“I was denied Harvoni, the medicine I need to treat my chronic condition, Hepatitis C. Apparently I am not sick enough. I filed a grievance with Anthem sending them all documentation for test results and procedures I have had. They said within 30 days I would have their decision. It’s way past that and still I have heard nothing.
On top of this chronic condition I also have Oral Lichen Planus, which is associated with Hepatitis C and causes me to have constant, painful mouth sores. If the sores don’t go away they could lead to oral cancer. I also have other medical conditions related to this virus, including Portal Hypertension, Esophageal Varices and I am constantly tired because the virus saps my energy. If I could be treated for the Hepatitis C, all of my other health issues would certainly improve. I am not sick enough? I disagree.”
UPDATE: Susan filed a complaint with her health plan and the Department of Managed Health Care and the Independent Medical Board overturned Anthem’s denial. Susan is now receiving Harvoni for Hepatitis C.
“Accessing affordable health care is important for patients like me. As a Hepatitis C patient, liver cancer survivor and the recipient of two liver transplants, I’ve faced barriers to getting the medicines I need to survive. So, I’ve made a point of educating myself, learning about the laws that were hurting me and fighting for access to quality health care. As patients we must remember that we have rights and deserve quality care!”
“As a healthy active mother and former business owner, I didn’t really worry about the specifics of my health insurance policy except for my co-pay and deductible – until about twenty years ago, when I was diagnosed with a chronic illness known as temporomandibular joint disorder or TMJ/TMD. I had to fight to get the disorder covered by insurance companies because it was not perceived as a chronic illness needing medically necessary treatment. I battle this chronic condition on a daily basis, which at times causes severe pain, tenderness and swelling in my face, jaw joint area, neck and shoulders. I know now that the details in my health insurance plan are important as ever and will determine my ability to live a productive, active, and pain free life.”
“My son was taken by ambulance and triaged to the closest trauma emergency room for a severe head and neck injury in 2014. When we arrived at the hospital, I was told by the person in admitting that the hospital was contracted by my insurance and I would only be responsible for covering my out-of-pocket costs. Six months later, I found out the attending ER physician assigned to my son’s care was not contracted with my insurance – or any other insurance company. I was billed directly from an outside entity and expected to pay for the full amount of the attending ER physician’s bill. I have spent so many countless hours of personal time trying to straighten out the billing mess from this one emergency room visit, that it’s time to share my story so that other people can help me figure out this confusing, frustrating and expensive system.”
“I grew up with the painful symptoms of an autoimmune disease called Ankylosing Spondylitis (AS), but was not diagnosed until 2013. Uninsured, I fought my way through the health care delivery system to find a primary care physician and Rheumatologist to get the treatment I needed. I not only have to fight this painful disease, but I have to fight to access the care and medicines I need on a daily basis. It shouldn’t be this difficult, especially when my disease is so painful.”