I am so upset about this

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

babybloo
Regular Member


Date Joined Aug 2005
Total Posts : 289
   Posted 2/2/2007 7:57 PM (GMT -7)   
I heard back from the Dr. Office and my insurance won't cover any of the medications until my OOP (out of pocket) is used up.  Thats 5000 dollars... and I just don't and won't have that and even then I will still be responsible for 20% plus the copay.  I thought at least one of them would have been covered.  Nope.  So I guess not long from now I won't be walking... I will never get to be who I used to be... and I can't see working for another 6 months as everyday is becoming more difficult.  Yet, I make too much to qualify for assistance... Lovely.
 
Would I have any shot if I quit work and went on disability?
Theresa
dx: Rheumatoid Arthritis.  Duration: 10yrs. Dx'ed 2006.  Asthma, hypertension, hypothyroid
 
Meds: Methotrexate 20mg wkly, Prednisone 20mg decreasing,  Advair 250/50, Diovan HCT 160mg/25mg QD, Synthroid .1mg QD, Women's One a Day, tylenol PRN.
 
 


Ducky
Veteran Member


Date Joined Mar 2005
Total Posts : 3199
   Posted 2/2/2007 8:13 PM (GMT -7)   
Hey Theresa.... so sorry to hear about your insurance... going on disability can take a long time... Erin, the other MOD for Arthritis, is still going through the appeals process for disability, and she has been out of work for a while now... I believe she has been denied 3 times.. Some of the companies will work with you and if you qualify, will give you the medicine at no cost. I know some people who have done it that have been on Enbrel and Humira.. and due to different issues, they gave them the med...You may want to call them and see if they have any type of assistant plan... Good look to you, and please keep us posted.. hang in there...
Moderator of Arthritis/Epilepsy Forums
Confirmed Diagnosis of - Psoriatic Arthritis/Spondylitis/Graves Disease/GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes/Chronic UTIs
Current Meds -  Enbrel/Prevacid/Synthroid/Nitrofurantoin
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots
Additional Supplements - Multi-Vitamin/Bromelian/Acidophilus/Green Tea
 


curley
Veteran Member


Date Joined Mar 2005
Total Posts : 4305
   Posted 2/2/2007 9:43 PM (GMT -7)   
Ducky is so right there are programs out to help people with there meds at little or no cost to you.I'm on disability and I was turned down three times before I got mine,it took me two years to get it.I wish you the best of luck and please let us know how it is going.
Curley
.........
 


erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 2/3/2007 10:26 AM (GMT -7)   
Hi Theresa,
What a pickle.  What meds are these?
There are way more RX assistance programs tha you think.  Even within the pharmacy...like Walgreens for example...they have special "non-insurance" cards you sign up for that allows you to save 10 to 20 percent on RX drugs...even if you have insurance.
 
If you honestly feel as though you will not physically be able to do your job...or any job in 6 months...you should start gathering all of your records & info NOW and perhaps start the SSDI process.
 
I was denied 4 times already and now am in the appeals process (2nd appeal...so this is the one with the court?) and I'll be waiting a year for a hearing they tell me.
 
And I'm at a point where I cannot be on my legs for longer than 5 to 10 minutes now...need crutches...and am pretty much housebound with the RA progression.  But since I'm NOT BLIND?  I'm denied.  Had to leave work in May 2005 and I was pretty much my own boss...so I was really doing NOTHING at work and could barely do that. (and that was only one day a week!)
 
When you lose your health ins.  you can apply for Medicaid (which was a lifesaver in my case)  All of my medications I get at no cost. And my meds? I would be paying OOP...well over $3000/month.  Now, you can get Medicaid without SSDI.
 
Also...speak to your pharmacist, they know more than we think they do! And I would also contact the patient assistance number of each drug you take...you may need to go throught the pharm. co. for that.
 
Oh, and there are times....that if your physician argues with the ins. co's....they can push for coverage.  My neurologist did this for me years ago. I had BCBS HMO and the price of meds was ridiculous! $800 copay for an antibiotic???? and seizure meds????? She did something! Not too many docs "like" doing this because it takes time.
 
Also...is there any way to get physician samples? Pharmaceutical Co's bombard offices with RX meds...and from personal experience, many of which are rotting away down in the basement never to be given out to people who need them. nono It's a shame.
 
But yeah...list the meds you need. Maybe someone here is on them and is in the same predicament.
{{{{{{{{{ there will be a way...don't worry }}}}}}}}}}
Arthritis Forum Moderator
Active Severe Rheumatory Arthritis. Crohns Disease. A.Chiari Malformation & right brain venous anomoly. Partial Complex Seizures (under control!). MVP & Tricuspid Valve Prolapse. Rheumatic heart & lung. Previous Lymes Disease for 10 years.
Meds: Remicade infusions 300mg Q3weeks; Intra-articular knee injections; Arthrotec; 6MP; Mesalamine 4Grams; Prednisone; Entocort; Meclizine; Augmentin; Reglan; LidoDerm; Diazepam; Restaril; Dilaudid. 


babybloo
Regular Member


Date Joined Aug 2005
Total Posts : 289
   Posted 2/3/2007 11:12 AM (GMT -7)   
I am not as down about this as last night. But still pretty upset. Thank you Erin and everyone for posting. Wondering if I should just give up on finding a solution but guess I need to keep trying. I want to continue to work but can see worsening almost daily especially over this past year that I don't see that I can. The meds the docs were trying to get for me was actually one of the three injectable biologics. Remicade, Enbrel, or Humira. The insurance co wants me to pay 1355 until I reach my 5000 OOP then 20% of that plus my copay of 50.00. No way I can do that. I am only just making it financially as it is. Even if I do get my credit cards paid off I could never pay that. Not sure how anyone really can. So, I am going to call the Rheumy office on Monday and ask about adding Sulfasalazine and Plaquenil to the Methotrexate to see if this works. Wonder if I can still take Pred or Relafen with this mix.

I have to be able to walk and live I can't be like this. This isn't living.

Theresa
dx: Rheumatoid Arthritis.  Duration: 10yrs. Dx'ed 2006.  Asthma, hypertension, hypothyroid
 
Meds: Methotrexate 20mg wkly, Prednisone 20mg decreasing,  Advair 250/50, Diovan HCT 160mg/25mg QD, Synthroid .1mg QD, Women's One a Day, tylenol PRN.
 
 


Jemima Puddleduck
Regular Member


Date Joined Oct 2006
Total Posts : 41
   Posted 2/5/2007 12:24 AM (GMT -7)   
Hi Theresa,

So sorry your insurance is crap. Try http://www.rxassist.org/ for help. It's a comprehensive directory of Patient Assistance Programs for free or low cost medications that is run by pharmaceutical companies. Don't give up...there's something out there for you.

I wish you well,
Jem

Jemima Puddleduck
Regular Member


Date Joined Oct 2006
Total Posts : 41
   Posted 2/5/2007 4:42 PM (GMT -7)   
Theresa,

Another thought, not just for you but everyone...clinical trials. Try this website http://www.clinicaltrials.gov/. There might be a clinical trial for medications in your area that you might be able to participate in.

Just a thought, take care...
Jem
New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, December 02, 2016 9:56 PM (GMT -7)
There are a total of 2,731,952 posts in 300,977 threads.
View Active Threads


Who's Online
This forum has 151137 registered members. Please welcome our newest member, Country girl2.
246 Guest(s), 5 Registered Member(s) are currently online.  Details
DBwithUC, letstryit, Fairwind, GustavoWoltmann, multifacetedme


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest
Advertisement
Advertisement

©1996-2016 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer