Guest guest Posted January 2, 2003 Report Share Posted January 2, 2003 I was wondering if any of you have experience getting the preauthorization for Enbrel approved by the insurance company for those with the Reactive Arthritis diagnosis. My preauth. for Remicade was denied last summer by Blue Cross/Blue Shield. I am switching to National Association of Letter rs and will be trying to do a preauth. for Enbrel soon. I'm worried the insurance company will deny because Enbrel is not specifically FDA-approved for Reactive Arthritis/Reiter's Syndrome. Does anybody have any advice/experience with this preauth. process for Enbrel? Janet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2003 Report Share Posted January 2, 2003 Janet I'm kind of dealing with the same thing at the moment. I had no trouble getting on remicade through medicaid --apparently the dr knew what to say and what strings to pull. I don't have that dr now though as he left. My new dr wants me on enbrel but he has to get the auth as right now even though i got my Number and everything for Enbrel, still insurance won't pay for it at the moment. The dr has to work it out. He said just do the remmy again but I'm concerned because my liver enzymes are getting higher.. were 69 at the last test before this one and I do'nt know my new results. On Thu, 2 Jan 2003, , Janet wrote: > I was wondering if any of you have experience getting the preauthorization > for Enbrel approved by the insurance company for those with the Reactive > Arthritis diagnosis. My preauth. for Remicade was denied last summer by > Blue Cross/Blue Shield. I am switching to National Association of Letter > rs and will be trying to do a preauth. for Enbrel soon. I'm worried > the insurance company will deny because Enbrel is not specifically > FDA-approved for Reactive Arthritis/Reiter's Syndrome. Does anybody have > any advice/experience with this preauth. process for Enbrel? > > Janet > Liz ~~~ " I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. " ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ EMAIL: juliette@... **ICQ 49746198** MSN & AIM LizKP1952** PERSONAL HOMEPAGE PAGE http://members.tripod.com/~LizK ADDult HOME PAGE: http://members.tripod.com/~LizK/addult.htm ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 2, 2003 Report Share Posted January 2, 2003 Hello Janet, I did have trouble getting approved for Enbrel for treatment of AS because it is not FDA approved for that purpose. My husband's company switched insurance companies as of the first of this year. My rheumatologist and opthalmologists both send very persuasive letters to the new company along with documentation of how Enbrel works on AS patients and, fortunately, they have agreed to pay 90%. I have read that some states have an appeal process for patients trying to receive coverage for meds - your state might be one of them. Good luck to you. judi " , Janet " wrote: > > I was wondering if any of you have experience getting the preauthorization > for Enbrel approved by the insurance company for those with the Reactive > Arthritis diagnosis. My preauth. for Remicade was denied last summer by > Blue Cross/Blue Shield. I am switching to National Association of Letter > rs and will be trying to do a preauth. for Enbrel soon. I'm worried > the insurance company will deny because Enbrel is not specifically > FDA-approved for Reactive Arthritis/Reiter's Syndrome. Does anybody have > any advice/experience with this preauth. process for Enbrel? > > Janet > > ------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2003 Report Share Posted January 4, 2003 Dear Janet, I was approved for Enbrel after my doctor changed my diagnosis to " Psoriatic Arthritis " . It's one leg of this lousy disease I have, but by focusing on that diagnosis, I got approved with no problem. Good Luck CelticJade (Judy D.) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2003 Report Share Posted January 6, 2003 Thanks for the info. Do you have psoriasis? My problem is I don't. I guess it's not a problem, it's good, but I wonder if you have to have psoriasis to get that diagnostic code? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2003 Report Share Posted January 18, 2003 Janet, I am going to start Enbrel too. My Doc is doing everything under one diagnoses of RA. He said I have a conglomerate of the rheumatic diseases, but insurance co.'s usually cover RA. We'll see. I hope this med works. I have a good feeling about it. Nothing else really helps, none of the pain meds even touch it. I go in the hospital for a kidney infection, they give me morphine and I still hurt from the spondy problem. The kidney at least quiets down, but when I get home from the hospital the residual from the infection has traveled to all the painful places, and makes me paralyzed with pain for a few weeks. I get suicidal, really. I have a couple of scripts of anti depressants I take daily, but when this type of pain starts, I am hanging on by my nails. I usually call my 7 year old grandson just to hear his voice keeps me hanging on. We are very close, and I call him my guardian angel. But I sure am hoping this Enbrel gives me back a least part of my life. I've always been very active and being stuck in the house in pain all the time, isn't what I call a life. I was married to a man 20 years younger than me for 10 years, and he couldn't keep up with me, then when I started being home bound, he left. Well, I should have known better. But we had a ball for all those years, traveling and just having a great time. Hope your Enbrel isn't too hard to get and works. Take care. EFD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 21, 2003 Report Share Posted January 21, 2003 EFD, Good luck with the Enbrel! Let us know how it turns out. I think the insurance company will approve it for RA. Wish I could talk my doc. into that diagnosis. I'm so sorry for your pain. The good news is that Enbrel seems to be the most effective for our type of arthritis, so I bet it will really help you. I'm sorry your husband wasn't man enough to hang around. I've read studies saying that men are much more likely to leave a disabled spouse, than women. Actually, it might have been spouses with cancer, women with cancer are more likely to be abandoned than men with cancer. But, the same principle applies. I always say having arthritis is like having cancer, except you don't die. Best regards, Janet Quote Link to comment Share on other sites More sharing options...
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