I've been taking Enbrel for well over a decade, so I'm used to the runaround that (USA) insurance companies give you whenever you change jobs or change insurance plans. They do anything and everything in their power to try not to pay for these biologics. Now I've just seen a new strategy and it only decreased my already rock-bottom view of them.

So first of all, this time I have not changed jobs, nor have I changed plans. Been on this plan for several years. Last week I went to THEIR online pharmacy (which I hate, but they force you to do things their way) to request a refill of my Enbrel. Yesterday I got a letter in the mail - yes, a SNAIL MAIL letter from United Health Care (my insurance). They sent me a pre-approval form, claimed that my doctor neglected to provide that information to them and that I needed to chase after my doctor to get on it. Here's the funny bit: this paper snail mail letter said that my doctor MUST provide the info within 24 hours or they'd decline the Enbrel.

Um, 24 hours from when? When they mailed it, when I received it? Or just some bs pretend 24 hour interval? Well, I called my doctor's office yesterday and asked them to call the insurance asshats. But today I got the answer to these burning questions....

Recieved another PAPER, SNAIL MAIL letter, this time from UHC's bs pharmacy manager (which I hate with the force of a thousand suns), telling me that since my doctor didn't provide details of trying less expensive meds first (basically what they wanted in the pre-approval), my Enbrel is now declined.

tl;dr: Wednesday get paper letter requesting info within 24 hours, Thursday get paper letter declining coverage

Edited to add: I'm going to file an appeal since they so "nicely" included instructions for how to do that (by paper notice, OF COURSE). I'm also going to file a complaint with my state bureau of insurance companies. Oh, and provide all the same into to my husband's HR team (it's his insurance). I'm too old and cranky these days to take this kind of shit lying down. So my fun task for today is pulling together names and dates and other pertinent facts.

Another edit: I just (unprompted as I was busy with other things) got a phone call from someone at the pharmacy benefit manager (OptumRX) saying that she was going to help me and my doctor with the appeal. I was like "that's nice but sending me a letter with the 24 hour notice is not cool so I'm going to file a complaint". We discussed and I convinced her that yes, the letters were on Optum letterhead (she tried to say they came from UHC) and that although they were dated last week, I didn't get them until yesterday and today (because, hello, postal mail). I got her email address and sent her scans of them. She said she was shocked and didn't know what was going on. Checked a few computer systems and found no evidence that they'd made any contact with my doctor. She wanted the scans so that she could talk to her boss because if this is happening to me it's likely they're doing it to other people too.

I'm sure it's just bureaucratic mix-ups but that's really no excuse for snail mailing notification of a requirement that has a 24 hour deadline. And then snail mailing another notification one day later letting me know my claim was denied. It kind of blows my mind how the people who work inside these companies have no bloody clue what's going on.