
So I have put in 2 appeals with Aetna to get Bri treatment with Remicade. So has her Rheum's office. Today Renee the Rheum's Infusion Benefit Coordinator called and said the insurance company has denied both of their appeals. I said " so is NO No or why can't we just keep appealing, keep fighting?" She said she is sending me a form to fill out which is a Patient Assistance Program to get an approval. This looks like it's a Johnson and Johnson Patient Assistance Foundation?! She also said that if they approve her Remicade treatment this way it would be approx $200 per treatment, which starts off every 2 then 2, then 4 weeks then 6 weeks etc. Hmmm...money tree...still haven't found it. Lottery...still never even win $1!! Yikes! This is so crazy! And I'm not going to say why me, why? This happens, and I will fight so hard and WIN against this insurance company!!! If my daughter has a chance of going BLIND because she can't get the meds she needs, or even to get cataracts or glaucoma-Oh No! I am fighting!! This is absurd. So I called back Aetna spoke with a rep and she said that the denial was for the Dr's office (rheumy) and my appeals are still pending for up to 30 days...huh? So you deny my Dr's request and he sent in all the info all I did was say I want to appeal I will NOT let my daughter lose her vision due to you not letting her have Remicade!! So 30 days is what she said...so we'll see! And on a document that Aetna sent me, it states "that I have the right to bring a civil action under Section 502(a) of ERISA, if aapplicable. A copy of the specific rule, guideline or protocol relied upon in the adverse benefit determination will be provided free of charge upon request" Well...I'm requesting! I will always fight for my kids rights, and this fight...I will not lose. She needs these meds and there is only one other option which is the Humira. And who knows if they would even approve that. But her eye dr and also her rheumy both felt like Remicade was her best chance at getting the eyes under control! I have had ONE CRAZY DAY from the minute I rolled myself out of bed. Won't go into it ...but horrible things happen in 3's and this day had 2!!! So if your reading this blog update please please pray for Bri's eyes, pray for her to heal, pray that if not Remicade then Humira. Maybe God's saying there's a reason she shouldn't have Remicade since there are crazy side effects, and it hasn't been approved to give to children! But still...maybe he's speaking to us in a whisper! God bless all the amazing families I have only met through blogs, arthritis.org and uveitis.org and FB of course who are going through similar situations. I am at a loss for words, and am off to bed, Please God let tomorrow be a new shiny nice, bright loving day:)God Bless


My daughter was diagnosed with JRA the week before Thanksgiving. I recently started a blog for her to be able to update our friends and family with how she’s doing (without having to personally call and e-mail every one of them :) And hopefully get to know other JRA kids. I’ve slowly been reading the blogs that I have been able to find and I got the chance to read some of Brianna’s today. I’m so sorry you are going thru all of this with the insurance…just one more thing a parent doesn’t need to deal with. This is all so new and unknown for us, which I’m sure you can understand and I have no idea what the future holds. Bevin has been on Naproxen for over 3 weeks (an OTC anti-inflammatory for over 2 weeks prior to the Naproxen) and it hasn’t made a difference, we see the Rheumatologist for a follow in mid-Jan to see where we go from here. Her eye exam came back fine thou. She has Poly, currently both hips, both knees and her left ankle are affected…it looks like her fingers may also be affected now. She’s only 1 so she can’t really tell us one way or the other. It’s nice to be able to find all these other people out there.
ReplyDeleteI hope your appeals get approved so Brianna’s Remicade get approved. She is an absolutely adorable little girl (Love the princess/fairy outfit).
My thoughts are with Brianna and your family!
Nicole :)
We recently started a blog for my daughter if you would like to read more about her story:
www.bevinsadventureswithjra.blogspot.com
I hope everything turned out okay with this insurance situation! Motivation is half the battle.
ReplyDeleteHi, I volunteer with IAAM (International Autoimmune Arthritis Movement~formerly the Buckle-Me-Up Movement!). What we've be working on in February and March has been reaching out to people on our JA blogger list and asking if we can post them as a resource on the JA page. To start, could we have contact info from you to add to our blogger list for our records. And if you give us the info, then we will also post your blog as a resource for others on the JA page. Please email me at danalm_iaam@yahoo.com and let me know.
ReplyDeleteWe also invite you to participate in World Autoimmune Arthritis Day on May 20th 2012!
World Autoimmune Arthritis Day
events.r20.constantcontact.com
Join us for a 47 hour, Global Online Virtual Convention aimed to bring global awareness while learning more about your disease and ways to manage it best!
Thanks, Dana M
My heart goes out to you and I know how it is like live with arthritis. Being adults, we cannot bare the pain and I have no idea how these little bundles cope up with it.
ReplyDeleteJust for your information, I went through a treatment which healed my joint pain in my knees and I heard that it is more effective on children. It is Stem Cell Therapy and may be you can try it out as well. It is a natural healing treatment method and it is worth giving a try. It worked for me and I hope it will work for you little daughter as well.