Ya gotta luv this crap (dealing with ins. co.)

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 2/19/2010 3:31 PM (GMT -6)   

I thought you'd enjoy this.

My insurance company will not approve Viagra.

Ok, they gave me a fax number to appeal. My doctor faxed a very nice letter to them explaining the medical necessity for this drug.

I didn't hear from them so I emailed them. I got a response that they never received any appeal. They gave me an address to send an appeal letter. So, I wrote a letter and sent it to them along with my doctor's letter. I just got a letter back from them, entitled "Misdirected Appeal." They were unable to process the appeal because it was sent to the wrong place. They didn't tell me the CORRECT place and, in fact, I have their email with the instructions, including the address where I sent the appeal to.

So, I call them and play press the button for almost an hour, only to find out that yes they do have the appeal and apparently it is being considered. LOL!! What fun it is dealing with these idiots. Frankly, I have no idea if the appeal is still in the hopper or not. I do have a call in to our HR person at work.

I'm glad I ordered the drug via ADC. Supposedly I should receive it in a week or so...HOPEFULLY.

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights.

Next Event: First post-op PSA on 3/1/10


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/19/2010 3:34 PM (GMT -6)   
I am not sure anyone's insurance paid for "sex drugs" after surgery. I could be wrong.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 288
   Posted 2/19/2010 3:47 PM (GMT -6)   
Insurance didn't pay and wouldn't pay even after my primary as well as my urologist appealed the decision. Both physicians have been quite liberal with providing me with samples of both Viagra and Cialis as long as I needed them and asked.

Take care,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy


profman
Regular Member


Date Joined Jan 2010
Total Posts : 55
   Posted 2/19/2010 3:55 PM (GMT -6)   
My insurance company will pay for 6 Viagra a month, even though the prescription called for 8 per month (I am supposed to take half a 100 mg pill every other day). Seems better than what no approval, but, my copay is $5 per pill, so it is still cheaper to order from overseas.
Diagnosed 9/4/09, age 59
PSA 3.5, up from 1.8 year before
First biopsy showed 3/10 positive cores, Gleason 3+3, less than 10% involvement in all three cores, diagnosed as T2a
Thinking of Active Surveillance but
Second biopsy showed 5/10 positive cores, Gleason 3+3, left side (4 postitive cores) had 40% involvement
RRP on 12/15/09, home 12/16
Catheter out on 12/29/09 (failed cystogram earlier)
Path report was all good news, Gleason 3+3, no margin involvement, no perineural involvement, everything clean other than core of prostate, tumor on both sides, but more prevalent on left side, 5% involvement, 42 gram organ
Within two days down to one pad a day, now continent except if I sleep more than four hours
Back to work 1/4/10
First PSA 1/28/10 - nondetectable, next scheduled June 2, 2010
ED present, although blood does flow after Viagra. working with pump now - still trying!


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 2/19/2010 3:55 PM (GMT -6)   
BC/BS would not pay for them.

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 2/19/2010 3:57 PM (GMT -6)   
My insurance would pay a little bit of 6 pills too.

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/19/2010 4:29 PM (GMT -6)   
Our insurance company allows 4 pills per month for John at a cost of $30 for the 4. We will soon be placing our first order with ADC.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 2/19/2010 4:41 PM (GMT -6)   
My insurance doesn't pay for ED drugs. I have put an order from ADC. I wanted to try and see if it helps so I ordered just 14 pills and the shipping cost was almost as much as the 17 pills
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11.5 months test 1/21/10 result 0.004

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