I'm feeling such relief I want to jump up & down like a little kid!
After my neuro & I decided on Aubagio we did all the necessary paperwork & sent it in. My insurance company rejected the request to cover Aubagio as it's a "Tier 5" medication.
For them to cover it, I first must have tried & "failed" with one of 4 other meds (umm- really? do they GET what "failure" means?).
3 of the 4 are injectables, and with my eczema, deliberately damaging my skin is not an option we want to explore. The 4th is an oral, but needs 2 doses a day. With my wacked out memory, both my neuro & I feel that I'll be more likely to be fully compliant taking meds if I only need to do it once a day. Needless to say, the frustration level was not fun.
Genzyme approved me to get Aubagio (at no charge to me) until my insurance appeals go through (up to a year!!!), so we decided to start. I'm doing great, no sx that bother me at all, my blood tests have come back great. We're planning another MRI 6 months from my start date (that was the end of Dec).
Thursday my dh & I went to an informational dinner Genzyme sponsored. One of the speakers was a neuro who mentioned having to help with appeals for the same type of insurance problem we're having. He says he's never not gotten an appeal approved. I begin to feel a bit hopeful.
We chatted with the Genzyme rep later in the evening, she asked the name of my neuro. When I told her, she smiled & said "You're that patient!" She has been working with my neuro on the appeal (but only knew my initials). She had discovered that my insurance policy had a clause that states that if I have been taking a "tier 5" medication for a minimum of 6 months and it proves to be "an effective therapy", the medication will be covered by my insurance. Crazy relief!!
It's the first thing that's made me feel some kind of hope since I accepted that I really have this monster.
After my neuro & I decided on Aubagio we did all the necessary paperwork & sent it in. My insurance company rejected the request to cover Aubagio as it's a "Tier 5" medication.
For them to cover it, I first must have tried & "failed" with one of 4 other meds (umm- really? do they GET what "failure" means?).
3 of the 4 are injectables, and with my eczema, deliberately damaging my skin is not an option we want to explore. The 4th is an oral, but needs 2 doses a day. With my wacked out memory, both my neuro & I feel that I'll be more likely to be fully compliant taking meds if I only need to do it once a day. Needless to say, the frustration level was not fun.
Genzyme approved me to get Aubagio (at no charge to me) until my insurance appeals go through (up to a year!!!), so we decided to start. I'm doing great, no sx that bother me at all, my blood tests have come back great. We're planning another MRI 6 months from my start date (that was the end of Dec).
Thursday my dh & I went to an informational dinner Genzyme sponsored. One of the speakers was a neuro who mentioned having to help with appeals for the same type of insurance problem we're having. He says he's never not gotten an appeal approved. I begin to feel a bit hopeful.
We chatted with the Genzyme rep later in the evening, she asked the name of my neuro. When I told her, she smiled & said "You're that patient!" She has been working with my neuro on the appeal (but only knew my initials). She had discovered that my insurance policy had a clause that states that if I have been taking a "tier 5" medication for a minimum of 6 months and it proves to be "an effective therapy", the medication will be covered by my insurance. Crazy relief!!
It's the first thing that's made me feel some kind of hope since I accepted that I really have this monster.
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