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Cigna and Remicade?

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Crohn's Disease
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Posted 8/15/2009 8:03 AM (GMT 0)
In 30 days I will be with Cigna's HMO plan (I don't know what tier yet), as I have switched from self-employment and Medicaid coverage to a FT job with good benefits. In the past I have had to maintain a very low income so that I could qualify for Medicaid. My son has severe Crohn's and takes Remicade every 6 weeks. Medicaid paid every penny, but living in poverty to get my son the treatment he needs was very hard on all of us.

Anyway, does anyone have any experience with Crohn's and Cigna? I'm very worried that it will end up being a huge hassle to 1) get my son approved for Remicade, and 2) worried that co-pays will drag me right back into poverty.
Posted 8/15/2009 12:05 PM (GMT 0)
My husband and I have Cigna (but it's the PPO not the HMO).  He had no problem being approved for Remicade.  I think we paid a $20 copay for the office visit but didn't have to pay anything for the medication itself. 

Hope this helps :)

Posted 8/15/2009 5:34 PM (GMT 0)
Phew! I hope that's how it shakes out for us as well!
Posted 8/15/2009 6:54 PM (GMT 0)
My husband and I have cigna (PPO) as well. He had no issue being approved for Remicade. Our out of pocked expense is also just the co-pay for the office visit - $40 in our case. Ironically, remicade is cheaper than his other medications in terms of what we pay out of pocket. I hope that'll be the case for you as well.

PV
Posted 8/15/2009 7:02 PM (GMT 0)
Are either of you enrolled in Well Aware, their program for people with chronic conditions? Is this helpful, or just another one of those programs that doesn't really do anything but mail you a bunch of stuff about IBD?
Posted 8/16/2009 2:48 AM (GMT 0)
I don't know what Well Aware is. We were enrolled in something though because when my husband was hospitalized some nurse through Cigna called us once or twice a month to check in. Although I'm sure the program is meant to be helpful, it was really just annoying. It was too stressful of a time to have to chat with her about how he was doing--no matter how well intentioned it was. Eventually, we ended up not answering the phone when she called :)
Posted 8/16/2009 3:08 AM (GMT 0)
I assumed it was just another group within Cigna working really, really hard to contain costs with horribly expensive patients and wondered what to expect from them.

I really do not want or need the phone calls, either. Annoying and invasive.
Posted 8/16/2009 12:40 PM (GMT 0)
One thing to be careful with Cigna (at least in my experience) is they would often deny claims of things that should be covered. My husband's first surgeon, for example. They rejected the claim saying it wasn't "medically necessary"--even though his colon had perferated. Also silly things, like certain medication's he received in the hospital, CAT scans or ostomy supplies. It was all cleared up after I talked to them on the phone but they'd often try to say it wasn't covered first until I pushed it. For instance, about a month ago, they rejected a claim for his ostomy supplies (even though we'd been getting his ostomy supplies covered at 100% for the past 5 months). I had to reiterate that, and they resubmited the claim.

In the end, I'm very happy with Cigna and their coverage--but sometimes you have to fight with them to get them to pay for what they're supposed to. At least in my experience.
Posted 8/16/2009 5:07 PM (GMT 0)
When my husband was in the hospital, they automatically put him on the well aware program - it was darned annoying. A cigna nurse would call you all the bloody time to ask you questions about whether you were taking your meds, etc. We asked them to take him off that program, and just stopped answering the phone when it said cigna.

They haven't called in a while . . . so maybe he's off that program. Also, they approve my husband for remicade for 8 infusions at a time, ie. they authorized 8 infusions, then after that the remicade nurse has to call back for more once those 8 have been done. And once, they said the infusion wasn't covered - we called them, and they said they'd made a mistake, and everything was ok.

I have never had to work with any other health insurance company - we were both healthy when we were insured by other companies, so they are the only health insurance company I have experience with. They do sometimes need a push to do the right thing, plus you get different answers everytime to talk to one of them on the phone (so I asked them to send me a letter home, instead of taking anything they say to be true, so that I have something in writing from them). But all in all so far, they haven't let us down.

PV
Posted 8/16/2009 5:08 PM (GMT 0)
This is all great info-- thanks so much.
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