Guest guest Posted May 8, 2006 Report Share Posted May 8, 2006 Hi Gang, Some of you may remember a post that did about the decision by the federal court of appeals in Washington, D.C. May 3rd. If you did not read it, you should! Here it is http://www.chicagotribune.com/business/chi-0605030241may03,1,1705921.story?coll=chi-business-hed & ctrack=1 & cset=true As I told you some time back I have been denied refill of my Cellcept which my rheumatologist was using (7 years) to help control that autoimmune disease which was the probable cause of pulmonary fibrosis. I did not tolerate routine immune suppressant drugs. This drug was not approved by the FDA but widely used for autoimmune diseases. My prescriptin drugs come through a company called Caremark RX. They 'manage' my prescriptins. They, this year, have denied coverage of Cellcept. They have changed dosage on three prescriptions. The docs are now having to write on each prescription..do not change dosage instructions. I just finished my second appeal. I used this information that sent. I believe that if it does not help in this appeal that I will be able to use this in a lawsuit under the ERISA act. I will certainly pursue it. I am reading horror stories online about this company. I read that thier stocks are up 50% and thier profit margins are way way up. All on the backs of suffering people. This fight has been exhausting for me. I get angry and get this big burst of energy, then I am so tired I cannot continue....then after a few days, I get mad again and off I go. It is unconsionable what insurance companys are allowed to do. They can make life or death decisons at will. My doctor helped me word this last appeal. If you ever write an appeal for treatment or drugs....do this! He said that I should 'ask for a medical review by a physician reviewer in the field of autoimmune disorders and that physician should give alternative treatment reccomendations (there are none that I tolerate) in writing to each of my doctors and myself'. He said that by law the insurance companies have to do that. I have done all that and now the wait begins again. I am worn out, but I feel good that I am fighting the fight. There are so many lives at stake....not just mine! I will let you know how this turns out. A very tired old gal....Joyce Quote Link to comment Share on other sites More sharing options...
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