Denied Again.....

[Syli]

Had a Grievance panel hearing on Wed w/ 5 medical directors. Gave me 10 min to make my presentation. I provided color pictures, doctors notes, spreadsheet outlining my p locations & joint issues, progression of medicines, and impact on quality of life.......all they bothered to ask was Who was the first to suggest Enbrel? So....is it fair to say it was suggested for your p? I said no, it is fair to say it was suggested for both. OK....so is it fair to say that it was suggested for your p first? grrrrrr Can everyone say the words....cold hearted.

Not sure what is next......is it worth continuing to fight for Enbrel and go to a Rheumatoligist to get more clinical back up. Or do i give up and try something else. MTX is out. Right now I'm just kind of sick of all the Drs, medicines...........

:confused:

[MikeK]

Hi Syli,

I'm so sorry. Stupid insurance companies! Please don't give up the fight! It sounds like it's time to call in the troops! Have you contacted the NPF? They have an insurance advocacy service, that will be more than happy to intervene on your behalf. Here's a link that describes the service: http://www.psoriasis.org/medical/advocacy/ and here's the contact info for the NPF:

National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195
Phone: (503) 244-7404 OR (800) 723-9166

Their hours are Monday through Friday from 8:00 a.m. to 5:00 p.m. and their in the Pacific Time Zone.

From what I understand, the people who manufacture Enbrel also help patients with insurance issues. Here's a link to their information:

http://www.enbrel.com/enl/enl01.jsp?fvar=1

The more people that you involve in your fight the better your chances probably are.

Good luck, please keep us posted and don't give up the fight.

Mike

[jevers]

Hi, Syli

I hope I don't sound like a broken record by saying this..but, I always recommend contacting your state insurance comissioner to file a complaint & appeal. Your insurance company will have to answer to them, and justify the denial.

I work for a large insurance company, and this does work. Not every time, but it is worth a try.

Good Luck!!!:cool:

[gailandray]

Hi Syli,

i'm sorry to hear about your battle for healthcare. Who are the culprits? One should not have to fight for the treatment of psoriasis, cancer, heart disease or any other medical ailment. Perhaps letters to your healthcare providers from those of us who suffer might make a difference. Let us know.

Gail

[cntw8]

Syli:
I am in the same boat. I too was denied, but I don't even have much of a leg to stand on since I don't really have PA. My derm even "fudged" the report to help it along and they still denied it. Keep us posted on how things go for you as these threads help my sanity and give me hope.
Anyone know when Enbrel will be approved for P use?

[SouthpawGrammer]

terrible so they are!!! but you will win through i am sure!

Good Luck Old Bean

Paw xxx

[Chikara]

I was talking to my boss earlier this week and she had an article about different things but one part was dedicated to insurance nightmares. I mentioned that a good portion of people with P are having problems getting approval for medications like Enbrel and Remicade even though some have been approved for them once before.

She said that the reason those patients are being denied approval is because the meds are so expensive. She is absolutely right, the charges are per injection.

So I guess money does make the world go 'round. I think the problem is, that insurance companies (and a good number of docs) don't see psoriasis as a serious medical problem. They see it as a simple dry skin thing that can be fixed with lotions.

Maybe one day things will change.

[gailandray]

Things need to change with the insurance companies. One thing that we can all do is to keep one another informed. Knowledge is power. It's important that the insurance companies are kept informed about psoriasis and this is where the NPF advocacy group can help. Joey sent lots of info to our insurance company and the denial was overturned. His info, plus ours and the doctor's, created a change. Persistence is important. Do not take no for an answer. It's important to remember that medical insurance can not be selectively exclusionary and thus cannot specifically exclude psoriasis from certain treatment programs. Continue to make those phone calls. Denial is unacceptable.

Gail