Monday, January 17, 2011
We won! A round of Novolog for the house please!
First things first - WE WON our grievance against Keystone Mercy Health Plan!
You remember the grievance, right?!! The one where, oh say Novolog, would not be 'medically necessary' for Grace. The one that stated she needed to try the formulary insulin, Humalog, before they would agree to step it on up to Novolog. Yeah, that one.
The representative from KM, a 'member advocate' which I found through the grace of God, called on Friday morning and said "I have great news, the medical director just approved Grace for Novolog. There will be no grievance hearing on January 25th (the one scheduled at 2 am, that was sweet) She's approved for 2 vials a month for one year, until January 2012."
I was speechless for one milli-second.
Then I screamed "YESSSSSS!!!!!" into the phone.
The advocate laughed.
Then she said, "You know, the medical director was only going to approve it for two months and I asked him, do you think this mom is not going to bring this up again in two months?? Then he agreed to a whole year!"
I wanted to kiss her, really, or at least a giant bear hug.
Cause this has been a S---load of work for me since I found out the denial.
But I was SO very ready.
I had, ready to go to the grievance hearing:
* A letter from Grace's endocrinologist on why she should stay on Novolog
* A letter from Gary, Grace's CDE, why she should stay on Novolog
* Two years worth of scripts for Novolog, printed out at CVS
* Two published articles about the difference between Humalog and Novolog
* A lawyer from the PA Health Law Project
I had all my bases covered. Completely.
And they folded.
I believe the current score is:
Penny - 1 Keystone Mercy - 0
Posted by Penny at 7:23 AM