This is hilarious to me

[Bandito]

So I have been being treated for MS for over a year and a half. I had been on Avonex since my diagnosis. Seeing that it wasn't working, my neurologist wanted to try me on Gilenya. I am still in the pre-certification stage with Aetna. I thought I was good to go and I get a letter from Aetna saying the prescription will be denied until I meet certain criteria. The first thing on the list says: "You must have a documented case or relapsing/remitting Multiple Sclerosis." Seriously??? You have been approving Avonex for a year and a half without blinking and now, all of a sudden, you are acting like I don't even have this disease???? I actually laughed at the lady when I called Aetna yesterday. Unreal. looks like more waiting. Apparently I also have to have a battery of tests before they will approve. I thought the tests were according to what the neuro wants. Gilenya thought too...geez.

[Alicious]

What on earth? Hopefully you can get their standards met without too much trouble. I want to laugh, but can't because it has to be a hassle for you.

[heliotrope]

I have to agree... insane...
Have you called your doctor? Sometimes (depending on the doctor), they're able to convince the insurance company to approve with fewer steps.... especially if those extra tests are going to cost the company more money and they'll still end up having to pay for gilenya. Keep in mind, their ultimate goal is not to have to pay for your medication.

[Scooter24]

No different from those getting Ampyra, some insurance co's required walking test, some didn't, some required precertification some didn't. Apparently it is up to each ins company, but there is a list of the required tests on the Gilenya web site.

[Bandito]

I did call my neuro. She is ordering me an ekg and I might be able to get by the eye exam as I just had my yearly with the eye doc. A much smaller list than what Aetna wants.

[pageturner]

FYI

The State of California just fined Aetna 300,00 for "wrongly refusing to pay claims."

Blue Shield just refused to pay a claim by one of my Drs as they say that I wasn't covered the day I had treatment.

Blue Shield was fined 900,000 for the same violation.

I pay almost 1300 a month (buy my own ins) and have a 7200 deductible. The check cleared my bank Oct 26 and Blue Shield says I wasn't covered in November.

Scammers! Anyone would think they're trying to get rid of me! (ha, ha)

Insurance companies in the Hall of Shame=

Blue Shield fined 900,000
Anthem Blue Cross fined 900,000
United/Pacificare 800,000
Healthnet fined 750,000
Kaiser fined 750,000
Cigna fined 450,000
Aetna fined 300,000

Ins companies are required to 95% of claims correctly and
"on average, plans paid about 80% of claims correctly."

If they give you more crap, call up your state insurance board.

[Bandito]

Well I just did some research and figured out that Aetna has criteria for pre-certification for only Gilenya and Tysabri. Still, you would think that, when I called the day after I filled out the paperwork, to see what my copay was going to be, they could have told me ahead of time.

[GinnyRuth]

We ain't seen nothing yet. Wait till this Obama care crap kicks in.

[floatingurboat]

Ugh I'm not a big fan of aetna myself. It took like 4 months of waiting for them to approve me for tysabri while in the meantime I got a nice weeklong hospital stay which I'm sure costed them alot more money then just approving me would have. Right now I'm waiting on them to approve a pain clinic refferal and they sure do like to take their sweet time, been waiting almost a month.

~Elly