Re: Enbrel--insurance stopped paying

[Guest guest]

In a message dated 09/09/2002 10:57:59 AM Eastern Daylight Time,

dbeamon@... writes:

> They also have

> not given us new insurance books to see what's covered or not

Cassie - they HAVE to give you written changes and books or an online site to

see what is covered. Contact member services and tell them if they can't

send you something to show what is covered they are in violation of the

insurance laws. If your coverage is through work, have your HR person call

and tell them that.

[Guest guest]

Enbrel is covered under our major medical since it is an injectable rather

than the prescription drug part of the policy. The down side is the

deductible and the percentage covered. It is better than nothing.

[Guest guest]

Cassie,

I can't understand an insurance company making a blanket satement like that. No

injectables? What about diabetics? I didn't quite understand your posting.

Have you been getting enbrel through your mail-in or locally? I get it from my

mail-in and they ship it in a cooler. I'd suggest that you talk to your HR

person and get all the straight facts. They really dropped the ball on this one

for not informing the employees of the changes. Sounds discrimanatory to me

anyway to pay for viagra and not something medically necessary. Get all the info

you can then start talking to an attorney. Good luck!

Eva

works4now2000 wrote:My insurance is through my employer and it stopped my

Enbrel coverage

stating they don't cover injectables. They didn't tell us they made

any changes in our plan other than who we mail our prescriptions to

or who we can buy from locally. What do I do now. They also have

not given us new insurance books to see what's covered or not. We

only got stuff for the mail in pharmacy. Viagra is covered even

though it's not something a person needs as a necessity of life.

It's like the H--- with us who need drugs to slow down this disease

and stop the crippling effects. The man can get Viagra and the woman

can't get help for anything. Cassie

[Guest guest]

Do they reject claims for insulin as well? Bullcorn!

Get angry with some customer service rep... Yell and

scream, and threaten a lawsuit.

--- works4now2000 <dbeamon@...> wrote:

> My insurance is through my employer and it stopped

> my Enbrel coverage

> stating they don't cover injectables. They didn't

[Guest guest]

Hi Cassie,

If you're working right now and getting insurance through your

employer, call the HR Benefits Manager. You may have to call HR and

ask who that is.

But tell them your situation and that you were receiving medication

and now it has suddenly stopped. That's the first step to figuring

out what's going on.

Best wishes,

Meghan

> My insurance is through my employer and it stopped my Enbrel

coverage

> stating they don't cover injectables. They didn't tell us they

made

> any changes in our plan other than who we mail our prescriptions to

> or who we can buy from locally. What do I do now. They also have

> not given us new insurance books to see what's covered or not. We

> only got stuff for the mail in pharmacy. Viagra is covered even

> though it's not something a person needs as a necessity of life.

> It's like the H--- with us who need drugs to slow down this disease

> and stop the crippling effects. The man can get Viagra and the

woman

> can't get help for anything. Cassie

[Guest guest]

To Clarify my post-- The company I work for is a family owned

business with several healthcare facilities. They are self insured

and they chose the plan changes, didn't tell us anything other than

changes as far as who we could use as participating pharmacies. Now

I have tried to get the Enbrel and was told " We don't cover

injectables " This includes insulin and any syringes/needles. They

didn't give us new books with what is covered in the plan. We were

told they will print new booklets and supply them later. I spoke to

the HR rep., Called Enbrel insurance rep at 18884Enbrel. spoke with

the other employee on the med and we plan to go together to speak to

the board which is the entire family owners. Next we plan to go to

the HR rep and pay him a not so friendly visit. His office is not on

the 1st floor. He may want to come to ground level before we reach

him or he may end up hung out that window. We are some mad women.

And all the employees are mad over the insurance changes. We are

seeing nothing being covered or payed and the cost went way up.

Cassie

[Guest guest]

Cassie,

Is your company self-insured? I'm no expert on insurance, but my husband

worked for a company that was self-insured and they did not give us any

books for about six months after changing our plan. We also did not know

what was covered and we did not know which doctors were in-network. We

ended up going to a doctor who was not in-network and the insurance paid

only 40% of the charge. When I complained to the HR department they were no

help. So I called the insurance commission and they said that since the

company was self-insured that they could basically do anything they want to

do. They even said that the company could cancel our insurance without even

notifying us. They said that any dispute about this problem would have to

go through labor relations but that we would have to get many of the

employees together to file a grievance. Unfortunately that was not an

option. Sometimes the little guys just can't win. I hope that this is not

the case with your insurance. I'm always afraid to put my two cents worth

in because I might be way off base, but this is what I was told.

Cheryl

[ ] Enbrel--insurance stopped paying

> My insurance is through my employer and it stopped my Enbrel coverage

> stating they don't cover injectables. They didn't tell us they made

> any changes in our plan other than who we mail our prescriptions to

> or who we can buy from locally. What do I do now. They also have

> not given us new insurance books to see what's covered or not. We

> only got stuff for the mail in pharmacy. Viagra is covered even

> though it's not something a person needs as a necessity of life.

> It's like the H--- with us who need drugs to slow down this disease

> and stop the crippling effects. The man can get Viagra and the woman

> can't get help for anything. Cassie

>

>

>

>

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aka(raharris@...).

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[Guest guest]

Cassie,

I have mixed feelings about unions, but if I were in your shoes I

would run, not walk, to the nearest union organizer and ask about

unionizing all employees within the company you work for. These days

an employer sponsored group health insurance plan is essential

because of the cost of private individual health insurance, and to

fail to provide one or to provide one as woefully inadequate as yours

is contemptible.

If you would like to pursue this approach, you can visit either of

the websites below to find out who to contact about it.

-- Ron

http://www.aflcio.org/voiceatwork/index.htm

http://www.teamster.org/join/join.htm

> To Clarify my post-- The company I work for is a family owned

> business with several healthcare facilities. They are self insured

> and they chose the plan changes, didn't tell us anything other than

> changes as far as who we could use as participating pharmacies.

[Guest guest]

In a message dated 09/09/2002 6:08:53 PM Eastern Daylight Time,

dbeamon@... writes:

> The company I work for is a family owned

> business with several healthcare facilities. They are self insured

> and they chose the plan changes, didn't tell us anything other than

> changes as far as who we could use as participating pharmacies

Cassie - self insured or not, they still have to comply with the law. Call

the insurance commissioner for your state if they don't resolve this problem.

[Guest guest]

I called the insurance commissioner and they want deal with the

problem because the employer is self-insured. They fall under

federal guidelines instead of state. We tried to form a union in the

past and people were fired for being trouble makers. The company

don't like unions in healthcare facilities, don't think nurse's

should be union members etc. I think they just want to get away with

everything they can. Cassie