I am currently being treated using an Injection called Xolair. I was denied coverage by Aetna for this so I have been paying out of pocket for 3 -4 months. This medication costs $2,000 a month and I have sold my car and taken out multiple loans in order to pay out of pocket. I was on medical disability for 4 months so this is not an optional treatment. I have also been to the emergency room 2 times with life threatening swelling of the face and mouth. Xolair is FDA approved for allergic asthma (which I have) but my primary conditions of urticaria and angiodema are not considered FDA approved. I was on continued steroids for months which was causing many other side effects so I had to be weaned off the steroids, put on medical disability and begin paying for Xolair treatments out of pocket. Thankfully, because Xolair is effective for me I have been back at work for 1 months and have very few flare ups. When I was trying to get approved I first called my pharmacy insurance which is United Health Care medco. I was told Xolair is covered under medical, not pharmacy. When I submitted a claim to Aetna for this treatment, I was denied saying that more testing was needed and my blood levels were not in a particular range. I have since had Xolair help me put together an appeal of this decision and sent this to Aetna. I called multiple times to check on the status and during the last call I was informed that I would be denied because this is covered my pharmacy, not medical insurance. At this time I have Aetna saying this claim belongs to United Health Care and United Health Care saying it belongs to Aetna. Now I finally got Aetna to admit it is under their coverage but will be denying me because I don’t fit the FDA approved guidlines. THey don’t even care that I’ve been using this for months and it’s the only reason I’m able to work again. It costs too much for them to even consider this. Aetna is full of s**t, and I don’t know how people working there can sleep at night.
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