Insurance co. denied humira for me, have to write an appeal letter

[Randypiper]

Humira isn't approved by the FDA for ulcerative colitis. I had great results with remicade but after 18 months developed drug induced lupus. My gastroenterologist and rheumatologist both recommended humira. All my records were submitted but Highmark denied it. I have 6 months to appeal and I’m considering getting professional help to write the appeal letter but don’t know how to find someone trained for this. Has anyone done this?

[Autumn Colors]

1. Ask your gastroenterologist if (s)he will write something

I do medical transcription and one of my clients is a gastro practice. They write appeals letters for their patients quite often. Call your doctor and tel him/her what happened.

[Randypiper]

2. Humira has to be preapproved

My gastroenterologist is the one who notified me that I was denied. He tried twice to get it for me. Now it has to go to an appeal.

[Autumn Colors]

3. But (s)he could still write the appeal letter

... and it would probably have more of an impact coming from him/her than coming from you.

EDIT: Doctor writes it, you pick up the letter and submit it to the appeals address.

[Randypiper]

4. He's tried twice and hasn't convinced them

This appeal is my last chance and that is why I'm trying to find someone that does appeal letters and knows what is effective.