Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Insurance

For anyone taking Enbrel or Remicade covered by insurance...

How long did the approval process take?

What insurance company?


TB

Many people on this site are covered by insurance.
However in my case, my insurance will not pay.

It does not mater on the insurance company as much as it matters what type of insurance options that your employer picked out.
EX. United Health care for one person is not always the same for another
What matters is what policy within that company that your employer paid for.

Betty

I'm sorry if I am asking dumb questions. It was just curiosity.

I was following some of the difficulties you have been writing about and you sure have a battle on your hands. Good luck with that.

My insurance has so far turned down the Remicade once and I am waiting to hear back about the appeal the Dr. sent. I noticed on one of the sites that somone mentioned it took them several appeals before they got a trial approval. Made me wonder if it is always this difficult no matter what insurance. Whether I should just give up on the one medication and see how they respond to the Enbrel request.

A friend suggested that I should contact the state insurance ombudsman if they take too long to make a decision but I had never heard of such a thing.

Anyway, I am just a newbie so hope I am not sounding to ignorant....


TB

Asking questions is not sounding ingorant.

The only way any of us has learned is to ask questions.....be it here or at home.

I had a long hard fight to get my insurance to pay for my sons Enbrel.

To make a looooong story short, in the end, the medical part of the insurance pays for his Enbrel not the pharmacy part.

The same as Bettys insurance, mine did not cover injections, but I got lucky and got in through the back door so to speak.

Something for you to look into. Seems they would be more open to do that for Remicade as you dont self inject at home as you would Enbrel. You actually have to go to the Doctors. Along the same lines as sending a kid in for his/her shots.....

Good luck, and please keep asking questions. If one person cant answer you, another one will come along to help you out.

Lori

Hi Terri and a great big
to KickAS!
I can't help you with your questions reguarding Remicade but I'm confident that someone here will be able to help you. I just wanted to take the time to
you.
Glad that you found this site and don't ever worry about asking folks around here anything. There is no such thing as a stupid question. Well there might be but folks will answer you anyway! I've heard alot of success stories through clinical trials or winning approval from the insurance companies to finally get the medication needed to battle AS.
Chris (fyrfytr187) just put up a thread about his success story finally getting approval from insurance for Remicade....he titled it "RIGHT ON THE MONEY" He might be a good one to ask!
Just surf around and you will find all kinds information and don't hesitate to ask questions, PM me if you want.
I read in your profile that you have a supportive husband. I am a supportive wife. My husband, Alan is the one with AS. KickAS has been a great place for both of us!

Good luck to you!

Liz



Cocoa Beach Sunrise
Begin each day with a smile on your face and a song in your heart!

Sassy,

Thank you so much for your kind response. This place is very informative. I am trying to find my way around. There is just soooo much information and I have limited time to explore it. Full time job, 2 hours of commuting, 3 year old son, husband, and a house that we are replacing the flooring in by ourselves. Leaves little time and energy. But everyone seems so kind and supportive. I will persevere.

TB

Liz,

Thank you for the warm welcome. I have been reading that particular post. It has been helpful.

Your husband is lucky. Having a supportive spouse makes a world of difference. I do appreciate my husband's support even though I know he can't fully understand my condition. Just knowing he is there to pick up the slack makes a world of difference.



TB

Hi terlybro,
Welcome to KickAS.org!!

As you have read I had quite a fight to get Remicade, even though it is approved for AS. My doctor, his staff and my wife and I fought tooth and nail to get my insurance to pay for it. My rheumy let me read the nasty letters he would write them. All I could do was laugh, because he didn't hold any punches. Finally it took the drug company getting involved to make them see the light. Something about my insurance company being one of the drug companies largest clients, it only took a phone call from the drug company to handle it...I'd like to have been on the other line during that conversation.

So if your fighting for Remicade or Enbrel, don't give up. You might try having your doctor submit it under a different diagnosis, one that is more general, like Seronegative Arthroscopy, instead of AS. All is fair in the insurance war.

Good Luck!!

Keep Kickin'AS
Chris

Hey TB

We all do what we need to do in life and still find a little time for KA.....like right now, I should be grocery shopping. This is a much nicer place to be

Lori

> right now, I should be grocery shopping. This is a much nicer place to be

Well, at risk of going all fluff-y here, I've got a nice New England Boiled Dinner cooking on the stove while I'm posting to KickAS (I know, I know, potatoes aren't approved for NSD, but it'd be... sacreligious to *not* have potatoes in it)...


-p