biologics or meds

[Quest4Cure]

Hi Glenda,

I agree sometime ya just get fed up. I am always nice I just call them and pester them till they follow thru on their responsibilities. That sometimes takes a few weeks to a few days.

One of my biggest complaints.....
What really gets me is when the physician MA or PA calls and talks so fast almost like a Auctioneer, to hurry up the call blow u off (I know they have millions to call.)..knowing that their answer is not what is expected or requested. I will purposely slow way down my speech pattern which enviably always slows down theirs. Somehow they seem to think I'm a bit slow ... It sets a different tone.
And I finally get results. It really works.

If that doesn't slow them down I will ask them to slow down explaining that I am having a hearing problem could they PLZ slow down. I may have to ask them more than once. Eventually they get it and I again get results.

Both instances I am reasonably given what I have asked for.. If it's the results to a test or something else. It works so if they think I am slow or a pest so be it. Information is the key to good health.

Silly but at least it's clear information..

[glenda grant]

Hi Glenda,

I agree sometime ya just get fed up. I am always nice I just call them and pester them till they follow thru on their responsibilities. That sometimes takes a few weeks to a few days.

One of my biggest complaints.....
What really gets me is when the physician MA or PA calls and talks so fast almost like a Auctioneer, to hurry up the call blow u off (I know they have millions to call.)..knowing that their answer is not what is expected or requested. I will purposely slow way down my speech pattern which enviably always slows down theirs. Somehow they seem to think I'm a bit slow ... It sets a different tone.
And I finally get results. It really works.

If that doesn't slow them down I will ask them to slow down explaining that I am having a hearing problem could they PLZ slow down. I may have to ask them more than once. Eventually they get it and I again get results.

Both instances I am reasonably given what I have asked for.. If it's the results to a test or something else. It works so if they think I am slow or a pest so be it. Information is the key to good health.

Silly but at least it's clear information..

Jiml.I started to post something to you where it went i don't know.So i will start over,I found out from Dr that my prescription plan doesn't want to pay for my treatment.So i told them,if you refuse me treatment i will be having lots of surgeries.I need a knee replacement and I think also a new hip.So if they don't help me in the long run it's going to cost them more in the long-run.I am not playing games with them.I have on my Ins. after all my deductibles and out of pocket money.I can go to the ER for free.Guess what they are going to see alot of me in the ER for all kinds of problems.Oh i will make them remember me.I guess it's what we have to do.I'll keep in touch.

[jiml]

Hi Glenda,

I agree sometime ya just get fed up. I am always nice I just call them and pester them till they follow thru on their responsibilities. That sometimes takes a few weeks to a few days.

One of my biggest complaints.....
What really gets me is when the physician MA or PA calls and talks so fast almost like a Auctioneer, to hurry up the call blow u off (I know they have millions to call.)..knowing that their answer is not what is expected or requested. I will purposely slow way down my speech pattern which enviably always slows down theirs. Somehow they seem to think I'm a bit slow ... It sets a different tone.
And I finally get results. It really works.

If that doesn't slow them down I will ask them to slow down explaining that I am having a hearing problem could they PLZ slow down. I may have to ask them more than once. Eventually they get it and I again get results.

Both instances I am reasonably given what I have asked for.. If it's the results to a test or something else. It works so if they think I am slow or a pest so be it. Information is the key to good health.

Silly but at least it's clear information..

Jiml.I started to post something to you where it went i don't know.So i will start over,I found out from Dr that my prescription plan doesn't want to pay for my treatment.So i told them,if you refuse me treatment i will be having lots of surgeries.I need a knee replacement and I think also a new hip.So if they don't help me in the long run it's going to cost them more in the long-run.I am not playing games with them.I have on my Ins. after all my deductibles and out of pocket money.I can go to the ER for free.Guess what they are going to see alot of me in the ER for all kinds of problems.Oh i will make them remember me.I guess it's what we have to do.I'll keep in touch.

Ooooh Glenda how awful....... They should have told you that from the start and given you something else, have they just said a straight no......... Or have they offered an alternative. They surely cant mess you about like this...... There must be a way to appeal. I'm like Fred I don't understand your system, but it seems not connected it would be useful if your doctors would ask your insurer if they will,fund a treatment before offering it to you.....
I would ask Mataribot if he knows a way forward for you and I will give it more thought
I am so angry for you that it has taken so long and then to get this negative

[Fred]

Jiml.I started to post something to you where it went i don't know.

It could be here: https://psoriasisclub.org/usercp.php?action=drafts If not it's gone.

[jiml]

Hi Glenda,

I agree sometime ya just get fed up. I am always nice I just call them and pester them till they follow thru on their responsibilities. That sometimes takes a few weeks to a few days.

One of my biggest complaints.....
What really gets me is when the physician MA or PA calls and talks so fast almost like a Auctioneer, to hurry up the call blow u off (I know they have millions to call.)..knowing that their answer is not what is expected or requested. I will purposely slow way down my speech pattern which enviably always slows down theirs. Somehow they seem to think I'm a bit slow ... It sets a different tone.
And I finally get results. It really works.

If that doesn't slow them down I will ask them to slow down explaining that I am having a hearing problem could they PLZ slow down. I may have to ask them more than once. Eventually they get it and I again get results.

Both instances I am reasonably given what I have asked for.. If it's the results to a test or something else. It works so if they think I am slow or a pest so be it. Information is the key to good health.

Silly but at least it's clear information..

Jiml.I started to post something to you where it went i don't know.So i will start over,I found out from Dr that my prescription plan doesn't want to pay for my treatment.So i told them,if you refuse me treatment i will be having lots of surgeries.I need a knee replacement and I think also a new hip.So if they don't help me in the long run it's going to cost them more in the long-run.I am not playing games with them.I have on my Ins. after all my deductibles and out of pocket money.I can go to the ER for free.Guess what they are going to see alot of me in the ER for all kinds of problems.Oh i will make them remember me.I guess it's what we have to do.I'll keep in touch.

Ooooh Glenda how awful....... They should have told you that from the start and given you something else, have they just said a straight no......... Or have they offered an alternative. They surely cant mess you about like this...... There must be a way to appeal. I'm like Fred I don't understand your system, but it seems not connected it would be useful if your doctors would ask your insurer if they will,fund a treatment before offering it to you.....
I would ask Mataribot if he knows a way forward for you and I will give it more thought
I am so angry for you that it has taken so long and then to get this negative

I found a little bit out for you I don't know if it will help or not.........

Most pharmaceutical companies have financial assistance programs available for high priced medications. They want people to take/use new drugs. They know if you can not afford their drug you will have the doctor prescribe a competitor, which they do not want. So check their website.

You can always appeal, but if it is not on their approved drug list you will probably not get anywhere with it. Most insurance companies will pay different for generic and non-generic and they will have a list of Formulary (approved) and Non-Formulary (not approved) drugs. They probably will not make an exception unless it is life threatening. If the medication is not on their formulary list then they will probably have a "similar" drug that is on the formulary list. Unfortunately their definition of "similar" is probably not the same as your definition.

Hope that may help

[jiml]

Fred has just pointed me at this post Biological Treatments For Psoriasis for you
If you click on the link to Simponi at the bottom of the post
That will take you to the Simponi official website
At the bottom left of their website is a link to prescription assistance click on that for help

That may help

Thanks Fred for your help

[glenda grant]

Hi Glenda,

I agree sometime ya just get fed up. I am always nice I just call them and pester them till they follow thru on their responsibilities. That sometimes takes a few weeks to a few days.

One of my biggest complaints.....
What really gets me is when the physician MA or PA calls and talks so fast almost like a Auctioneer, to hurry up the call blow u off (I know they have millions to call.)..knowing that their answer is not what is expected or requested. I will purposely slow way down my speech pattern which enviably always slows down theirs. Somehow they seem to think I'm a bit slow ... It sets a different tone.
And I finally get results. It really works.

If that doesn't slow them down I will ask them to slow down explaining that I am having a hearing problem could they PLZ slow down. I may have to ask them more than once. Eventually they get it and I again get results.

Both instances I am reasonably given what I have asked for.. If it's the results to a test or something else. It works so if they think I am slow or a pest so be it. Information is the key to good health.

Silly but at least it's clear information..

Jiml.I started to post something to you where it went i don't know.So i will start over,I found out from Dr that my prescription plan doesn't want to pay for my treatment.So i told them,if you refuse me treatment i will be having lots of surgeries.I need a knee replacement and I think also a new hip.So if they don't help me in the long run it's going to cost them more in the long-run.I am not playing games with them.I have on my Ins. after all my deductibles and out of pocket money.I can go to the ER for free.Guess what they are going to see alot of me in the ER for all kinds of problems.Oh i will make them remember me.I guess it's what we have to do.I'll keep in touch.

Ooooh Glenda how awful....... They should have told you that from the start and given you something else, have they just said a straight no......... Or have they offered an alternative. They surely cant mess you about like this...... There must be a way to appeal. I'm like Fred I don't understand your system, but it seems not connected it would be useful if your doctors would ask your insurer if they will,fund a treatment before offering it to you.....
I would ask Mataribot if he knows a way forward for you and I will give it more thought
I am so angry for you that it has taken so long and then to get this negative

Jiml,called my rhemmy today and i think i am finally getting somewhere.My ins. refused the Simponi Aria is because it's for RA not PSA.So,i was told he sent in a new request for Embril now it's wait and see.They will call me as soon as they hear from the Ins. Co.I got an appointment with my Dermotologist for Oct.13.Hey looks like i'm on a roll now.About time eh!!Now it's just wait to get my call.Thanks for all the information you have given me.

[jiml]

I hope you get it soon it seems ridiculous that it's taken so long to get the facts straight and then when they decide that you shouldn't have it it's then going to be another two weeks to get the right stuff. Seems they just don't care . They need some organisation over there so the rheumatologist knows what is and isn't allowed
Surely one phone call should have found that out months ago.....
Good luck and I ,hope you get relief soon
Jim

[glenda grant]

I hope you get it soon it seems ridiculous that it's taken so long to get the facts straight and then when they decide that you shouldn't have it it's then going to be another two weeks to get the right stuff. Seems they just don't care . They need some organisation over there so the rheumatologist knows what is and isn't allowed
Surely one phone call should have found that out months ago.....
Good luck and I ,hope you get relief soon
Jim

thank you i'll keep in touch with you as soon as i hear something.thanks for being a friend

[jiml]

I hope you get it soon it seems ridiculous that it's taken so long to get the facts straight and then when they decide that you shouldn't have it it's then going to be another two weeks to get the right stuff. Seems they just don't care . They need some organisation over there so the rheumatologist knows what is and isn't allowed
Surely one phone call should have found that out months ago.....
Good luck and I ,hope you get relief soon
Jim

thank you i'll keep in touch with you as soon as i hear something.thanks for being a friend

thanks for coming back, and thank you for listening I can ramble on a bit, we are all friends here and will always try to help each other.