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........
i admire your patience and persistence
you must have great blood pressure since you have a nice steady manner.
Ros
The pharmacy I use, brick and mortar,has to order a specific mfg for one of my scripts since I'm allergic to their usual (cheapest let's face it) mfg. I have been calling for a refill a week ahead of time and call a day or two in advance of picking it up to be sure. The first 3 times they had to order it last minute even though I had reviewed it either in person or over the phone when I refilled. Now they're ordering a refill supply as soon as they fill the last one & we're practically besties (more likely they know I'll be calling or coming in and were tired of apoligizing). I've always been courteous, but it took probably 6 times for them to get on board.
Hoping you get the quick relief from the meds-
There should be an order date on your package.
Mark it on your calendar, set an alarm, what ever it takes call that order in.
I felt some relief after the first injection, also felt side effects sinus headache & congestion.
Pharmacy & dr said take something right after injection. Which I did for first couple months. Mucinex D was my choice.
Really really hoping this works for you.
Sorry but have to chuckle over UPS & FED EX.
Not chuckling over the fact I use the same darn pharmacy.
Keep us informed.
Sammy
oh that's precious
i am referring YOU to gambler's anonymous :)
Ros