Fake diagnosis to get drug

[nogutsnoglory]

Has anyone tried a fake diagnosis ie: psoriasis to obtain insurance coverage for a drug that looks effective for crohns but would be off label use like Stelara?

 

[Jennifer]

Nope, never done that, didn't have to though (not saying I never would if it were needed). Insurance companies are a HUGE pain and if your doctor is willing to go along, by all means. More power to you.

 

[Lisa]

I haven't - and it would be considered fraud if caught.....to me, not worth it - I'd find another doctor who was willing to try different therapies that may work.....

 

[Jennifer]

Or if you keep asking over and over the insurance company may give eventually but there's no telling how long that would take. My first response was meant for if there were no other options.

 

[PsychoJane]

Hmm, I'm not used to how it works in the states but is it to your insurance company that you would want to fake a diagnosis to obtain coverage?

Is there any safer way to get it, like can insurance companies allow exception drugs at times? That is how it works with the system here but I am mostly naive to what can be done regarding US insurance coverage. I just know that false statement can lead to annoying fines and worse =S

 

[nogutsnoglory]

Unfortunately insurance won't cover off label use of drugs usually since its not medically substantiated.

 

[2thFairy]

Has your doctor written a letter of appeal to the insurance company?

If that doesn't work, you could also trying writing to the drug company and see if they have a patient assistance program that will allow you to get the drug at a significantly reduced cost and/or free if you qualify. Many large drug companies have programs like that.

Either way, if you go the fake diagnosis route, you and your doctor are commiting fraud and that is really REALLY scary!

 

[nogutsnoglory]

Well I'm just inquiring as to whether people did this I don't have a drug in mind or want to do it.

Also doctor note and appeal won't help when the insurance company doesn't consider a drug that hasn't been approved for crohns.

 

[Cupcake]

I wouldn't think faking it would work, but my GI mentioned that because I do have mild psoriasis, perhaps being recommended to a dermatologist with her writing a letter would be a last ditch.

 

[Cupcake]

Has your doctor written a letter of appeal to the insurance company?

If that doesn't work, you could also trying writing to the drug company and see if they have a patient assistance program that will allow you to get the drug at a significantly reduced cost and/or free if you qualify. Many large drug companies have programs like that.

Either way, if you go the fake diagnosis route, you and your doctor are commiting fraud and that is really REALLY scary!

The patient assistance program will not cover off lable usage.

 

[2thFairy]

Good point!