Insurance and Crohn's Treatments

While I am not completely educated on your personal insurance plan, I would not be too worried about the majority of your tests being covered. Remicade on the other hand, may be little harder to get approved if you have not tried and failed on all of the lower classes of medications. Most doctors offices will make sure that your insurance will approve it before they actually prescribe it. I was in the hospital and be being diagnosed with Crohn's when I was approved for Remicade. It was actually my first real crohn's medication that I ever used. When I changed insurance companies a year later, I had no problem getting approved for continued use because I had been on it for so long. Make sure that you find out how much your insurance will cover before you receive your first infusion. It all depends on your dose and how much you weigh, but my remicade was really expensive for my insurance company. It ranged anywhere from $10,000 to $17,000 an infusion because I was on the 10 dose every 4 weeks. Luckily, I only had to pay $25 for the hospital IV Therapy and the medication was completely covered. I have seen many posts on here about people have to cover 10% to 20% which can get very expensive.

I did when I was trying to get approval for humira, but they accepted it in the end. Probably for the very reason randy mentioned and the fact that my doctor was very persistent in the case.
If you have any problems just keep trying and make sure you have a doctor that is wiling to fight for you.
Best of luck!!

Hi there Indigo,

I have the same insurance as you and actually I had to postpone a capsule endoscopy I had scheduled for yesterday for next Tuesday because they were dragging their feet on pre-authorizing the procedure.  With that being said even with all of the roadblocks they throw in the way the insurance company eventually approves what is needed.  Often times it just takes a savvy doctor or office staff to reword the prescription or orders so that it will get their approval. 

Good luck with the remicade... 

Thanks for your replies!

Gracie, I had the very same issue before my small capsule was done a few months ago!!  Thank goodness they approved it and I was able to get the procedure done!

I get nervous because my Serology 7 test was not covered and I worry about other things not getting covered that I might need. 

Great point though, Linjade.  I am very thankful I have insurance.  Just disappointed I ended up with such a dang expensive disease!