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


Alexis Nicole said...

whoooohooo!!! You kick a** d mama!!! Youre awesome!

Joanne said...

Great job Penny! What great news!

Lorraine of "This is Caleb..." said...

Congrats! That's great!


Pam said...

Woo hoo! Great job, Penny! (I secretly knew you'd win all along. You're one fierce mama-pancreas!)

Denise said...


Anonymous said...

Love it!!! Good job mama! ((hugs))

Stacy said...


Meri said...

Congratulations! I am SO SO proud of you! Woot! I hope you celebrated your awesomeness! If not, Friday night...toast your hard work!

Jules said...

Great news, Penny. Woo Hoo!

Anonymous said...

Congrats, Penny. You gave em heck and got a well-deserved (though overdue) win on that one! Nicely done. That advocate deserves a drink from the DOC, too!!

Bennet said...


Misty said...

Woo Hoo!!! So proud of you for your hard work...and for stickin' it to em! Congrats!!

Hallie Addington said...

YES!!!!!! You rock, Mama! So proud and so happy for you!!

k2 said...


Anonymous said...

Can you send me the info on the articles about Novolog vs Humalog?