Help! Insurance & Remicade

[lt_333]

Hi
I have been on enbrel for 6 months & has done pretty good for PA but very little for P. My RA said she could put me on remicade to give a try as some folks have had good reaction to remicade and not enbrel & vice versa. My insurance co said go to hell basically that it aint approved for p or pa...i have ind blue cross.

I am crushed....i was so looking forward to the "potential" of the huge amount of coverage i have getting better.

Any advice on how, if and ?? i can get this approved or not. Or any other ideas. Thought about talking to the derm about amevive but then I won't have PA relief which is worse pain than ugly damn red skin. thx..I am bummed

[Eve-Maridy_R]

Note from the Psoriasis Foundation Member Services Coordinator:

From getting an insurance company to cover ultraviolet light therapy to securing reimbursement for necessary lab tests, the National Psoriasis Foundation regularly goes to bat for medical professionals and patients on insurance issues. We can support patients and physicians by making phone calls and by sending letters and supporting materials.

The Psoriasis Foundation has booklets and other educational materials specifically created to help educate insurance companies about psoriasis, and to convince them of the significance of adequately and fairly covering psoriasis treatments.

In addition, to help the physicians and patients fight back, the Psoriasis Foundation has prepared sample letters that can be used when a reimbursement issue is under dispute. These letters can be downloaded, then printed and used as a model for personalized letters.

When health care providers and people with psoriasis are presented with an insurance problem, the Psoriasis Foundation stands ready to help in any way it can.

Please call us so we can help you. You can reach our Advocacy Coordinator, Joey Shearer, toll-free at 800.723.9166, ext. 407.

Sincerely,

Eve-Maridy Rice
Member Services Coordinator
erice@psoriasis.org

[Allie]

You need to have your Dr. pull some information justifying the usuage of the med for p and pa. Generally most insurances will deny on the first approach, but if you and your Dr. are willing to fight for it - then they will pay for it.

example: I was on wand treatment for my scalp in HS. When I left for college, my Dr. requested my insurance buy me a wand to take with me. My insurance denied it b/c they felt it was unjustified. He sent copies of my chart along with a billing statement to the insurance over the past year & it proved not only had the wand been helping me, but the insurance co. had paid for it 3x's over - paying for my office visits.

GOOD LUCK!!