Tip for getting Enbrel covered

** Originally posted by merito **

My derm told me that if I had some signs of joint pain that I would be much more likely to get it covered. Then he asked me (with a wink-wink, nod-nod) if I had morning stiffness or pain, redness, swelling in my fingers/toes. The questioning went like this: "Do you have any pain or stiffness in your fingers or toes?" "Does it help me get Enbrel covered?" "Yes." "Well I do then". "OK" ...

Mine was covered with Cigna without so much as needing a doctor approval. Just $5 a month for a $1200 prescription.

So if your derm is not willing to help you get it approved by all means necessary, I would find a new derm. It's just a matter of time before it is approved for P, so I don't even see this as unethical.

I have been asking for Enbrel for years. The same derm would not even prescribe it to me 6 months earlier because he said it would not be covered. Then at some point just before my last visit he got a visit from the Enbrel sales rep. Must have been a good rep.

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** Originally posted by khorath **

My doctor and I talked about this. In fact, he discussed my case with a group of doctors. They said, "Just kick him in the knees and then you can say his knees hurt." ;) They were kidding, of course.

However, we both felt like it would be unethical to lie. I don't want to appear to be a prude, but I still believe in honesty and doing the right thing. Does it seem fair? No. Does our healthcare system need some sort of change? Yep. But, until then, I believe we need to play by the rules. Besides, false claims are what make insurance premiums go up anyway. If we don't like the rules that our insurance companies have, change companies. Otherwise, I believe honesty is the best policy. What goes around comes around.

But, that's just me. I am in no way passing judgment on anyone else. ;)

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** Originally posted by makeitgoaway **

Personally, as long as I wasn't hurting anyone or keeping someone from a treatment who needed it more than me, I would say what ever was necessary to get the treatment that I need. I hope that doesn't make me a bad person. I know a bit about how insurance companies operate, and $ what $ drives $ them $ to $ make $ a lot $ of $ the $ treatment $ decisions $ that $ they $ do $ regarding $ what $ treatments $ are $ best $ for $ the $ patient.

Just my 2 cents

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** Originally posted by Syli **

Fellow p's :).......and then no matter which way you go with the derm you are left at the toss up with the Medical Director at the health insurance co depending on which you have. I had no problem with my derm who automatically put me down for pa without asking me the direct question although I do have morning stiffness and joint pain but not an official diagnosis backed up by x-rays. My ins co (BC/BS) made me go through a 3 week ordeal just to say no........its the luck of the draw as is anything in life.......:rolleyes:

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** Originally posted by mama **


I$ just $ loved $ your $ post!;) ;) ;)

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