DENIED!

[Egg]

I've been waiting for four days for my insurance co. to authorize my prescription for Enbrel. I finally just found out that it was denied. I'm ready to run amuck! My doctor said they would try to re-submit it, but it doesn't look good. How can this be? Is there anything else that can be done? This has been the first time in years I've felt positive about any treatment, and now I can't even get approval for it. If anyone has any suggestions PLEASE let me know.

[chaimFL]

Its tough because enbrel is not yet approved for the treatment of psoriasis. It's only approved to treat psoriatic arthritis. Aside from that many insurance companies are approving it for the treatment of psoriasis....maybe because it is awaiting approval or maybe because some companies are more liberal than others. The NPF has an advocacy department that can help you fight for approval. You can certainly appeal, but you should consult the NPF to find out how to get the furthest.

[MikeK]

Hi Egg,

I'm so sorry to hear that you're claim was denied. This happens all to frequently, unfortunately. Hopefully the decision will be overturned on appeal. Call the NPF. They have an insurance advocacy service that will try to help you obtain coverage. Here's a link to the description of the service:
http://psoriasis.org/medical/advocacy/ and here's there's contact info:

National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195
Phone: 503.244.7404 OR 800.723.9166
Fax: 503.245-0626
E-mail: getinfo@psoriasis.org

Their regular business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time.

You also should contact Enliven Services. They have insurance specialists that will try to assist you with coverage issues related to Enbrel. Here's a link for some additional info: http://enbrel.com/enliven/enbrelenliven-insurance.jsp

You can also try contracting your State's insurance commission. You can obtain their contact info from the phone book. You can also get it from your state's "official" website. So that you know what to look for, I live in New Jersey and here's what our "official" website looks like: http://www.state.nj.us/ (I have it in my favorites, however I was just able to find it by doing a google search for New Jersey official website.)

Hang in there! Good luck. Hope this helps and please keep us posted.

Mike

[rosee_posey]

Hiya Egg,

If your doc has been denied, you could also try another doctor who prescribes it more....

You could try a Rheumatologist - don't forget to tell him how stiff your joints are in the morning!!!

Hang on, Stay cool, and whatever you do -
DON'T GIVE UP THE FIGHT!

- rose

[heatherf]

Mine was only approved because of the stiffness of my shoulders and neck in the morning and my knees hurting so badly when I bent down. Insurance companies don't care about psoriasis sufferers and that is so unfair. So, even though I take pride in being an honest person, I say if you don't have achy joints - then develop them!!!