Cobra Health Insurance

[jasperboye]

Hi everyone-

It's been a loooong while since I've been around- I am sorry for the absence. It's been a crazy few months- I've moved across the country (Boston to Los Angeles)- and have had quite a few changes come my way. But I'm getting more and more settled these days so hopefully I can come around a bit more.

Anyway, I was hoping someone could help me out with my situation. I am on Enbrel (50mgs/wk) I had great health insurance in Boston and have continued with it through Cobra since my move. In December, my new health insurance through my new job will kick in and I need some advice on what to do. Has anyone been in this situation before? I am switching to Blue Cross Blue Shield PPO in January- I would like to set up an appointment with a Doctor in the area now so I can get in before all this happens- First, does anyone have any suggestions for great Derms in this area- I live in the Santa Monica area and am willing to travel any distance for a good Derm. I know with Blue Cross/Blue Shield it is often a pain in the butt to get Enbrel approved- so would love a Derm that would fight for me.Second, can anyone tell me how it works switching insurances like this- do I have to see a Doctor under my new Health insurance before I can continue with Enbrel under their plan? Third- any other advice from people who have been in this situation- what they did, what went wrong/right. Anything will help!

Thanks everyone. I'll be around a bit more from now on!

Katie :D

[jdeldrid]

Katie,

Your new health insurance should be required to honor anything you were on before, without requiring any step therapy or preconditions, as long as you've been continuously insured, which it sounds like you have. As long as your scripts are from a legitimate doctor, they're required to honor those as well -- you can't be made to pay for an appointment just to get a script from a doc they cover.

-Jaye

[SuzanneT]

Hi Katie,
Welcome to Southern California! Mike asked me if I would pop in here to see if I had a derm recommendation. I live in South Orange County, which is a bit of a hike from Santa Monica (depending on the time of day and the traffic:) )

First of all, have you checked the Blue Cross policy? I had Blue Cross last year, and I was approved for Enbrel by my derm, but Blue Cross recently changed a lot of policies so that my monthly copay would have been almost $800!!! :eek: They only cover 80% when it comes to injectibles. I did some research, and during open enrollment I switched to Kaiser. I must say that I have been thrilled with Kaiser, both the doctors and the coverage. I now pay a $25 copay for Enbrel. Not sure if you have any options other than Blue Cross with cobra?

Mike, if you could point me in the direction of where to find the list of NPF derms, I can find the link to Dr. Weinberg (?) I think that's his name, he is with UC Irvine, and is one of the top docs and is also associated with NPF. I just need the link to find his contact info. I saw him when I had Blue Cross, as well as a couple of interns that he brought in to look at my foot :D. He knows his stuff. I'm happy with my Kaiser derm right now, but I think that Dr. Weinberg is really a specialist in Psoriasis, although there are several I'm sure in the LA area (the trick is to find one that specializes in P, not Botox :)

Let me know if I can help further - and good luck!
Sue

[MikeK]

Katie!

Welcome back! You headed west without letting us know. I would have come up to Boston and given you a proper send off! How are you? How is your sister?

Since Suzanne is kind of sort of a neighbor of yours, I figured that you benefit from her throughts. Thanks, Suzanne,

Mike, if you could point me in the direction of where to find the list of NPF derms, I can find the link to Dr. Weinberg (?) I think that's his name, he is with UC Irvine, and is one of the top docs and is also associated with NPF. I just need the link to find his contact info. I saw him when I had Blue Cross, as well as a couple of interns that he brought in to look at my foot :D. He knows his stuff. I'm happy with my Kaiser derm right now, but I think that Dr. Weinberg is really a specialist in Psoriasis, although there are several I'm sure in the LA area (the trick is to find one that specializes in P, not Botox :)Is this the derm you were talking about Suzanne? (Even if he isn't -- he sounds like he's anything but Dr. Botox, which is exactly the kind of derm we're all looking for. :) )

Gerald D. Weinstein, M.D.
Dermatologist

University of California, Irvine
Dermatology
Irvine, CA 92697
Phone: (949) 824-5515
www.ucihs.uci.edu
Mapquest Directions

Topical psoriasis treatments
Broad-band UVB
Narrow-band UVB
PUVA
PUVA oral
Palm/sole photothereapy unit
Prescriptions for home UVB
Laser therapies
Modified Goeckerman regimen
Oral/injectable medications
Amevive
Cyclosporine
Enbrel
MTX
Oral Retinoids
Arthritis treatments/medications
Psoriasis clinical trials

41 Years Treating Psoriasis
100 Psoriasis Patients / month
20 Psoriatic Arthritis Patients / month

University of Pennsylvania Medical School
Los Angeles County General Hospital (Intern
National Cancer Institute, NIH (Clinical Associate) University of Miami Medical School (Dermatology residency)

American Academy of Dermatology
American Medical Association
Society of Investigative Dermatology
Medical Advisory Board, National Psoriasis Foundation
California Medical Association
Orange County Medical Association
Professor of Dermatology, University of CA, Irvine.
Multiple courses and lectures given on psoriasis over 40 years.

Phototherapy Referrals
Oral/injectable medications
Cyclosporine
Enbrel
MTX
Oral Retinoids
Raptiva
Arthritis treatments/medications
Source: http://www.psoriasis.org/treatment/directory/index.php.

Mike

[SCCatman]

Your new insurance company does not have to cover meds that you are already on. It does help though. Earlier this year I switched insurance companies while on Enbrel. I had to get reapproved. It only took a few days.
Try to switch as soon after a refill as possible so you have a "supply." Hint, if you new coverage comes in, get it filled asap, you can do Enbrel twice a week, so tou can get a bi tof a boost. You can verifythis with you doc, as he/she won't care that both insurance companies pay for a month.

I would talk to the HR dept.

If it is not an HMO, you can make an appontment before you get coverage for an appontment after the insurance takes effect, note many derms have long waiting list, and that if you tell them you need to get you Rx renwed, they can work you in.
Consider that some insurance companies require you go to a GP to get a refereal to a derm. If so, get started on that!

Also, my new insurance had a specal phone number to call to get Rx's moved over. That number could not move Enbrel over though.

If your new insurance is PPO, you may be able to use your old doc and Rx.

Good luck,
Dennis

[Raynard_the_Fox]

Welcome to LA. :cool:

My derm is in the Valley, which is not a long drive, execpt for the fact that you will need to take the 405 :rolleyes: to get there. (Mike can tell you about that).

However he is a good derm, at least I liked him and he wrote a few letters and made calls for me when I was trying to get aproved for Enbrel. I have been bad and have not been to see him in a while but will just throw this out there as an option. It does not list that he does Biologics on the page I found but he does do them all, HE wanted me to start with on other then Enbrel but in the end since that is the one I wanted he went with it. so he is willing to respect your wishes when it comes to tretments.

William R. Coleman, M.D.

# Dermatologist


Northridge Dermatology Associates
9535 Reseda Boulevard
Suite 304
Northridge, CA 91324
Phone: (818) 886-3884
www.northridgederm.com
Map Directions (http://www.mapquest.com/maps/map.adp?country=US&address=9535%20Reseda%20Boulevard&city=Northridge&state=CA&zipcode=91324)


# Topical psoriasis treatments
# Broad-band UVB
# PUVA
# PUVA oral
# PUVA topical
# Palm/sole photothereapy unit
# Modified Goeckerman regimen
# Oral/injectable medications
# Cyclosporine
# MTX
# Oral Retinoids


# 13 Years Treating Psoriasis
# 25 Psoriasis Patients / month
# 5 Psoriatic Arthritis Patients / month


Medical School - University of California, Los Angeles; Internship - University of Washington; Residency - University of California, Los Angeles

American Society for Dermatologic Surgery; American Society for Laser Medicine and Surgery; Los Angeles Metropolitan Dermatologic Society; San Fernando Valley Dermatologic Society; Alpha Omega Alpha Medical Honors Society; Phi Beta Kappa; American Academy of Dermatology

Hope this helps, and best of luck here in LA.

-Fox

[SuzanneT]

Thanks, Mike! That's the link I was looking for. Yes, Dr. Weinstein is the derm I was referring to!

Good Luck, Katie :)

[jasperboye]

Thank you so much for all of your suggestions and advice. I will definitely look into those doctors (thanks Fox and Suzanne)- great to have folks in the area that can suggest docs that have worked for them!

This whole insurance-switching thing is a little overwhelming- especially since I found a treatment that really works for me and I don't want to loose it! I'm sure I'll have more questions as it gets closer, but for now you've all given me a great place to start from!!

Thanks Mike- My sister and I are doing great-- LOVING the sunshine!! No more winters- my skin is much happier here too:) I do miss Boston a lot though... There's no place like it.

If ever there is a LA get-together, count me in!

Thanks again everyone,
Katie

[jasperboye]

Hi-
I just found out my company recently switched to Health Net insurance- Anyone have any experience with Health Net and Enbrel? -- it says in their booklet that I would be responsible for 30% of injectible drugs- yikes. I'm sure with enbrel that's pretty pricey... I have the option for an HMO/PPO... all I know is I need to find a derm ASAP as I only have a 1 month supply of enbrel left!

Thanks for your help and suggestions!
Katie

[ericm]

Katie,

HMOs are sometimes a better deal by putting a cap on health care bills thru co-pay instead of percentage of the bills. If you are interested, contact/visit the membership office at Kaiser, located off FWY 10 @ La Cienega. Ask to see a written policy of their drug plans (and exceptions) for Enbrel to treat your Psoriasis. That way you will know exactly how much you will pay and whether they will cover your critical health care needs.

FYI: Irvine can be an hour drive from Santa Monica depending on traffic (which is all day anyway!).

eric

Hi-
I just found out my company recently switched to Health Net insurance- Anyone have any experience with Health Net and Enbrel? -- it says in their booklet that I would be responsible for 30% of injectible drugs- yikes. I'm sure with enbrel that's pretty pricey... I have the option for an HMO/PPO... all I know is I need to find a derm ASAP as I only have a 1 month supply of enbrel left!

Thanks for your help and suggestions!
Katie

[jdeldrid]

Is the 30% copay subject to a yearly limit? I ask because my policy does the same thing with Remicade and Amevieve, but with a 20% copay. I would only pay the 20% up to a total out of pocket limit of $2500/year, so it's not that bad, although it's a big hit at the beginning of the year if I switch to Remicade.

[ouchyk]

Katie,

Any chance you can talk to Enliven and find out if you can have some financial offset if the medication is 30% ( YIKES ).... :eek: Here is a post for h e l p...

http://www.psoriasis.org/advocacy/assistance/insurance/programs.php

Karen

P.s. come back it's going to snow soon lol....

[MikeK]

Katie,

Any chance you can talk to Enliven and find out if you can have some financial offset if the medication is 30% ( YIKES ).... :eek: YIKES is right! :eek:

I agree with Karen. Please give Enliven Services a call. They were able to help Sue (beachbound) significantly lower her Enbrel out of pocket expenses. She discusses her experience in the following threads:

http://www.psoriasis.org/forum/showthread.php?t=11307;

http://www.psoriasis.org/forum/showthread.php?t=11753.

It's also possible that you might qualify for Enbrel's assitance program, the ENcourage Foundation (http://www.encouragefoundation.com/).

In addition to checking out the assistance programs in Karen's link, you also might want to check some of the programs in this thread: http://www.psoriasis.org/forum/showthread.php?t=12379. We don't know very much about most of them, but some of them say that they provide co-payment assistance.

I hope this helps.

Good luck. Keep us posted.

Mike