How long does it usually take for approval? It has been two weeks and I called the dr office and they said they are working on it. Called the insurance company and they have nor heard from dr. What is a girl to do? I was hopeful but now depressed again. I want to go to my son’s football game this weekend but I am so sore and stiff I hope I can go.
I read all your post and people are working, moving furniture going about their day and I can barely get out of the house. I feel like my hands are fusing together but I know they are not. I have stiffness, pain and inflammation is my upper extremities, swollen toe, feet hurt, ankle hurts, ugh!!!
My daughter (10 years) said to me last night, “mommy when you get cured I’ll have my ole mom back.”. I wanted to cry. There is cure and all I read is negative stuff where is the positive.
Rebel mom, I share you pain and frustration. So sorry that you have to go through that. I am assuming that you are waiting for the insurance to approve drug treatment? I am not sure how long it takes in the US, but I can imagine how frustrated you must be to hear that they have not heard from the doctor yet. If I were you, I would call the doctor and follow up, and keep following up with the insurance company/doctor/etc, until you know they have it...they say something about the squeaky wheel....so I guess making alot of noise about it wouldn't hurt. Good luck to you.
Do you have a separate carrier for your rx coverage? That's who the dr would be working with for pre approval for medication. If you called your medical carrier they would have no knowledge of what was going on with your rx carrier. I'd say to follow up with your doctor to find out exactly what's going on and what the time frame is.
Get a copy of the date/time stamp of the fax from your Docs, telling them "apparently the insurance company has "lost it" and you need to follow up. (if the Doc's office has screwed up, they will get it taken care of immediatly and get you bridge meds) In the meantime you need some "bridge meds" THEN call the insurance company quality assurance department and tell THEM they have had the info for over two weeks. Pre-authorization should NEVER take that long as this is to allow for mobility(don't use "pain") and that you would hate to have a hospitalization for treatment.,that you understand things can get caught up in paperwork snafu's, and that it must be VERY difficult being in their position of making sure things happen and the terms of your policy are met. Would it help them if you placed a call to the State Insurance Commissioners office, as you are concerned that someone in their office is practicing medicine thinking they know your needs better than your doctorS (this is a great line you'll use it several times over the years, it almost always works make sure you use the plural form of doctor)
You should have your meds by day end or the next day. (or at least a call saying its being taken care of) They will walk it through from that point. Ask them if they want to authorize local supply via fax or overnight you meds from their formulary.
Use my word's these are ALL terms that will inform them you are NOT to be messed with and know what you are up to. be kind, pleasant (so pleasant that flies are attracted to your mouth) and make sure they understand its someone else fault and that you are helping the person you are talking make sure there is no blame on them when the big guns come out.
If the insurance company starts to give you a run around have you fill out a complaint form, inquiry, etc etc inform them you will fill out only one form and that will be with the insurance commissioner and "what is your name again?) Never threaten legal action EVER, always let the person you are talking to believe that you think they can solve the the problem (these are call center employees they can do much more than you think and if they kick the call upline they lose "points") If you demand a supervisor too early in the process, you are screwed. there are no "supervisors" generally only more experienced employees trained to handle difficult customers, if you are ever labeled as difficult your life can become a living hell.
If none of the above works, let me know (on this thread) we can go from there. I think we have ALL faced similar at one time or another.
What I was told is that it would take 3 to 4 weeks to get everything done and in the mail. After I got my tb test done. Then the doctor will call the pharmacy and they will take care of the insurance company, before they ship the medication they will give me a price and the doctors office will fill out everything for cost help then after I ok the price everything will be shipped over night and they will get me in that next day for my first dose. This is for Enbrel.
Saw dr. today and he said i was a severe case. My joints are not affected though as far as deformative goes but does see some mobility issues. He has high hopes!
Read your thread about the diet..I put myself on an anti-inflmatory diet. I eat no red meat, chicken only coldwater fish and only fruits and veggies. I also have a smoothy of fruits and a protein powder that is not soy base, it is whey base. No dairy. Have not been on it long enough to see how it goes but I have lost 51 lbs which is going to help with my joints. Doc does want to elimiate some of my meds but wants to see how I tolerate enbrel first. see him in five weeks unless need to see him earlier.
Sorry but that is not an anti inflammatory diet. It is high in carbs !! Fruit and veg are sugar - even though you need a little, if you use them then you are feeding the Klebsiella or whatever you want to call it. I bought those books - anti inflammatory diet books and have since chucked them in the bin. They play safe to avoid controversy by not really tackling the main issues - red meat may have some arachidonic acid which may be more inflammatory than some fish, but basically is a nutrient dense food with a lot of good fat. vegetable oils are inherently inflammatory - Milk may be a problem as it is high in carbs relatively , but even if you are lactose intolerant , yoghurt and butter tend to help by providing an anaerobic environment which suppresses the gut bacteria which irritate the good. Read the ideas for anti inflammatory diet that dare acknowledge the importance of saturated fat - try Cooling Inflammation blog by the scientist Ayers and look at his suggestions. Please believe me- I have suffered for 20 years and am now unbelievably well doing this. No one in my family can quite believe it . Sincerely , Melanie J ps I have read absolutely hundreds of questioning and up to date research to get to this place.