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    Will appeal no insurance on Copaxone 40

    Has anyone else ever done this? Any tips?

    I've read some tips online, and I'm awaiting records from the clinic. I also hope to get my doc to write appeal letter as well.

    Has anyone been successful?

    ~ Faith
    ~ Faith
    MSWorld Volunteer -- Moderator since JUN2012
    (now a Mimibug)

    Symptoms began in JAN02
    - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
    - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
    .

    - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
    - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

    #2
    copay assistance

    When I was on the 40mg, because I had private insurance through my employer, they said I qualified for the copay assistance program, so the 40mg was free to me. What I don't understand is I have to pay the $40.00 copay per month for the 20mg. Crazy.

    Do you have private insurance, because if you do, the copay assistance program through TEVA will make it free to you. Have you called Shared Solutions?

    Comment


      #3
      Have private insurance, through my husband's employer. Covers Copaxone 20, but not Copaxone 40. And yeah. Shared Solutions would cover the copay, but I can afford my $30. Just not the other $6000.

      ~ Faith
      ~ Faith
      MSWorld Volunteer -- Moderator since JUN2012
      (now a Mimibug)

      Symptoms began in JAN02
      - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
      - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
      .

      - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
      - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

      Comment


        #4
        Maybe no one has appealed?
        ~ Faith
        MSWorld Volunteer -- Moderator since JUN2012
        (now a Mimibug)

        Symptoms began in JAN02
        - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
        - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
        .

        - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
        - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

        Comment


          #5
          I have not appealed, Mamabug. My doctor's office says they have had no luck with this--no success for any patient on appeal. Every month when I order my medicine, I ask if the formulary has been changed. Until it is, I guess it is still an every day thing for me.
          Carole
          diagnosed 10/25/11

          Comment


            #6
            I have appeald

            I had to go through kaisers appeal process. Initial appeal was denied. I appealed that decision and the denial was reversed and should be on new dosing soon. Took 5 months total.

            Comment


              #7
              yes I have appealed with medical provider. It was initially denied. I took it to the next step in the appeal process and the denial was over turned and meds were approved. should be starting soon. took 5 months total.

              Comment


                #8
                OK. Good to know. I'm also concerned about those who have had trouble adjusting to the different dosage. Makes me wonder if going through the appeal process is worth it.
                ~ Faith
                MSWorld Volunteer -- Moderator since JUN2012
                (now a Mimibug)

                Symptoms began in JAN02
                - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                .

                - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                Comment


                  #9
                  Got approved for the 40!

                  I had a call from my pharmacy yesterday that my new prescription for the 40 mg had been approved, and it is on its way! Apparently, after October 1st United Health Care is now approving the prescriptions for all its plans. I am a little concerned due to all I have read on these boards, but honestly the idea of taking less shots makes me so happy!
                  Carole
                  diagnosed 10/25/11

                  Comment


                    #10
                    Really? United health care is my insurance. Will look into it.
                    ~ Faith
                    MSWorld Volunteer -- Moderator since JUN2012
                    (now a Mimibug)

                    Symptoms began in JAN02
                    - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                    - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                    .

                    - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                    - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                    Comment


                      #11
                      My doctor submitted an appeal when it was denied. The annoying thing was when it was denied they basically deleted my account because they said I wasn't covered anymore.

                      I said we just tried to switch to 40 instead of 20 and they said when that happened my status was switched to "not covered"

                      I had to recreate my account 2-3 hour process and get my 20mg resent in.

                      It was way more annoying than it was worth. Back on 20s and after reading all these negative comments I might just stick with 20s

                      Comment

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