/Vent (insurance sucks, may not be able to go on Humira)

Sara,
I know that it seems like the end of the world and that everyone is against you but you are going to be strong and make it. Take a deep breath and understand that a lot of the stress and problems that you are having are being made worse by the emotional side effects of the prednisone. It is hard to understand why your doc wants to keep you on it but realize that if you are still having some symptoms at 10 mg, you will be have worse symptoms with none. Hang in there and see your primary care doc for pain medication. Most G.I.s are old school and only want to deal with antispasmotic meds but the majority of us on here are on pain medicaton or have it for emergency use and we get it from our primary care doc or a pain specialist at a pain clinic.
As for the humira situation, there are other options out there for people with poor insurance or no insurance. Have you looked into Cimzia yet? It is just like humira but newer and has the best financial aid program of any of the TNF inhibitors. I did not have to pain 1 dime of out of pocket money when I was on it and they had a homecare nurse come and administer the injection every month. Remicade also has a reimbursment program called Remistart that pays for much of the medication. So that are other options out there but you will probably need to tell your doctor about them to get the ball rolling.
It is also ok to vent and get all of this off your chest. You have had this disease long enough to understand that very few people outside of the website will truly understand your daily battles. They will listen at first but become intimidated by them and shut off the listening skills. This site is the perfect place to vent and let it all out. We have all been where you are at or in similar predicaments and can sympathize.There are so many bad things that come with the Crohn's package but the one good thing is that you are able to see the people around you for who they really are. You are able to see the good people that are there to lift you up when times are hard and are able to see those that are only there when times are good. I consider this a blessing and now know the people that I choose to keep within my innercircle and the people of this website are in it. Despite not knowing each other on a face to face relationship, we are all linked with a common bond and can strengthen one another. Hang in there and always remember that this too shall pass. I always think of the saying that you have to take 2 steps into the darkness before you can take 1 step into the light. The same goes with this disease and the fact that before you can obtain remission you must go through all the testing, flares, and medication trials to find what is going to help you but you will find something that will work. Endure till the End.

Hi Sara,
I understand how frustrating this can be. I had to do all my own legwork when my Doc wanted me on Humira and it needed to be Prior Auth'd.

Best thing to do is go to the Humira website (humira.com) and click on the Patient Assistance tab. There is a phone number there where you can call Humira and talk to them about the situation. I signed up so that it drops my copay from $50 to $5 per month. They also talk about people with no insurance or who are underinsured as you are. I have learned and as many people know on this site, you have to be your own advocate.

I don't know anything about Cimzia as it was not covered under my insurance, but it wouldn't hurt to check out their patient assistance program either. Talk to whoever it takes to get you on the medication that you need.

Good luck to you!!

Sara, I am so sorry you are going through this and the emotional stress cannot be helping at all. I am suprised that the insurance lists humira as a pharmacy benefit. For my insurance it is paid under medical. I am not on it myself but I work for the health insurance company and many of the injectibles that are used for crohns are paid under medical. You may want to check with the insurance commisoners office in your are to see what other options you have. I know where I am the Insurance Commisioner keeps a pretty tight rein on insurance companies. Best of luck to you and I will keep you in my prayers.

Sara, typically an approval letter is a guarantee of payment. At this point since they have screwed up royally I would definitely look into checking with the insurance commissioner to see if they can be held liable to pay even if they sent a denial also. The approval typically trumps the denial. You really have to keep on the insurance.