Access to care: Family fights pharmacy's error

When Miriam's son, Zach, developed severe plaque psoriasis that covered a significant portion of his skin, initial treatments did not work.

His dermatologist prescribed Zach a biologic medication. The specialty pharmacy sent a letter to Miriam stating insurance covered the medication. Then the company reversed its decision and said the medication was not covered, leaving the family with a huge bill.

Miriam spent hours on the phone with various pharmacy representatives, trying to get reimbursement for the pharmacy's error. Miriam's numerous calls and letters—as well as the suggestion that she would contact a local TV station—eventually paid off. The pharmacy backed down.

Zach recently graduated from college and plans to attend graduate school to pursue a degree in clinical social work. He is now on the biologic drug Humira, and although his insurance company does not cover the treatments, he is receiving full assistance from the drug's manufacturer, Abbott through the Humira Protection Plan.

Miriam is volunteering with the National Psoriasis Foundation's Access and Insurance Mentors (AIM) program to coach others appealing insurance denials or mistakes.

Do you have a story about your success with an insurance company and want to help others get the coverage they need? Do you need a volunteer mentor who can coach you through the appeal process? Contact the Foundation's health policy manager at advocacy@psoriasis.org or call 800.723.9166 ext. 550.

F.A.N. mail—July 2009