Insurance Issues

I debated about sharing this issue, but I thought that maybe some other JA parents might face similar situations and may need to know that someone else is in the middle of this little battle. This journey is a whole lot easier to navigate when you know that others are walking ahead and beside and behind---those ahead can lend moral support and offer some wisdom; those beside sometimes help to prop you up when you're feeling weak (and vice versa); and those behind are often watching your steps---you can point out a few places that might be tricky or give some advice on the best path in a rocky terrain. For me, as a believer, I also know that as we walk this journey on earth, we are never alone, and Jesus is always drawing us to a better understanding of God and His tremendous love for us---no matter the circumstances He allows us to encounter. I can place my trust in Him, knowing that He loves my children even more than I do! His plan is for their good, and He makes beauty from ashes.

We encountered a little glitch in this JA Journey which I just found out about today. Anna has been on Humira (along with Methotrexate) for about two years now, I believe. Her joints seem quiet for now, and her eyes, as my last post indicated, are clear for the first time in a very, very long time. However, my husband's employer changed insurance contracts. Changing from one very reputable company to another very reputable company, with the promise that the coverage is nearly identical. The changeover date was July 1st. Since we had ample notice, and since Anna had an appointment with the rheumatologist in early June, I mentioned this change to him. He promptly gave me the name and contact information of the administrative person in his department who takes care of all of these specialty medications (like Humira), with advice to call her as soon as I received the new insurance cards and information.

So we did all of that in early July---got the name of the specialty mail order pharmacy which this new insurance company uses, gave the information to C.L. (the administrative person), and had a few conversations with customer service reps for the insurance company as well as C.L. (Oh, and before July 1st, I made sure that I ordered one more delivery from the previous mail order pharmacy, so that we would have a good supply as we make these changes.) So C.L. called me this afternoon. The new insurance company has denied the Humira. They say that it's not a medication to treat Juvenile Arthritis, and besides that, their limit on Humira is two syringes per month (we've been getting four--Anna gets a shot every 10 days).

So I said to C.L., "What's the next step?" She said the next step is to appeal--their department (and Anna's doctor) will go to battle with the insurance company. Can I tell you that I'm not all that upset about this yet? (I think my husband was rather perturbed---usually our reactions to such things are the other way around!) Right now I'm feeling rather calm, thinking that this insurance company does NOT know how many children are being treated with Humira, and it's making a huge difference when other medications have stopped working (at least in Anna's case---she doesn't have many options left). Maybe another reason I'm not too upset right now is that I remember when Anna's pediatric rheumatologist first prescribed Humira for her. He was telling me that the insurance companies usually reject it at first, but they go to battle, and he said (with confidence), "We always win."