insurance..insurance..????

[carl7777]

Is there any recourse to a insurance that refuses to pay for the enbrel treatments? I am covered with P and I am not sure but my legs, shoulders and generally my whole body aches...I never heard of PA till I found this site ....Anyway I am sure that some of you folks have had to battle the Insurance Demons..Any help or suggestions would be appreciated. They sure love to take your money but seldom give any back without a fight.....Thanks for taking time to even read my question.

[Zwijndrecht]

...mostly on what your policy says.

If it does not seem to exclude it, then contact your state insurance commissioner. Also contact NPF, they can help with info. They have examples of letters to write on this website.

See http://www.psoriasis.org/medical/advocacy/

Best of luck, I feel the pain and the agony.

Z:(

[gailandray]

What reason did your insurance give for not paying for Enbrel? Is it because it is not FDA approved for psoriasis? If so, how about switching gears and pursuing the Amevive route which is FDA approved. Just a suggestion.

Don't give up.
gail

[Kimbercat]

You might also take a look at the info under the orange Resources tab, and click on advocacy. I know that NPF has 2 advocates who might be able to assist you. Good luck.

[khorath]

Originally posted by carl7777
Is there any recourse to a insurance that refuses to pay for the enbrel treatments? I am covered with P and I am not sure but my legs, shoulders and generally my whole body aches...I never heard of PA till I found this site ....Anyway I am sure that some of you folks have had to battle the Insurance Demons..Any help or suggestions would be appreciated. They sure love to take your money but seldom give any back without a fight.....Thanks for taking time to even read my question.

I understand perfectly. I fought with my insurance for over a month (about 3 appeals total) before I gave up. My derm wrote several letters. My insurance will only cover treatments approved by the FDA. Even if my derm says I need it (off label prescription), they will only pay if the FDA says it is OK for my particular disease (P in this case). Nothing personal, they say, but that is their rule.

I had to end up using Amevive (whole other story). We are just buying time until Enbrel is approved for P, too.

[jperng]

Enbrel is not approved by FDA for treating PA yet? I think I read somewhere that it is. and I got my approval for Enbrel in like 30 seconds and only have to 20 bucks each month.

[jperng]

Enbrel is not approved by FDA for treating PA yet? I think I read somewhere that it is. and I got my approval for Enbrel in like 30 seconds and only have to 20 bucks each month.
PS I have horizon HMO PPO blue cross blue shields

[khorath]

PA - yes. P - no.

[makeitgoaway]

Originally posted by carl7777
Is there any recourse to a insurance that refuses to pay for the enbrel treatments? I am covered with P and I am not sure but my legs, shoulders and generally my whole body aches...I never heard of PA till I found this site ....Anyway I am sure that some of you folks have had to battle the Insurance Demons..Any help or suggestions would be appreciated. They sure love to take your money but seldom give any back without a fight.....Thanks for taking time to even read my question.

Get PA!

[baka83]

When I first got the OK to use Enbrel the main thing my derm ask was, Have I been diagnosed with PA , That is the main purpose of enbrel is to relieve arthritis conditions.
Get diagnosed with PA and then submit to insurance and see what happens. I believe that they found out that when used for PA it also clearded P in some people.

I hope this is of some help
Good Luck
Baka