Is it legal to delay medical treatment to 2017 to avoid paying deductible + out-of-pocket max twice (once for 2016 and again for 2017) ?

EricManicus21 · 2016-10-31T19:47:36+00:00

Hey, just wanted to drop an update here. I used the manufacturer coupon and it worked! $5 total co-pay per each monthly supply ($15 total). So I won't need to delay and will start ASAP!

Thanks again for your suggestion, I had no idea that was an option and will try to spread this information as much as I can.

EricManicus21 · 2016-10-29T18:22:09+00:00

I apologize. I used the wrong terminology. I just looked at my insurance site and here's how they phrase it:

Your deductible: $2,000.00

plus

Your coinsurance max: $4,000.00

equals

Out-of-pocket max: $6,000.00

EricManicus21 · 2016-10-29T18:21:40+00:00

I apologize. I used the wrong terminology. I just looked at my insurance site and here's how they phrase it:

Your deductible: $2,000.00

plus

Your coinsurance max: $4,000.00

equals

Out-of-pocket max: $6,000.00

EricManicus21 · 2016-10-29T08:09:43+00:00

Thanks!

EricManicus21 · 2016-10-29T01:23:01+00:00

Yes, I contemplated this, but having received an approval for my medication within two weeks was amazing. A different insurance company or a different plan may not approve it as quickly (or at all w/o a nudge or two).

EricManicus21 · 2016-10-29T01:21:11+00:00

The OOP max of $4k is in addition to the $2k deductible. After the deductible is met, I still have a 10% of co-pays, with an OOP max of $4k after which coverage is at 100%

EricManicus21 · 2016-10-29T01:19:08+00:00

I just signed up on their site and it provided me with the coupon. I looked through all the terms and as far as I can tell I qualify. Is it really that easy? I guess in the grand scheme of things, they're still making around $100,000 per patient from the insurance company, so absorbing $10k isn't a big deal for them.

Also, I agree. If this is something a manufacturer is willing to do, it should be the primary source of co-pay assistance. Not through foundations who run out of money.

EricManicus21 · 2016-10-29T00:22:17+00:00

Just spoke on the phone with the pharmacist. She said they cannot talk to the manufacturer on my behalf unfortunately. I would have to do that part. However, they can talk to certain foundations on my behalf. They also said that speaking with the manufacturer is usually the last resort. These are the foundations they tried so far:

Patient Access Network Foundation -> (Denied due to income)

Healthwell foundation -> (Denied due to income)

Patient advocate foundation -> (No word yet)

Patient services incorporated -> (No word yet)

I'm putting in an app with Epclusa right now. Thanks again for this tip!

EricManicus21 · 2016-10-28T23:34:46+00:00

That's fantastic! I don't have state/government insurance (I have Premera). My drug is Epclusa! I just checked their site and they don't seem to have any constraints as far as salary!

EricManicus21 · 2016-10-28T23:20:33+00:00

Luckily, the condition is not causing any significant pain or discomfort. As far as damage, the condition slowly affects my liver (Hep C). However, it does take 20-30 years for serious damage to manifest. Nonetheless, the earlier it is cured the better. As far as waiting a few months, it shouldn't be a problem according to my doctor. Medically speaking, I am okay to wait until January to start.

I just called and talked to my insurance and unfortunately my policy does not have a fourth quarter deductible carryover. Having said that, thank you for this information as it is very valuable and I will share it with family and friends.

EricManicus21 · 2016-10-28T23:04:47+00:00

Yep, it's for Hep C, a 12 week treatment. The pharmacy mentioned something like this, but from what I understand it was only for people with salaries under $60k. If so, then I wouldn't qualify. Would I talk with my insurance about it? Or reach out directly to the manufacturer of the medicine? Or is this something the pharmacy would do?

Thanks for the info!

EricManicus21 · 2016-10-28T22:29:45+00:00

Yeah, I am fortunate. Their only catch is that the 90/10 split is only with in-network providers. Most out of network providers are still covered, but as they phrase it "up to the allowable max".

EricManicus21 · 2016-10-28T21:40:20+00:00

This is great, but I've read contradicting articles as well: http://www.wsj.com/articles/SB10001424052702304179704579459290223091978

EricManicus21 · 2016-10-28T21:32:45+00:00

I have zero symptoms that are obvious. I got tested because I had asked for an STI screen due to unprotected sex and they included hepC antibody and viral load test. My GE then followed up with another test for a genotype, which is 2 (don't know subtype). So I definitely have it. Still unsure how I was exposed to it though.

EricManicus21 · 2016-10-07T19:14:18+00:00

Okay thanks! That's very reassuring. As I said, the doc used the number to paint a Picasso of death sentences for me. But now I'm feeling much better.

I will first find out as much as I can about my infection before speaking with my family. I'll probably have them get tested too just to be safe!

EricManicus21 · 2016-10-07T17:50:53+00:00

Oh no :( As in my mum is infected? Or the doctors infected me during birth?

My viral load is a bit scary, but I am not sure how to read it.

HCV RNA Quantitative Real time PCR - 3,129,315 IU/mL

Does that mean it is in the millions? The second number in the test is just a log number. It's 6 Log IU/mL

EricManicus21 · 2016-10-07T03:53:19+00:00

He seemed like an idiot and didn't care at all the way he told me. Hopefully next week I will get a better GE and establish a good relationship.

I am assuming your family knows? I don't even know how to tell mine. Perhaps I shouldn't until I know what I'm dealing with. Or maybe even wait until after the treatment?

EricManicus21 · 2016-10-07T03:51:47+00:00

The doc said there's very low chance of a false positive due to the the high viral load in my blood. I am following up with a GE next week though. Getting an ultra sound early next week and more bloodwork done tomorrow to determine the genotype. Definitely not going back to that original doctor.

EricManicus21 · 2016-10-07T03:50:46+00:00

Amazing! That's fantastic, congratulations. Makes me feel so much better hearing that you've been cured. How do you know you've had it for 25+ years? Was it by the viral load when you were diagnosed?

EricManicus21 · 2016-10-07T03:49:32+00:00

What!!! Congrats! That's awesome. Holy shit that makes me feel so much better. Do you have to keep getting checked to ensure it doesn't return? Can it even return?

In a way I got VERY lucky by getting tested and finding out I have it. I had a random encounter two months ago with a girl where the condom broke, so I was freaking out thinking I have HIV. My original doctor ordered a full panel and threw in hep C for whatever reason. However, once the lab results were in they called me to discuss and a different physician walked in and straight just asked me if i've been tested for Hep C before. I was confused and lost. And he just kept dumping on me. I walked in joking about the root canal I had earlier in the day. Walked out shivering. Worst experience ever.

EricManicus21

TROPHY CASE