I received notification today that my request for weekly humira was denied by my insurance.
There are instructions on how to appeal, but when I read them, I felt like a gibbering idiot, not knowing how to follow the procedure. It was as though my IQ dropped 50 points. For crying out loud I used to teach people how to deal with all kinds of forms.
It seems far more cost effective for them to allow weekly Humira instead of Remicade treatments, but I really don't know.
I will talk to my dr later this week, and see what her suggestion is.
I am really really bummed.
Kathy~I responded to you at RAF but my suggestion is to let your doctor file the request.
I was approved right away for weekly injections after doing the bi-weekly ones for 6 months. (We never tried before) I never did anything...my doctor did it all. I just got a call the next day letting me know it was approved. My co-pay didn't even increase. I get 4 injections for !! That's more than 00 worth of medication.
Somehow I think when it comes from your doctor you get better results....faster.
Good Luck. Weekly made a big difference for me.
Kathy, Go figure. My insurance approved Enbrel over Humira. It makes no sense. Like Lovie said, you have to show that one treatment is not effective to go on to the next treatment. Will your rd help you? I think insurance companies like to mess with you - wear you down. Besides while they are "reviewing" and denying they are not paying !!!! AS it turns out, I think the Enbrel is good for me. I would HATE TO WAIT TWO WEEKS FOR MY INJECTION
Obviously SOME people are taking it weekly, so it must be effective for them that way. at this point I'd settle for every 10 days..
check out the humira.com website, download the paperwork and give it to your doctor. No one will be denied. JoanneKathy; I like Humira; but wasn't 100% sold on it until I switched to weekly. The majority of people do just take it bi-weekly though.
How long have you been on it? Do you take MTX too? I really think that's what makes the difference for me.
I take MTX, have for about 14 months.
My dr made the request for weekly humira..
I failed enbrel gave that a 4 month trial. We actually have fantastic insurance, as long as we get meds through the mail, we have ZERO $ copay...
I am mailing a copy of the denial letter to the dr, see if he can help with the appeal.