United Health Care Sucks

I was just forced to change insurance from Medica to UHC. I was covered for bags and supplies almost 100% with Medica and now I'm not covered at all. I pay the same amount , but UHC says they do not cover supplies that you can buy over the counter. The person i talked to on the phone told me that my condition is not major. I asked her if I should than make my own bags out of sandwich bags. She was not very understanding. My ostomie nurse told me to do everything in my power to switch away from United Health Care. She said they are the worst insurance in the business and the have gotten complaints from all kinds of patients. Has anyone had this problem? I really feel bad for those without insurance. My bill this month out of pocket will be 150.00. Life changes everyday. I have the option of getting the j-pouch. Do you guys with the pouch think thats a good move. Atleast i would not have to buy supplies. Thanks, Westcoast Joe    P.S. Atleast my Gopher hockey team is still #1

Thanks for the heads up re: UHC.  I'm eligible for Medicare this spring and am looking at options for supplement insurance.  If anybody is really happy with their supplement company, please point me in a reliable direction.

UHC Insurance and their lack of paying for ostomy supplies is a well known issue and one the UOAA is currently trying to rectify. Read about it at http://capwiz.com/uoaa/issues/alert/?alertid=90260

                   

Good luck.

mrz.B: I think the problem here is that they've been led to believe your disease free when in reality, you're in remission. Your diagnosis is still crohn's. Have your doctor intervene on your behalf - he/she should be able to straighten these people out.

I know the bummer of changing insurance plans...I have changed mine about 4 times in the last 3 years. with a lapse of coverage here and there. It is always a nightmare. The worst part for me, most plans now have a new deductible plan for "self-injectable" medications. Previously, Aetna Health would only charge me my regular brand name deductible for Humira ( take 2 40mg syrings every two weeks) so I was out $40 a month. No big deal to feel better, right? Then I changed to Blue Cross, and now to Healthnet. Both of those companies have a 70/30 split for "self-injectables". At the current cost for Humira, which is more than Remicade, it costs about $5000 a month retail. While Humira is an awesome medication that has had more benefits for me than anything else I have ever taken, in over 15 years with Crohn's, I could not afford $1200 - $1500 a month for my share of the cost.

So I called Humira's Patient Assitance Program. They told me since I have insurance (good or bad, does not matter) I am not eligible for the Assistance Program, but they will help me with the approval process with my ins. plan.

The problem was not that my plan denied me, it is that the copay is too darn high, even with the approval. So, I asked for an appeal application and wrote a three page heartfelt letter to the program directors, and the CEO/Board of Directors for Abbott Laboratories (Humira's maker). Lo and behold, I received a call a few days later that they were "reviewing my application for an exception". Another few days later they called and have just sent me a FREE 3 month supply (that's 15K worht of medicine, just cause I asked twice)

I know it is a different scenario you are talking about, but at least the lesson is....give it all you got, fight the good fight, and you may win a battle or two every now and then.

By the way, if you have not heard of Humira as treatment for Crohn's, ask your doctor, it was just approved by the FDA this month for treatment of Moderate to Severe Crohn's disease, when other medicines have not been effective. Humira is basically the next generation of Remicade. It works the same way, but is more tolerated by your immune system, and so you won't develop antibodies for the medication itself.

Unfortunately, I had gone too long without it, and now I will have an ileostomy scheduled for April 20th, with or without the Humira.

I know inside that it will work out for the best but I am thinking about it everyday. Now I hear about the J-pouch deal and think maybe I should ask my doc about that.

but wait, that means revising the authorization I just received for the ileo operation from my healthplan!!! that was a pain to get that authorization to begin with....such is life, I suppose. just one foot in front of the other.....

whatever, you do, if you can buy Aetna Health insurance, do it, they were the best!!!!

I guess I will be going through all of these supply coverage issues soon, since my surgery is coming up....I wish there was a store you could shop at, not just online, where they sell al this stuff and you can look at it before buying it. I just want to go see this stuff ahead of time....

Talk to you all later......

Nathanael from Sunny Southern California

What a bummer about the insurance plans! As I understand it, the only way you can get out of preexisting condition exclusions in California is to join a group plan through your employer, there are other rules about having had to have had continuous coverage and such, but the rules are confusing and it is difficult to find one place you can learn about all these rules, let alone keep up with the changes that happen to these rules on a constant basis.

The worst part, as you know, is that you can ask the insurance companies themselves a question, but they give you a different answer every time you ask.

try going to this website, www.ileostomy-surgery.com or http://www.bcirostomy.com

They can perform a BCIR surgery. This converts a ileostomy into an internal pouch that you drain yourself with a small tube. It is pretty amazing. However, not everyone is a candidate. Their website says they help with the insurance authorization process. Give the doc a call.

I get my temp ileostomy in 5 weeks. Fortunately, I have insurance in effect and they will cover the whole cost.

Good luck and keep your head up.