Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
Hi all. Back in December my husband got a letter from the company he retired from stating that he must call their medical benefits department and "certify" any of his dependents so their insurance could continue. If we did not call by January 15th, I would be cancelled from his insurance plan. Being his wife, and a dependent on his plan, we called the company on January 10th and spoke to their "Certification Department", where after giving answers to their many questions, the gal on the phone proudly (well, maybe not proudly) stated "Your wife has been certified as your dependent is will continue on your medical insurance for another year." On February 6th I went to get a prescription filled and I was told by the pharmacy technician "Oh, your insurance was cancelled as of January 31st!" I was like....".oh great.....I can see this now".....So I called the benefits department and yes, they did cancel me even though we went thru the process to certify me. I called them on February 6th and was told they would open a ticket on this right away, blah blah blah and should have this resolved soon since she could see were we did call in and spoke to the Certification Department. I was also told by the gal I spoke to she would call me back the next day, but no, she did not call. I was lucky enough to get her on the phone yesterday, and again, she said she would call me back today, but no......not a phone call. I am starting to get a little worried this is going to turn into a real nightmare. I already had to pay over $100 for two prescriptions because my doctor said I really could not go without them. So here is the real dilemma: In less than 3 weeks I will be out of my Enbrel shots. (Thank God I got my refill done on January 29th!!) This is a super expensive drug and have heard the shots costs something like $800 each. I am trying to see what I can do just in case they keep dragging their feet on this and things are not resolved soon. This is a HUGE national employer, and I am probably just a little nothing on their list. Kinda like "Take a number, we will get to you when we can!" I am also starting to get a little anxiety over this!!! Anyone have suggestions on maybe where I can get Enbrel at a discount or what I can do? My pharmacy gave me some discounts on a few of the meds but the Enbrel comes from Optum RX which mails the shots to me.
I had to go to a mail order Rx because of my insurance and we were not sure I would get my Humira in time for my dose that week. It was confusing to order even to the nurse who deals with this all the time. So my doctor walks in the room and gave me, for free, a month worth of Humira.
Good luck, hope this gets worked out fast for you
Cindy
http://www.enbrel.com/ENBREL-support-program.jspx
That does sound like a nightmare and I've had my fair share of insurance fun!
May I suggest that you check with your Rheumy to see if he has any shots that he could supply you with at no charge due to the circumstances.
I know that my Rheumy keeps some samples of Enbrel in his office.
I'm sorry about the run-around.
May the insurance God's look upon you favorably from here on out!!!
Be Well,
TheWino
if that doesn't work, call enbrel. if you haven't already signed up for their enbrel support, get signed up for it. explain the situation to them and see if there is something they can do in the interim.
and keep calling. no matter how many times someone says they'll call you back, you call them back. stay on top of them. that's the only way to get stuff done some times. just keep calling and write down who you speak to and what day it is and what happened.
I went through Optum for my Enbrel & had the co pay assistance.
I'd stay on the phone also, squeaky wheel thing.
Obviously they made a mistake can you ask to speak to a supervisor or someone above the person you've been speaking to?
Let them know you have a disease that requires medical attention & medication. You cant afford to pay out of pocket because they don't have it together.
Very unfair, just the stress of it all.
A more drastic measure would be contacting the news.
We have the problem solvers here & they love to go after the "big dogs", large powerful companies.
I really hope you get this solved. It's a shame these things happen because someone usually fails to do their job.
Let us know & take good care,
Sammy
From what I can tell, most insurance companies are acting like spoiled 4-year-olds and having little hissy fits about having to change their business practices to comply with the Affordable Care Act. Remember too, the longer they can put you off, the longer they can go without coughing up for the Enbrel.
They should have to reimburse you for anything extra you spend to keep your prescriptions filled while they have their little episode.
Any chance the benefits people (I assume MS is big enough to be self-insured?) are just playing passive --aggressive games to keep from shelling out for your Enbrel? Kind of the medical equivalent of firing someone 3 weeks before they become eligible for their pension? Or just incompetent?
Love your Monument Valley photo, by the way.
I went through Optum RX for my Enbrel & they set it up.
If not it's worth asking.
I don't get the hold up on the insurance.
Do you have the name, date & so on when you enrolled?
Maybe a supervisors name with a certified letter?
If this continues you may want to contact the news, let the company know your going to do so if this is not resolved. No company wants bad publicity. May be worth a try.
I did this with my builder after multiple attempts to get his attention on a problem we had with our new home. Also informed him I'd contact an attorney. I put CC on the bottom of the letter I composed & after months of no responses we had communication with in a week.
Funny thing is I simply put initials under the CC, I know not nice of me.
Never sent a copy to anyone but believe me I would have if he would not have responded.
This is awful. There's no reason they should make you wait this long.
If any thing I'd stay on them squeaky wheel thing again. Seems to work for most people.
Sammy
I to, cannot figure out why they are playing "slo-ball". I am wondering if they had a big glitch. Everyone who has a dependent on their plan had to call the benefit department between January 1st and January 17th, and you can imagine how many thousands of people had to call this department to "certify" their dependents.