so he is looking into possible trials in the line of targeted therapies,such as immune fherapy or even possibly one of the Ibrance trials on patients who are not first line but running out of options!


Prayers and positive woo woo welcome.
Hugs,
Carol

lintx

Hi Carol

You've got it...prayers and woo woo, too!  I like your new picture.  Hugs, Linda

button2

Thinking of you Carol...hugs,

Thinking of you Carol...hugs, Anna

1surfermom

button2 said:

Thinking of you Carol...hugs,

Thinking of you Carol...hugs, Anna

+++Woo Woo !!!!

Hi Carol,

How frustrating. I hope and pray that the appeal goes through for you. I hate that your care and life issues have to be infront of some autocrat at an insurance company who is only concerened with the bottom line (that of making a profit). I feel it is unconscionable  and I don't know how these people sleep at night. Ok rant over, on a happier note I love your new profile picture. Remember that  you are never far from my thoughts. Love Surf 

 

GlowMore

1surfermom said:

+++Woo Woo !!!!

Hi Carol,

How frustrating. I hope and pray that the appeal goes through for you. I hate that your care and life issues have to be infront of some autocrat at an insurance company who is only concerened with the bottom line (that of making a profit). I feel it is unconscionable  and I don't know how these people sleep at night. Ok rant over, on a happier note I love your new profile picture. Remember that  you are never far from my thoughts. Love Surf 

 

How.....

How long will it take your Doc to look into the possibilities available?  Sending prayers for quick answers....and for possible miracles....they do happen......at least I believe in them.....and you are sure entitled to one right about now....perhaps it will be a miracle of PEACE and a lessening of PAIN...but whatever it is...I'm praying for it for you.  Big Hug...sent with Love....  Glo

aisling8

GlowMore said:

How.....

How long will it take your Doc to look into the possibilities available?  Sending prayers for quick answers....and for possible miracles....they do happen......at least I believe in them.....and you are sure entitled to one right about now....perhaps it will be a miracle of PEACE and a lessening of PAIN...but whatever it is...I'm praying for it for you.  Big Hug...sent with Love....  Glo

oh, dear

Mostly what comes to mind would NOT be classified as prayers and positive woo woo, but swear words. It seems almost criminal to me that people's lives come down to statistics and percentages and hardline rules and someone can actually say no and be able to sleep at night. 

I'm still rooting for the miracle. Seems the odds of that happening are greater than getting an insurance company to be compassionate:)

Sending hugs and love and a bouquet of flowers and a virgin margarita (oh, okay, a pitcher).

xoxo

Victoria

 

camul

aisling8 said:

oh, dear

Mostly what comes to mind would NOT be classified as prayers and positive woo woo, but swear words. It seems almost criminal to me that people's lives come down to statistics and percentages and hardline rules and someone can actually say no and be able to sleep at night. 

I'm still rooting for the miracle. Seems the odds of that happening are greater than getting an insurance company to be compassionate:)

Sending hugs and love and a bouquet of flowers and a virgin margarita (oh, okay, a pitcher).

xoxo

Victoria

 

yeah, swear words weede where I went.
The whole thing su ks. Amazing that aome twit at a desk is defermining what tx I can have. It costs 8k a monfh for the Ibrance, but if they approve me, then we cn go to Pfitzef and get qualified for their pro bono (lost cause) They just write it off. That is how most of the new med re pproved for cancer patients. Pfitzer is expecfing fhis to be one of thwir most profitable years bcuz of the Ibrance.

tufi000

camul said:

yeah, swear words weede where I went.
The whole thing su ks. Amazing that aome twit at a desk is defermining what tx I can have. It costs 8k a monfh for the Ibrance, but if they approve me, then we cn go to Pfitzef and get qualified for their pro bono (lost cause) They just write it off. That is how most of the new med re pproved for cancer patients. Pfitzer is expecfing fhis to be one of thwir most profitable years bcuz of the Ibrance.

WOOT! WOOT!   
Hoping the

WOOT! WOOT!   

Hoping the universe is there for you as assisting you is necessary for its balance. I would hope, even without UHC, that the doc reports maybe could make Pfizer do their pro-bono thing anyway.  Oh my dear, we continue to be here for you with all the words we have heard and used for years and hurt in our hearts for your frustrarion and struggle.

Jean 0609

Sending positive thoughts and prayers

Dear Carol,

thinking of you.

 

xoxo,

jean

 

Jan11

Suggestion

Show your oncologist the Insurance Companies denial letter, and then have your doctor justifiy his recommendation, then you provide your doctors letter to the insurance company and then

you state the following. '  I expect an answer from three experts from your INSUORANCE company to provide me with an explanation as to why this medication was denied when my physician has recommended it and the FDA is not considered to be an expert witness that can be called in to court and they don't set the standards of care in any field of medicine for medical treatment.  My contention at this time is that your Insurance Company is acting in in"BAD FAITH CLAIMS PRACTICE" and therefore if I don't receive an answer to my request with in 15 days I will be forced to hire a planitiff's attorney on a contigency fee bases and claim attorney fees, court cost, breach of contract, Bad Faith Claims Practice and claim the punitive damages that I am entilled to under the present law.  Please note that your experts must be properly credientialed - Board Certified in Oncology and the standard of care required is the "GOLD STANDARD OF CARE.  I can assure you that all these damages will far exceed $8,000 a month. " Punitive damages generally will go in to the millions.  I would also like to know if you are licensed in your state as an Adjustor.

Then go to an attorney and show them this = I have won two cases like this.

 

camul

Jan11 said:

Suggestion

Show your oncologist the Insurance Companies denial letter, and then have your doctor justifiy his recommendation, then you provide your doctors letter to the insurance company and then

you state the following. '  I expect an answer from three experts from your INSUORANCE company to provide me with an explanation as to why this medication was denied when my physician has recommended it and the FDA is not considered to be an expert witness that can be called in to court and they don't set the standards of care in any field of medicine for medical treatment.  My contention at this time is that your Insurance Company is acting in in"BAD FAITH CLAIMS PRACTICE" and therefore if I don't receive an answer to my request with in 15 days I will be forced to hire a planitiff's attorney on a contigency fee bases and claim attorney fees, court cost, breach of contract, Bad Faith Claims Practice and claim the punitive damages that I am entilled to under the present law.  Please note that your experts must be properly credientialed - Board Certified in Oncology and the standard of care required is the "GOLD STANDARD OF CARE.  I can assure you that all these damages will far exceed $8,000 a month. " Punitive damages generally will go in to the millions.  I would also like to know if you are licensed in your state as an Adjustor.

Then go to an attorney and show them this = I have won two cases like this.

 

my Dr got the denial.

He has sent in 4 appeals.  I live in a state that is o be of 15 that are not a part of the national insurance.agreement or whatever it is called.

I learned this when I tried to get in a trial at the Mayo Cli'm of and was toldLyons would not approve my participation.  I then tried o be at Johns Hopkins, went out there and learned I would have to have the cash up front as  I live in a state that does nit have t o recognize trials as a vial form of treatment.  They too explained that I live in a state that is not part'm of the nation's'll insurance (I forget what they called it).  

My doctors have been pretty amazing at getting most of this covered.  It has been 5 y www a 're of treatment and 4 major surgeries the year prior, they have been amazing in the time their billing dept. And advocates have spent fighting on my behalf (yes itbenefits them t poo get paid), but there have been more denials then I ever imagined and got really bad once I was on Medicare!

 

 

Jan11

Suggestion

The FDA is the entitiy that approves of drugs according to their own set criteria they do not set the standards of medical care, and they approve regimes in chemothery with out recommending one drug over another.  they approve of regimes of medical treatmen literatilly can be 20 different regimes and  - they are not Board Certified Onocologist and they will not get involved with breach of contract or bad faith claims practice  - to be an expert the doctor must boarrd certified in ocnologI.  This is not the FDA role and they will testify to their limited ability this dispute is between your doctor and the Insurance company but it will not work. 

The nurses from  Insurance companies can not get give expert opinions because they are not octors and they are funtion out side their Nursing Practice Act and you can report them to their nussing board and Family Practice dortors- freguently  Medical Dirctors of  Inurance companies however, they also are not qualified because the are not board certified in Oconology it must be proper expert and family prratice doctors don't qualify.

Go to attorney now and I would recomment medical malpractice attorny who is certified in Medical Malpractice, this is very important medical experts can make or break your case but the puplic is getting tired of Adustors who denie claims on such ridiculous arguments such as the FDA - the FDA is irrevelent to your legal case and they most likely would refuse to get involved. Do what I said.   FDA is irrevelant from a legal perspective!!!!!!  Do not caught up in a false argument.

disneyfan2008

hugs

hugs