[dshobbies]

We've been around the block with insurance companies so many times we now view them as the 'enemy', for they stand between us and our options for what is deemed the best or better medically sound treatment(s). I was told by my pm that treatments are considered experiemental/inv. for about 5 years after FDA approval but I assume there must be exemptions.

All that being said, yes, there have been those that were fortunate enough and have fought enough to get coverage, though few and far between. Charite even provides a kit with instructions for insurance appeals. But, if you have little time, you may be out of luck.

I would suggest appealing with a request for a peer to peer consultation with your doctor. The insurance company must then provide an equivalent physician, whose speciality matches that of your doctor and who is knowledgable in ADRs. At least your physician will be able to provide details that make an ADR a better treatment for you and will be speaking to someone who is not and ENT or internest, etc. Then again, I gave up and went to Germany but that was going to be my next appeal had I continued to fight.

Paulette did win a limited appeal and provided me with excellent questions. If your time is limited, you may only have time for one appeal so you'll want to get everything in there. Paulette, are you there??????

I wish you every good luck, Dale