Absolutely Ridiculous

Just got totally denied a medication that would be of help to me because insurance won't pay for it. What the heck is up with insurance denials???

Wanted to give Otrexup a try and my RA Doctor would like me on this medication (auto Injectible methotrexate) to get my inflammatory arthritis down....but with the $130.00 coupon it's still about $435.00 because insurance won't cover any of it...just great...Why even bother to be covered with insurance if all they are going to do is deny everything. My knees are inflamed, my feet are inflamed and my right hand is inflamed...if I could I would tell this denial person you should go through in my foot steps for 2 whole days having everything associated with my auto immune diseases and then see how fast they'd be able to get the medication.

It's United Healthcare folks just a heads up, I have MRI proof of RA in my right hand and plenty of inflammation to show a judge...

Just airing this out

Thank you. The problem is insurance wants me to take the mtx pills, but I have a history of ulcers and the pill form of mtx might send me to the ER....

Insurance has no right to do this to me, I'm on a stomach medication for years and they should see that, so why would my doctor risk my life with pills...

Why do I have to fight everything? So tired of this ...

I called the manufacturer and found paperwork to fill out and then they will help get it approved with my insurance...

Got mine crossed too!

Hi Chartreux,
I just joined 2day & wanted to offer support and some viable options pertaining to your insurance delemia.
My brother and I both have AS. His insurance denied to pay for his infusions. I checked every charity that was helping people pay for Rx meds & finally found one that accepted him. Before that, I contacted the manufacturer to see if they offered any assistance in paying for their medication. Of course, they didn't. Also check with your state's Department of Social Services. If they can't help, maybe than can point you in the direction. Best wishes.

I'm sorry. That really sucks. I hate it when the insurance company thinks they know more than the doctors.

Chartreux, I inject MTX weekly and I dont pay anywhere near that even without insurance. I think its about 80$ for a two month supply but the caveat is that I have to use a regular syringe and I get small bottles of MTX and I inject in my butt but I am sure that it could just as easily be injected to the stomach without much effort as long as the needle was a small enough gauge. MTX is available in 2ml bottles that are a one time use (no preservatives).

I had this conversation with my Doctor last visit because I was not able to refill my MTX script due to it being unavailable a few months back. She told me the reason was due to this new auto injectible that they are charging so much money for. She is extremely upset because she has several patients who inject MTX and are not able to afford any of the biologics or this new injectible MTX pen. She thinks they are gouging everyone and I would have to agree. I wonder if the insurance co's are not wanting to cover it because of this or something... Take care

I am sorry to hear that :( hang in there and maybe your nurse could give you these instead?

Once my GP prescribed me a sleep aid that my insurance would not pay for- said I had to take something else. She was adamant that her choice was best for me and called the insurance co. herself. They relented and covered the med- is that something you might be able to pursue?