A Constant Frustration

Being on Long Term Disability can be challenging for most people. As a nurse there are aspects of it I can relate to from a health management stand point. I feel for those who don't have a medical background - the endless medical jargon, what the Dr. needs to put on the forms to get a treatment or payment approved. It can be totally mind boggling - for me the frustration is palpable especially when they refuse my treatments. With Sjogren's Syndrome there are a lot off label treatments (a drug is used for a disease it is not designed to treat) so the Dr. has to send in letters and appeals to show why it is justified. This does not mean the insurance company will approve it though. Currently, I am trying to get Orencia approved and have been denied. The Dr. has sent in the appeal and sited the research that supports its use in my case. Now the waiting game - during this time my symptoms are getting worse and if they deny the appeal we start all over with another drug. Of course the other option would be to pay for the Orencia and it's administration out of pocket at a cost of approximately $8000.00 or more and if it doesn't work no refunds! I wish our government would do something to let Dr's. treat patients how they see fit but I'm sure there would be strings attached. To those of you in this situation - do your own research into the medication and it's use in your diagnosis you can submit this to your insurance company, weigh all your options, look at the website for the maker of the drug, sometimes they have free or low cost options if bought directly from them - most of all do NOT GET DISCOURAGED!!! The stress may make you feel worse! Smile - people will wonder what you're up to (lol - my Dad used to say all the time)!