Frustration with Insurance

December 4, 2006

I had been taking MTX and Humira and it was not giving the results my

doctor or myself had so hoped for. I had a nice case of pnemonia, so

while recovering from this, my doctor had put in for my insurance to

approve switching to Remicade. Once I had FINALLY recovered, and was

at a follow up visit, my rheumy told me my insurance approved the

Remicade and here is the infusion center and to call and set up for

the first. I was nervous, but had started to have a major flar from

being of my meds for so long. This is where things begin to go

downhill.......

I got a call from the prescription side the day before my Remicade

infusion, they are very sorry no one has called me, since they had

the order for Remicade for over a month and had failed to call me.

My insurance has a provision that they have to ship Remicade to an

infusion center. So, I call and the infusion center I am set up will

has never heard of that and will not accept outside medication. So,

they cancel my infusion. My insurance company says they will search

for me, so I do not have to worry or take time from my day, but will

contact me back and apologize for the additional delay. Each day I

call and get no response.

After 3 additional weeks and being told that no infustion center

would take outside medication they were still searching. My doctor

stated she wanted to change to Enbrel since I could barely walk,

since my sed rates were higher than they ever had been. I could

barely get out of bed. I had never had a flare as what I was

experiencing. I was involving my Corporate office in dealing with

this. They told me that they would not approve Enbrel since I had

not tried Remicade. To which, I lost my patience and was on the

verge of screaming and crying as I explained that due to Federal Laws

that regulate pharmacies, you cannot bring in outside medication as

so required by our prescription services. My doctor got approval for

this medication the end of September and it is now November and I am

barely able to function, since I cannot get Remicade and I cannot get

Enbrel. What are my options now?

A decision was finally made and I was sent Enbrel the day after

Thanksgiving. I never knew you could get salivary gland infections,

but before Thanksgiving, I did and was the sickest I have been. So,

finally my infection is gone and Sunday I was able to give myself my

first Enbrel shot. I had no idea I woudl get approval for a

medication and than not be able to physcially get it.

Debbie

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