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Medical Forum / Diseases and Disorders / Arthritis / May 2005Getting prescription for Enbrel approved by insurance
The insurance company will cover Enbrel if the doctor sends the required lab work and documentation. What lab work have people sent that has worked successfully? If the MRI and Xrays throughout the body show arthritis, is that usually enough? ANY HELP WOULD BE APPRECIATED FOR THIS EXPENSIVE DRUG. Thank you. > The insurance company will cover Enbrel if the doctor sends the required > lab [quoted text clipped - 6 lines] > > Thank you. Usually,,, the insurance company needs to know that you have tried and failed with the cheaper drugs or DMARDs. Its all about money. As far as I know, the most expensive is Remicade because of the need for RNs to give it to you. The cheaper drugs are Methx and Arava and maybe a couple more that I have not taken. The truth of it is that your immune system must be controlled and the insurance need to do that so that they do not have to pay for $40, 000 joint replacements but in my world its about my arteries and veins and organs that inflam.arth can ruin. harv the expense of remicade is the drug, the mark up, not the nurses. i know from the breakdown of the bill. the costs from the hosptial itself is minimal as compared to the drug cost. jeffy > > The insurance company will cover Enbrel if the doctor sends the required > > lab [quoted text clipped - 18 lines] > inflam.arth can ruin. > harv > the expense of remicade is the drug, the mark up, not the nurses. i know > from the breakdown of the bill. the costs from the hosptial itself is > minimal as compared to the drug cost. > jeffy On my bill, it was $285 per hour for two hours.... in my world that is a great deal of money. I know the cost of the Remicade itself is high but Soc.Sec is involved which probably pushed the cost up. In some peoples world the cost of having the gov. involved is free and they need to look a little clooooser. IMO Harv how would you like my $7,000 bill to ponder over? jeffy > > the expense of remicade is the drug, the mark up, not the nurses. i know > > from the breakdown of the bill. the costs from the hosptial itself is [quoted text clipped - 7 lines] > little clooooser. IMO > Harv Harv wrote: > I know, the most expensive is Remicade because of the need > for RNs to give it to you. Humira and other newer drugs are more expensive. When an RN has 4, 5, 6 people in chairs receiving Remicade (or another drug), the per-person expense is much less. If the doctor's office is conducting drug trials (like mine is) the drug manufacturer pays for the RN's time. ... AGENT 007's tombstone: His Number Was Up. > Harv wrote: > [quoted text clipped - 7 lines] > the doctor's office is conducting drug trials (like mine is) the > drug manufacturer pays for the RN's time. Hi Chief, I think there are 5 chairs in the main room and another room with 3. The listed charges were the same no matter if I was my myself or both rooms going. I am sorry to read that Humira cost more. I am now back on Enbrel because of the reaction to Remicde and in 3-4 years when my insurance runs out,, I have no idea what will take place. I may invest in a wheelchair if the good Lord gives me that much time. Harv Harv wrote: > Hi Chief, I think there are 5 chairs in the main room and another > room with 3. The listed charges were the same no matter if I was > my myself or both rooms going. That's what I've been suspecting. Medicare and insurance companies are being double/tripled billed for the same procedure. > I am sorry to read that Humira cost more. That's why I was denied it and put on Remicade. ... !llaW ehT ffO ,rorriM ,rorriM > Harv wrote: > [quoted text clipped - 11 lines] > > ... !llaW ehT ffO ,rorriM ,rorriM I got into a huge fight with the "doctor" who was overseeing my last round of allergy shots. There had to be an MD present for the shots to be administered. So they were billing for an MD office visit for each shot. But there were usually about 20 of us there at a time waiting for our ten minutes to make sure there was no reaction. And I don't think I ever even met the doctor in charge. he sould be reported to your insurance company. they can't charge for "office calls" and never see you. it is called "fraud". jeffy > > Harv wrote: > > [quoted text clipped - 18 lines] > minutes to make sure there was no reaction. And I don't think I ever even > met the doctor in charge. >> I got into a huge fight with the "doctor" who was overseeing my last round >> of allergy shots. There had to be an MD present for the shots to be >> administered. So they were billing for an MD office visit for each shot. >> But there were usually about 20 of us there at a time waiting for our ten >> minutes to make sure there was no reaction. And I don't think I ever even >> met the doctor in charge. Whoa! I've had allergy shots at three different offices, thanks to moves, and never had anyone try to pull that crap. Today, I suspect the insurance companies wouldn't let him get away with it.  SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare >>> I got into a huge fight with the "doctor" who was overseeing my last >>> round [quoted text clipped - 11 lines] > insurance > companies wouldn't let him get away with it. Mine wouldn't pay it then. He thought I would! Jo true, however the charge for infusion is the same whether or not there are 10 people or 1 person present at the time. .... it's called "overhead". jeffy > Harv wrote: > [quoted text clipped - 9 lines] > > ... AGENT 007's tombstone: His Number Was Up. |
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