u/Alternative_Air_1523

I’m recently diagnosed with Crohn’s and hopefully starting treatment soon. My doctor submitted Skyrizi to my insurance for treatment, which they denied. They determined that the medication was not medically necessary. I’ve read multiple posts about insurance denying treatment.

I have blue cross blue shield and am curious about others experiences fighting insurance for treatment? Is this going to be an excessively long process? My doctor warned me that it isn’t uncommon for insurance to deny treatment and that seems wild to me. I called my doctors office and they said they would appeal the decision on my behalf. I’m just frustrated that it’s already been nearly 2 months since I was diagnosed and treatment doesn’t feel relatively close to starting.

A little backstory here. I’m 34 and for as long as I can remember I’ve had bowel issues. As a kid when my parents brought it up to my doctor it was brushed off as IBS and I managed with Imodium.

I learned how to manage it as my urgency for a restroom really only appeared in the short period after eating. So naturally if I was going out, I’d eat as little as possible to prevent any issues. I still had my bad days where it didn’t matter if or how much I ate but it wasn’t terrible. Fast forward to 2018/2019 I started getting random fevers. They’d last about 24-48 hours and go away. Since the fevers didn’t last long and I was deployed at the time, I figured it wasn’t environment related and never thought anything of it. The fever came back almost at an annual basis until last year where I started getting them on a quarterly and then monthly basis to start this year.

I had a fever for most of the month of March this year. I ended up in the hospital with sepsis for about a week and then had a couple more weeks of antibiotics through IV after I was released. In the hospital while looking for the source of my infection, they found inflammation in my abdomen and upon a colonoscopy they said it appears I have Crohn’s based on the biopsy they did and with my GI follow up, she recommended biologics for treatment due to where it’s located in my small intestine.

I know I’m not a doctor but I’m having a hard time accepting this as a diagnosis. Aside from frequent use of the restroom, I don’t have pain or blood or anything. I get that I have inflammation and my most recent labs showed high levels for my calprotectin so clearly something’s wrong. It just felt so quick to diagnose and jump to treatment options. I have an MRI scheduled next week so maybe that will tell more of a story too.

I’ve lived like this for so long that the frequent trips to the restroom became my norm. I haven’t dealt with any serious health issues before so I think it’s just overwhelming to accept this and start medications when I don’t feel any different than I have for most of my life. Aside from the fevers, of course. Those haven’t come back since my hospitalization luckily.