Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 I'm replying to here, but this might be of interest to many of you. I am a nurse with RA, and I work as a medical review nurse for a health insurance company and might have a bit of information to offer you - and perhaps a bit of help working your way thru the maze that insurances can cause. I just attended a presentation by the Chief of Rheumatology at Univ. of Calif. at San Francisco a week ago. One of the highlights mentioned was the added benefit of methotrexate WITH a DMARD (such as Enbrel, Remicade, Humira....) over the long course of time with respect to prevention of joint damage. You might wish to present this to the rheumatologist who has been following you. In addition, it might help you to explore in detail with him/her the exact reason he mentioned the quality of your insurance..... here is why..... Most insurance companies set the allowance they will pay a physician providing injectable and IV infusion medications if the physician is the one actually dispensing the medication, instead of a pharmacy or home health agency. Often, that allowance may not even cover the physician's overhead costs. If the doctor is contracted with your insurance, he can legally ONLY charge you a standard co-insurance payment, unless you sign a different agreement and agree to pay more - I would NEVER advise this. You have the right to protest directly with your insurance company and as far as your state insurance commissioner if you are unable to get the care you need because of this situation. I see exceptions being made all the time. Please feel free to contact me in my private e-mail if I can help you to walk thru the insurance maze. I will need to know where you reside (state/country). I started on Enbrel about a month ago and continue on methotrexate and plaquenil. The company I work for, and the one that insures me, separated out self-injectable drugs, such as Enbrel, into a separate benefit catagory. I am now paying $327 per month co-insurance payment, which is 30% of the cost of the drug. I'm shocked at how much money comes out of my pocket, when I feel I have a "good" insurance plan. I am blessed to be able to squeeze out the money, but I know there are people who are not able to get the medication they need because they cannot afford it. I hope to begin an advocation program on the behalf of ALL of us as soon as I am back on track with life. At least I feel the Enbrel has been almost miraculous in how much better I feel. God's blessings to you all..... and good luck! Sandy From: " Matthies" Reply-Rheumatoid Arthritis Rheumatoid Arthritis Subject: yikes! Date: Mon, 26 May 2003 05:55:03 -0000 Hi all. I woke up yesterday to realize that I can't straighten my left arm all the way. The elbow seems stuck in about a 15 degree angle. Usually with joint pain, it hurts me to bend but not to extend and even with the pain I can "force" it bent or straight. With my elbow... it literally cannot straighten. I'm on day 2 of this with no improvement. Is this a normal "flare up" or has anyone else experienced this?? Also I am somewhat in between rheumatologists as my former one said he wouldn't even think about putting me on any other drug than methotrexate unless I had better insurance. The funny thing is... my insurance really is not that bad. I wasn't willing to stay with any doctor who wasn't willing to entertain all the options for treatment. I'm worried that my RA is somewhat aggressive and am worried about holding back in the first two years. So anyway, if this new symptom is somewhat normal, I'll hold off until I have an appointment with my new doc... Any advice? Also Jay, I've been thinking about you and hope that your symptoms are getting better... 7.5mg of prednisone really isn't very high... I was started off on 10mg and noticed results but when I tapered off to 7.5 the pain started coming back. I know everyone is different and I don't assume to be a Dr., but just a thought. Good luck! I hope everyone is having a good holiday and getting some chances to relax. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 27, 2003 Report Share Posted May 27, 2003 Hi Sandy..I, too, am a Nurse and on Enbrel….I, too, have noticed a difference….if I wee to pay out of pocket, it would cost me $1400.00/month!!!!! It is just sickening how high a med can cost, and for some of those who need it, they can't afford it!!!! sherri ----- Original Message ----- From: sandy f Rheumatoid Arthritis Sent: Monday, May 26, 2003 8:58 PM Subject: Insurance and medications I'm replying to here, but this might be of interest to many of you. I am a nurse with RA, and I work as a medical review nurse for a health insurance company and might have a bit of information to offer you - and perhaps a bit of help working your way thru the maze that insurances can cause. I just attended a presentation by the Chief of Rheumatology at Univ. of Calif. at San Francisco a week ago. One of the highlights mentioned was the added benefit of methotrexate WITH a DMARD (such as Enbrel, Remicade, Humira....) over the long course of time with respect to prevention of joint damage. You might wish to present this to the rheumatologist who has been following you. In addition, it might help you to explore in detail with him/her the exact reason he mentioned the quality of your insurance..... here is why..... Most insurance companies set the allowance they will pay a physician providing injectable and IV infusion medications if the physician is the one actually dispensing the medication, instead of a pharmacy or home health agency. Often, that allowance may not even cover the physician's overhead costs. If the doctor is contracted with your insurance, he can legally ONLY charge you a standard co-insurance payment, unless you sign a different agreement and agree to pay more - I would NEVER advise this. You have the right to protest directly with your insurance company and as far as your state insurance commissioner if you are unable to get the care you need because of this situation. I see exceptions being made all the time. Please feel free to contact me in my private e-mail if I can help you to walk thru the insurance maze. I will need to know where you reside (state/country). I started on Enbrel about a month ago and continue on methotrexate and plaquenil. The company I work for, and the one that insures me, separated out self-injectable drugs, such as Enbrel, into a separate benefit catagory. I am now paying $327 per month co-insurance payment, which is 30% of the cost of the drug. I'm shocked at how much money comes out of my pocket, when I feel I have a "good" insurance plan. I am blessed to be able to squeeze out the money, but I know there are people who are not able to get the medication they need because they cannot afford it. I hope to begin an advocation program on the behalf of ALL of us as soon as I am back on track with life. At least I feel the Enbrel has been almost miraculous in how much better I feel. God's blessings to you all..... and good luck! Sandy From: " Matthies" Reply-Rheumatoid Arthritis Rheumatoid Arthritis Subject: yikes! Date: Mon, 26 May 2003 05:55:03 -0000 Hi all. I woke up yesterday to realize that I can't straighten my left arm all the way. The elbow seems stuck in about a 15 degree angle. Usually with joint pain, it hurts me to bend but not to extend and even with the pain I can "force" it bent or straight. With my elbow... it literally cannot straighten. I'm on day 2 of this with no improvement. Is this a normal "flare up" or has anyone else experienced this?? Also I am somewhat in between rheumatologists as my former one said he wouldn't even think about putting me on any other drug than methotrexate unless I had better insurance. The funny thing is... my insurance really is not that bad. I wasn't willing to stay with any doctor who wasn't willing to entertain all the options for treatment. I'm worried that my RA is somewhat aggressive and am worried about holding back in the first two years. So anyway, if this new symptom is somewhat normal, I'll hold off until I have an appointment with my new doc... Any advice? Also Jay, I've been thinking about you and hope that your symptoms are getting better... 7.5mg of prednisone really isn't very high... I was started off on 10mg and noticed results but when I tapered off to 7.5 the pain started coming back. I know everyone is different and I don't assume to be a Dr., but just a thought. Good luck! I hope everyone is having a good holiday and getting some chances to relax. Quote Link to comment Share on other sites More sharing options...
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