Good News Everybody (California fighting the insurance machine!)

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saidinstouch

Joined
Nov 8, 2007
Messages
491
Hi everyone,

I think I mentioned a while back that my mom was involved with administrative actions against PacifiCare by the state of California. Well she was interviewed by the LA Times for an article discussing the actions being taken. Her testimony could be a key part of getting a ruling against PacifiCare and I wanted to share the article with you. I for one am glad we are getting changes to our health system. I don't know if it will be better or not, but I feel we will prevent this kind of BS from happening to people again, and if it does, we will have more defined recourse.

Without my mom's assistance fighting the company for me to allow me to continue my remicade at the time, I would not have finished college and would not be currently studying for my PhD to examine glucocorticoid induced osteoporosis. My entire life could have been ruined without her help and I wanted to share that with you all. Lets hope California gets the ruling they are seeking and can send the message that screwing your members is not a valid business model.

http://www.latimes.com/business/la-fi-pacificare-unitedhealth-20100908,0,6380098.story

I hope you all enjoy the article and the fact someone is fighting for our rights in at least some small way.

-Andrew
 
Hi Andrew, Good article. Its about time someone brings suet against some of these ins. companies. They always seem to come up with some reason not to cover something.

Good luck
 
I sat in on a day of the testimony and talked to lawyers for the insurance commissioner here in California. It is amazing the defense PacifiCare is putting up...amazing how terrible it is from what I saw. Even if the fine was reduced to be in the hundreds of millions from the maximum listed here (the most likely result is they will be reduced) it would be a big win for us little guys!
 
I spent many months trying to get coverage for my Humira. Finally my MIL brought it up with a senator... She sent it on to the person who works with insurance (maybe insurance commissioner?) Then it was approved quite quickly. Sad that we have to bully them to get them to stop bullying us.

My MIL thanked her the other day (two years later) and she said she remembered doing it. A lot of people with our condition have been having trouble getting their meds covered. I suppose because so many of our options are so expensive.
 
diesanduhr said:
I spent many months trying to get coverage for my Humira. Finally my MIL brought it up with a senator... She sent it on to the person who works with insurance (maybe insurance commissioner?) Then it was approved quite quickly. Sad that we have to bully them to get them to stop bullying us.

My MIL thanked her the other day (two years later) and she said she remembered doing it. A lot of people with our condition have been having trouble getting their meds covered. I suppose because so many of our options are so expensive.
Click to expand...

I had a member of the department of insurance in California call Blue Cross once after they delayed my approval of humira for over a month and they told HER that they weren't going to approve it. Can you imagine the balls on that person to say that to your regulator after she told them they had to approve it based on the facts? In the end it was approved less than a week later, but the delay in meds got me hospitalized right as I started graduate school.

I am hoping that if/when the state wins this action it is large enough to ensure that 1) companies see it isnt profitable to act like this anymore (at least in Cali) and 2) other states start to really investigate these companies and go after them with the same voracity. It is the only way to prevent the kind of harassment we receive in the future.
 
saidinstouch said:
I had a member of the department of insurance in California call Blue Cross once after they delayed my approval of humira for over a month and they told HER that they weren't going to approve it. Can you imagine the balls on that person to say that to your regulator after she told them they had to approve it based on the facts? In the end it was approved less than a week later, but the delay in meds got me hospitalized right as I started graduate school.

I am hoping that if/when the state wins this action it is large enough to ensure that 1) companies see it isnt profitable to act like this anymore (at least in Cali) and 2) other states start to really investigate these companies and go after them with the same voracity. It is the only way to prevent the kind of harassment we receive in the future.
Click to expand...

That's awful! I'm sorry you had to deal with that. I think it's ridiculous that they can make us "fail" on "first line" therapies (in other words let us get sicker and sicker) before giving us the drugs that have been shown to work. My GI told me they've seen people time after time just get worse while taking the "first line" therapies so it's better to just start with what will work. I would have happily taken Imuran, but apparently I don't have the enzyme necessary to metabolize it. My insurance compay wanted me to "fail" on steroids before letting me have Humira. What the heck? Who stays on steroids long term unless they absolutely have to?

I have to remember to send in my prior-auth two months before hand. They definitely take their time in approving it.
 
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