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...
Every month since the beginning like this:
Take Humira every other Monday morning and they send two doses at a time. Took it 1/3 and then 1/17. That used up supply. Next dose scheduled for 1/31 (this coming Monday).
Yesterday I called the specialty pharm that BC/BS of AL demanded that I use. Checked on balance, yes ins paid Dec but have not approved January, Pharm sent request on 1/13. I then called BC/BS and asked was there a problem, had anything changed, was any change anticipated? Response was, "No, everything is just as is was and you can go ahead and order your next does."
This morning call spec pharm again....."We've still not gotten insurance verification, we cannot place that order for you until we do. We'll submit an emergency request right now, call us back right after lunch and we can still have it sent overnight."
Every month, same old song and dance. Yes, I've called/emailed complaints to BC/BS, the insurance commissioner of the state, the governor of the state, humira, prime specialty pharmacy.
Am I (we) not the customer? This is beyond ridiculous. Every month I am careful, specific, well planned and organized. I have a feeling that I am actually one of the lucky sufferers because eventually, at the last minute, everything clicks in place (so far). How many out there suffer because of this crap and can't get the meds? JMO, I think there's now a new level of Hell for the people causing this pain and suffering.
Rant over. Thank you for your attention.
Take Humira every other Monday morning and they send two doses at a time. Took it 1/3 and then 1/17. That used up supply. Next dose scheduled for 1/31 (this coming Monday).
Yesterday I called the specialty pharm that BC/BS of AL demanded that I use. Checked on balance, yes ins paid Dec but have not approved January, Pharm sent request on 1/13. I then called BC/BS and asked was there a problem, had anything changed, was any change anticipated? Response was, "No, everything is just as is was and you can go ahead and order your next does."
This morning call spec pharm again....."We've still not gotten insurance verification, we cannot place that order for you until we do. We'll submit an emergency request right now, call us back right after lunch and we can still have it sent overnight."
Every month, same old song and dance. Yes, I've called/emailed complaints to BC/BS, the insurance commissioner of the state, the governor of the state, humira, prime specialty pharmacy.
Am I (we) not the customer? This is beyond ridiculous. Every month I am careful, specific, well planned and organized. I have a feeling that I am actually one of the lucky sufferers because eventually, at the last minute, everything clicks in place (so far). How many out there suffer because of this crap and can't get the meds? JMO, I think there's now a new level of Hell for the people causing this pain and suffering.
Rant over. Thank you for your attention.
Of course they're just throwing Methotrexate at us like it's candy. Why? Because its cheap. And hey it actually works for a lot of people including myself (except high liver enzyme labs).
But I'm curious how much better some of the newer biologics are out there?
A few, of course have gone over to the dark side. Years ago I had to get a concurring second opinion before having surgery. The doctor I was seeing said I could go to anyone else in my town or the Big City Down the Hill, but to stay away from one, Dr. X. Reason? "We have a hunch the insurance companies are paying him to say 'no.'"
Now, in your situation, Nonightshades, follow the money. Your prescription costs how much, $2500 or so a month? How many people in your BS/BS use Humira or another equally pricy drug? Now multiply. Big bucks. Every day, every half-day even, they can delay paying for these prescriptions is good. So your blood pressure goes up, so you're irate. Who cares? You're just some random guy on the phone. Not like it's a local place where you and your tire iron can walk in and have a chat with them.
These insurance companies are big businesses. Most of them, even some with 501(c)3 status, are in it for reasons other than to heal the sick and soothe the afflicted.
You are, in your words, " . . . careful, specific, well planned and organized." I'd add "intelligent" and "determined" to that list too. If it's this hard far you, imagine how spotty access to drugs must be for someone with less ability to lean on these %$#&%@s. Imagine how much money is saved each day by hiring minimum-wage, poorly trained people to deny and delay and dither.
Rant might be over. Might not. I've had a hell of a week, and I'm on a tear.
Patience folks......it is a virtue that I struggle to keep yet must be practiced.