- Joined
- Nov 6, 2022
- Messages
- 14
- Reason
- CALS
- Diagnosis
- 11/2022
- Country
- US
- State
- TX
- City
- Sugar Land
My pals has had 2 big insurance rejections this week. The first was the ventilator. The insurance says no even though he qualifies bc his FVC(?) is below 50%. The pulmonologist asked for an AVAP ( not sure if that the right term) but insurance says my Pals only needs a bipap. The drs response to the denial was to wait until we complained and then appeal (also denied) and now we have to wait until Monday to find out the next steps. He still hasn’t said why he asked for the more expensive machine. We can pay for the cheaper machine out of pocket. At this point, something is better than nothing, right?
The second rejection was RADICAVA. Insurance said breathing had to be over 80%. The ALS clinic response to the denial was “oh well…we tried.” No appeal will be done.
When my pals was diagnosed in Nov 22, I was terrified, but his he could breath and functionality wasn’t too bad. Then I started looking at ALS sites and there was hope, not of a cure per se, but hope for time, which is important for our 3 school aged kids. One site even said something like the era of “we can’t help you so home to die” was over. I kept saying he’s not dead so enjoy today. Well…now I’m rapidly loosing all hope and I feel there is no time. In the 6 months since his diagnosis, my husband’s breathing has become very compromised but we can’t get a machine and he is loosing functionality but he can’t get Radicava. We even tried to buy a bipap in January before his breathing got real bad and were told we had to get a prescription. Now we have a prescription but it’s tied up with the insurance denial. No one at the ALS clinic seems to care. Not sure what to do. Any ideas?
Thanks for letting me vent.
The second rejection was RADICAVA. Insurance said breathing had to be over 80%. The ALS clinic response to the denial was “oh well…we tried.” No appeal will be done.
When my pals was diagnosed in Nov 22, I was terrified, but his he could breath and functionality wasn’t too bad. Then I started looking at ALS sites and there was hope, not of a cure per se, but hope for time, which is important for our 3 school aged kids. One site even said something like the era of “we can’t help you so home to die” was over. I kept saying he’s not dead so enjoy today. Well…now I’m rapidly loosing all hope and I feel there is no time. In the 6 months since his diagnosis, my husband’s breathing has become very compromised but we can’t get a machine and he is loosing functionality but he can’t get Radicava. We even tried to buy a bipap in January before his breathing got real bad and were told we had to get a prescription. Now we have a prescription but it’s tied up with the insurance denial. No one at the ALS clinic seems to care. Not sure what to do. Any ideas?
Thanks for letting me vent.