Hey all. My rheumy said he has appealed to my insurance company for other patients before. Sometimes, he's appealed the same case more than once. They have always come back with a resounding no. I did find out, though, that I can switch insurance in october; I don't have to wait until January. I'm looking into the different options right now. I think I can hold out as long as October, although I'm sure there will days where I will eat my words!
As far as preexisting conditions, I've heard rumors that insurance doesn't screen for preexisting conditions (aside from cancer, or other terminal illnesses) if you are getting through your employer. If you are getting it on your own, however, they will make it very difficult to qualify. I'm not sure of the rationale behind this, but it's only a rumor anyway. I won't know until I try to switch. My only dx is RA, though. My doctors have not officially labeled anything else (IBD, in particular). RA, although an expensive illness, is usually not terminal. I don't think it would be grounds for an insurance company to turn me down, would it?
In any case, I'm now on a quest to improve the quality of my life.
My rheumy has made it clear to me that he will NOT appeal the insurance company on my behalf. He has done so for other patients with this particular insurance company and has never been successful. He has fought my insurance company on other medication related issues, though, so it's not that he's usually not willing to go to bat for me. Just with this particular issue--he feels it is a futile effort on his part. He has upped my tramadol, and I'm grudgingly taking a bit more than usual. I do not want a stronger pain med. As an ex-smoker, I'm considered an ex-drug addict and the risk of addiction to the heavier pain killers is increased. Last thing in the world I need right now is to end up like Rush Limbaugh!
He told me yesterday that my arthritis is progressing--perhaps my RF has gone up?--and that the tnf-inhibitors can make arthritis worse before it makes it better. If I find the tramadol is not working effectively, I'll call him and ask for something else.
Perhaps I will call. Maybe their response to me will be different from their response to my rheumatologist.
Hi Duck. I called my insurance company on Friday. They said they didn't have a problem with it. But after I thought about it, I believe my rheumatologist said that it would be covered for psoriatic arthritis (what you have), but is not FDA approved for RA (@ 100 mg/week). I will call Medco back tomorrow and clarify with them. If they truly don't have a problem with prescribing that dosage for RA, then I will call my rheumatologist and ask if he would go ahead and try it (he has to write another letter justifying it). I took my enbrel injection yesterday, and I felt horrible this morning, but this afternoon, I am truly feeling the benefit of it. I think 100 mg/week would really help me for a while. Otherwise, I guess I'll just have to suck it up and deal until the enbrel fully kicks in.