Insurance Woes

[sgingle]

I am new to the forum, although I was diagnosed with PA about a year ago. I have had P most of my life and have used every OTC product there is, all to no avail. I had carpal tunnel surgery sometime back and the surgeon was the one who determined the arthritis. He sent me to a wonderful rheumatologist who diagnosed the PA on my first visit. I have taken Celebrex and now Bextra but the symptoms have worsened. My doc wants to go to Enbrel but my insurance carrier has refused coverage. They will approve Methotrexate, but my doc thinks I would be best served by going straight to the Enbrel. Does anyone have any experience, advice to going head to toe with the insurance companies? I am grateful to have found this board....I am tired of fighting this stuff all alone. My wondeful husband tries but it is hard to describe to someone else the feelings of isolation, pain and the constant itching!!
Thanks,
Sheila

[MikeK]

Hi Sheila,

Welcome to the Board! :cool: I'm sorry to hear that you're going though such a rough time and that your insurance company is being less then helpful with regard to your treatment options.

Here's a couple of quick suggestions:

1) Call the NPF. They have an insurance advocacy service that will try to help you with your appeal. Here's a link to the NPF's description of their service: http://psoriasis.org/medical/advocacy/ and here's the NPF's contact information:

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.

2) The Company that makes enbrel, has employees that deal with insurance coverage issues. Here's a link for some additional information: http://enbrel.com/enliven/enbrelenliven-insurance.jsp.

3) Call your state's insurance department or commission and ask it they can help. Their number should be in the phone book or on your state's "official" website. I live in New Jersey and here is what are "official" website looks like http://www.state.nj.us/. (I have it book marked, but I just found it by doing a google search for "New Jersey Official website".

I hope this helps in some small way.

Hank in there. Good luck. Keep us posted and please don't be a stranger.

Mike

[nla]

I am new here, too, so perhaps I shouldn't be putting my 2 cents worth in yet, but.....I thought I was going to run into the same thing with my health insurance. My doctor wrote me a letter of medical necessity as to why she thought I would do better on the Enbrel vs. the MTX. Is there any medical reason your doctor could come up with for you as to why Enbrel would be the better choice for you? Any other drug allergies or reactions in the past to anything? I will be starting the Enbrel in a few weeks so I am glad to see so many positive things about it on the boards. Hopefully it will help. Good luck. Be persistent and see if your doctor can become one of your advocates.

I also feel like this place is a God-send. It's so nice to get information, input and support from everyone. Thank you all!

Nancy

[sgingle]

Thanks so very much Mike and Nancy. I am following up on all of your suggestions. It is great to finally feel that I am not alone. I look forward to getting to know all of you better.
Sheila

[nla]

Dear Sheila,

I am also looking forward to communicating with everyone on this site. Good luck in whatever option you end up trying. I do hope you can find something that will provide relief and no nasty side effects. Please keep me posted on how you are doing. Now that I'm going to start Enbrel in April I'm sure I'll be starting a new thread or two due to my Enbrel-hysetria. Right now I'm trying to figure out why in the world I am just so afraid of the possible side effects of aggressive treatment...more so than I am afraid of the disease process itself - go figure!

Take care and keep us all posted!
Nancy

[nla]

Oops! I meant to type "hysteria". See what I mean? Just THINKING of starting Enbrel makes me nervous! Anyone got any suggestions on re-gaining some of my saniety through all of this?

Nancy

[sgingle]

My doc called today (well the nurse called for him) and said that the insurance company was refusing to move on this at all...he suggested that I go ahead and begin a regime of Sulfasalazine as what the insurance companies look for is that you have tried a number of drugs. What has been anyone's experience with Sulfasalazine? I am a college instructor and it is almost the end of the semester (:eek: ) and stress is rampant...I am also trying to begin a Ph.D. program...so you can imagine that my P is really acting up - I don't think the Sulfasalazine will address that at all....it is so discouraging to think that our lives our already stressed by this disease and then the insurance company adds to it. I had called Enbrel some time back and they had contacted the insurance company on my behalf...to no avail. It is so discouraging. I am thankful for this board....everyone, take care.
Sheila