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...
For a brief recap to start -
At my last appointment in November, since I had new insurance I had the doc write an Rx for Humira - I had been receiving it for free thanks to the Abvie Foundation prior.
Received a denial letter which said that I had to try Enbrel first. After 2 phone calls and a letter directly to the doc I had no response at all about the denial letter and about getting a pre-authoriztion for Enbrel. I had taken my last injection of Humira in the middle of December and have been going downhill since. To say I was upset about all this is being nice......
Doc came in and the first thing he asked is why I wasn't still taking Humira. So I told him the story, and he became flustered for a lack of a better term. He had not received my letter (never made it from the office to him) and said there was no excuse for the office staff to not return my phone calls. That being said, he was more upset about how the insurance companies try to dictate what he does. This doc is one of the heads of a huge arthritis research center. As I have seen in the past he is so focused on the science of the disease he doesn't realize what happens in the office. His point was that the Humira was working for me and should not have to change just because an insurance company says so.
Instead of dwelling on what happened, he immediately wrote me an Rx for 1 year worth of Enbrel plus my other regulars of Methotrexate, Folic Acid, and Prednisone.
Well I get home and call the insurance company since I didn't know what to do with the written Rx. The rep was very nice to me, and started by looking up Enbrel to see that it was covered. Yes, it is in fact covered, but needs a pre-authorization. I told her about the denial letter about the Humira which stated that Enbrel was OK, but that didn't matter. Now....only the doctor's office can call for this pre-authorization.....oh boy....here we go again. So I take a deep breath and call. I spoke to a girl who sounded very knowledgeable about these things, and took down all the info. She asked to give her a couple days.......
Man oh man - I know I am not the only one having problems like this - I've seen quite a few posts in the past weeks with similar problems.
It isn't over 'till it's over........
At my last appointment in November, since I had new insurance I had the doc write an Rx for Humira - I had been receiving it for free thanks to the Abvie Foundation prior.
Received a denial letter which said that I had to try Enbrel first. After 2 phone calls and a letter directly to the doc I had no response at all about the denial letter and about getting a pre-authoriztion for Enbrel. I had taken my last injection of Humira in the middle of December and have been going downhill since. To say I was upset about all this is being nice......
Doc came in and the first thing he asked is why I wasn't still taking Humira. So I told him the story, and he became flustered for a lack of a better term. He had not received my letter (never made it from the office to him) and said there was no excuse for the office staff to not return my phone calls. That being said, he was more upset about how the insurance companies try to dictate what he does. This doc is one of the heads of a huge arthritis research center. As I have seen in the past he is so focused on the science of the disease he doesn't realize what happens in the office. His point was that the Humira was working for me and should not have to change just because an insurance company says so.
Instead of dwelling on what happened, he immediately wrote me an Rx for 1 year worth of Enbrel plus my other regulars of Methotrexate, Folic Acid, and Prednisone.
Well I get home and call the insurance company since I didn't know what to do with the written Rx. The rep was very nice to me, and started by looking up Enbrel to see that it was covered. Yes, it is in fact covered, but needs a pre-authorization. I told her about the denial letter about the Humira which stated that Enbrel was OK, but that didn't matter. Now....only the doctor's office can call for this pre-authorization.....oh boy....here we go again. So I take a deep breath and call. I spoke to a girl who sounded very knowledgeable about these things, and took down all the info. She asked to give her a couple days.......
Man oh man - I know I am not the only one having problems like this - I've seen quite a few posts in the past weeks with similar problems.
It isn't over 'till it's over........
Coaltrain
I am ready to start using Italian non printables that my dad uses when he loses bets with bookies.
i can feel you getting closer. but not really. 48 hours? so we'll hear an update from you on Friday?
Ros
I'm certainly not holding my breath. Plus now I am already 1 month into the 6 month worth of pre-authorization period.........
I'm too wrecked tonight, but in the morning I may start a "mail-order horror story" thread.
Ros, teach us those curses. A few of us could use them on the phone with mail-order specialty pharmacies.
How can things get so screwed up?
I've been there my friend, wrong pharmacy, on the phone with insurance & pharmacy on hold & disconnected.....
I was in tears & ready to use language I do not use..
Someone did not do their job & this is occurring far to often.
Let's hope this patient advocate gets the job done.
I'd be on the phone after 48 hrs.
Unreal just unreal.
I'll be sending positive thoughts your way.
Sammy
Recap: last week (March 12) I spent 2 hours on the phone between my insurance company and Acreedo. When I called Acreedo they told me they couldn't fill my Rx. Then I call the insurance company who directs me right back to Acreedo. The final person I talked to at Acreedo who called herself a patient advocate promised to call my doctor's office and request a new Rx that would then be expedited to the fulfillment center.
Update today - March 17. I called the number that the patient advocate gave me to call to check on any progress. This number was answered by the Acreedo billing department. After a very long pause after introducing myself, the rep could not find me at all in the system. Great.......
She then transferred me to a general rep at Acreedo - I'm thinking I am going to have to start this whole circle jerk over again like last week. She finds me in the system, but has no record of my Rx. I told her of my conversation with a patient advocate last week. I am told that a patient advocate can not call a doctor's office for an Rx - only a pharmacist can. Great.......
She puts me on hold again saying she wants to look into something else. When she comes back she says that she did in fact find where my original Rx I mailed in was received. The person who processed my Rx sent it to the wrong place to be fulfilled. The rep said she called this wrong place but the Rx could not be located. Great.......
She then sees where the patient advocate did in fact send a fax to my doctor's office with a request for a new Rx be sent to Acreedo. That was on March 12 and that is the end of the line.
So.....now it is back to my doctor's office. Great.......the last time this office was expected to do something it was 3 months until my next visit to get it straightened out. Great......
This rep did offer this - she said she was going to call my doctor's office and try to get an office staff to talk directly to a pharmacist. She didn't have high hopes since the office person would have to be put on hold while she got a pharmacist on the line.
I thanked her graciously for trying to help me, and that is where I am at now. At least this Acreedo rep admitted my Rx was lost by them, but now the ball lies in my doctor's office once again which I have no faith at all in getting them to respond to Acreedo.
I cannot believe you have to go through this.
I know your confidence lacks when it comes it your doctors office but you may want to call & put a request in personally for that Enbrel to be faxed. Perhaps you'll get a clue if there's any improvement with the staff since speaking with your doctor.
This is total BS. Excuse my english but it should not be this hard to obtain a script.
My experience is new with Acreedo, but not real impressed thus far.
I'm sooo sorry you have to go through this.
You sure don't need the stress.
Let's hope they get this settled & expedite your Enbrel.
I'm wondering if you can file a complaint? Someone should be held accountable here. This is costing you your health, not to mention the stress.
Wishing you the best of luck this time around.
Thanks for the update.
Sammy
From what you have said, it sounds like your doctor is a good guy but he is completely surrounded by idiots and incompetents. It may be time to drive over to the office and throw a fit in person. Don't leave until you are satisfied that all is settled, and hit them up for a syringe or two of Enbrel to tide you over. Yes, they have some, and can give it to you free.
Once agian, back to my motto: it shouldn't have to be this hard.
I wonder if you were at the doctor's office and did all the calling to Acreedo from there? Then at least you can say "I am currently at the doctor's office, so you if you get a pharmacist on the line, I'll produce the person here"
This has been the only way I have been able to advance my daughter's health concerns to the next level. And I know it's a pain since we all feel so bad, but it's just going to feel worse without the medicine.
The last thing anything one wants in their waitig room is a chatty person talking about how they've been screwed over by the doctor.
I still won't really believe it until the stuff is in my hands, but delivery via UPS is supposed to be Friday.
I looked back on my calendar - tomorrow it will be exactly 4 months since this all started - I've been without any biologic for 3 months now.
All of these requirements have to be met to consider it successful :)
Looks like your added push got it done!
it is 8:30 AM eastern standard time
SEND PICTURE OF BOX IN AT FRONT DOOR PLEASE :)
have fingers crossed for you.
Fingers crossed for you CT.
Sammy
I feel like a grumpy old fogey but it seems like the kind of comedy sketches I used to enjoy when younger which point up the stupidity of 'stuff". If one little thing is done in the wrong order (well just have got Windows H8 so know about that) or someone doesnt do their job (was that Malaysian plane properly serviced pre flight? My son had bad experience with them so know they can stuff up) things go wrong.... Life should be more common sense than that. My daughter, then about 9, had to wait six weeks for an xray after she fell off her bunk and hurt her foot because the dr I took her to filled in the wrong form for the hospital. Nothing in their System allowed them to ring the dr or adjust to the circumstances. When they rang six weeks later to come in for the xray, I said well luckily it wasnt broken or she would be in a bad way no. They still wanted to do the xray - so I let them waste the state's money - at least with that I knew there wasnt anything tiny that had rehealed incorrectly or similar.
Anyway you have done ok in the end but what price stress and delay? The System is Satisfied but the idea of real people and suffering??? Nah that isnt taken into consideration...
Glad for you!
http://www.sterlingrun.com/photos/var/resizes/Gear-Testing/Misc/IMGK3343_DxO.jpg?m=1395433433
Funny - I specifically asked if the shipment was coming UPS or FedEx - they told me UPS. And who comes down the driveway this afternoon....FedEx....
Oh well - I guess I can finally close this chapter. So glad that part is over, but the Rx is monthly and only has 2 refills. Get to go through it all again in June.
It was nice that they sent along a big pack of alcohol wipes and a sharps container. Lots of paperwork also, but no instructions on how to obtain a refill. Guess I'll have to call when it comes time.
Got a dose in me already - hoping it takes quicker that last time with Humira which took 3-4 months. Of course I can't be so lucky as some - I read a thread in this forum where it takes 4 days to feel better........!!??
Thank you all for pushing me along. Honestly I was to the point a couple times of just giving up. You all have helped my like this a couple times in the past - Thank You!
You now have a lifetime supply of alcohol prep pads. No other swag? An Enbrel hat or tshirt?