insurance dance : Do I need a new doc? | Arthritis Information

 

Hi, I have been sick most of my life with some auto-im ne thing: graves disease, sjogrens, and celiac...now ra. that is after I blew up like a balloon and my doctor thought, "Hmmm,,,this could be ra instead of fibromyalgia." Well, I have been on plaquenil for years for sjogrens, that hit a wall and stopped working and now its mtx which at 6 pills a week for the past 8-9 weeks has not done a thing. My dr. stated that the insurance does not like to pay for humira, etc, despite the fact that I have the best ins. plan. She stated that someday I would be on those drugs, as if to say, "yes when its the end of your journey", we can try them... In the meantime, I had to cut work back, I have an 11 yr old, am 41, you kn9ow the story and I have to live...I have to turn the steering wheel, etc to get to work...she stated that I am probably depressed too. Duh? Do you think? Even without my masters I could figure that out. Ok, my point...there is one trust me...just venting....she said it is all insurance driven but then went into a long statement as to how humira, enbrel, rem, are last resort drugs and she would like to keep me offof them as long as poss? Do I need a new Dr? My hair is thinning, I feel dizzy, and then the ra pain that goes with the side effects, any thoughts? Sorry for the rambling...just got home from work and I could cry...
Nat

So much depends on the insurance company.  It took a few days for approval for my enbrel and just over a week for the remicade.  I think I have a great plan with the insurance, but the longer this goes on the more I feel nickel and dimed.  I would talk to the dr.  I would like to think the dr would try anything they could to slow this thing down to limit any damage since this isn't going away.

Hi Nat:  Welcome to the place to ask questions and vent.  In answer to approval from your insurance co. for the biologics....CALL YOUR INSURANCE COMPANY YOURSELF, don't depend on your RD to know what each ins. co. is going to authorize. The number for authorization for medical procedures and meds, should be on the back of your insurance card or in the explanation of benefits booklet.  

 The longer you wait to go into remission the worse the damage is to your joints.  It doesn't sound as if you're in remission. 

From what I've read and from talking with my RD the earlier you start biologics the greater your chance for remission.  I'm one of those people that waited because I thought I was in remission without medication, but I wasn't.

Is there another RD in your area?  Call your ins. co., and do your homework.  Go to John Hopkins arthritis site, NIH, and any other site that's informative.  Knowlege is power.  Let us know how you do. 

 

I feel like my doctor tends to go after RA pretty aggresivly, he told me that if he cant get his RA patients almost completely symptom free in 4 months, he goes for one of the biologics. He gave me my choice of the 3 major players and so I asked him to give me the low down on all of them and what his personal recommendation would be. In the end we decided on Enbrel and I just got approved by the insurance company. My perscription plan is through Medco. MTX takes about 3 months to work. I was on it for 3 1/2 months with no improvment and even some new pain in joints that were okay before. It is pretty standard practice for insurance companies to want the doctor to try the other drugs first and then if they fail to go for the biologics. We have another thread here where we are talking about how much waiting becomes a part of your life with RA.  Welcome to the wonderful world of RA and the perpetual waiting game!
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