Appealing My Denial For Joint Pain

[Trigirl13]

Just wanted to post on here and let you all know where I am at with my claim now. I currently was awarded 100% for hypothyroidism/bradycardia and 50% for depression. I was denied joint pain, which really is ridiculous, since half of my service medical record states chronic joint pain in it. So I have a lawyer helping with all this. My biggest concern is getting the medication that I need for my condition, out of pocket costs range from $2500 to $3000, and I just don't have the money to pay for that. I am currently getting samples from the my local doc office ( I have an amazing none VA doc.) and have put in a request through the company to receive assistance with the cost, so I will be covered for at least a year. I will be happy when all this is done, but understand that it is a long waiting game at this point. Thank you for all the support I have received so far and will receive in the future.

[BakerGeckos]

Hmmm your 100% the VA treats your SC and NON-SC conditions once you hit 50% without a co-pay, Call and schedule a VA appointment. I do know that you most likely won't get any of the DESIGNER meds that your non-va doctor has you on without going through all the other older cheaper drugs...

[carlie]

Hmmm your 100% the VA treats your SC and NON-SC conditions once you hit 50% without a co-pay, Call and schedule a VA appointment. I do know that you most likely won't get any of the DESIGNER meds that your non-va doctor has you on without going through all the other older cheaper drugs...

Tri,

Ditto on the above but need to add:

If the lower cost drugs do not work for you as intended - the VA pharmacy can order

what you need if your doc states that the generics don't work for you.

Can you post what RX costs so much ?

[Trigirl13]

Yeah, there is no generic for it, it is called Enbrel and is considered a biologic, it suppresses my immune system( I have to take an auto-injected shot once a week). I will make an appointment. I pretty much have tried everything on the market, found out I was allergic to a few and some flat out do not work. I have to stop taking anti inflammatory medication because after 4 years taking a high dose every day, my stomach lining is damaged. I have been through the trial and error phase with this illness and it has sucked, on medication put me in the hospital because I had such a bad reaction to it, I really hope I don't have to go through that again. This medication has been a God send for me, because I feel like it gives me back my life and I am able to be an active mother again.

[Trigirl13]

So I called the local clinic today and found out they are not accepting new patients in their clinic.

[BakerGeckos]

Hmmm I would then call administration and ask them to continue you with your private doctor since the clnic isn't accepting, You can take you script from your private doctor to you Primary Care Doctor and ask him to authorize it...that's another option....

[Trigirl13]

okay thank you!!