cost of remicade

 I just found out my united health care insurance does not cover remicade. Does anybody know anything about the cost i'm about to inherit? April 14th I get another scope which my body is telling me I will fail so the next and last choice is remicade. This was determined by my dr. since i've pretty much exhausted my other options. I'm hoping to delay the start of remicade until July when i can establish a new FSA withdrawal plan. Any help will be greatly appreciated. Just found this site accidentally somehow last month. Thank God!!!! Just got computer 1 year ago. Thank God for the internet!!!!  Suffering 21 years with ulcerative colitis induced by ibuprophene taken for joint pain 1988. After 1 week of ibu I was bleeding and still am!!!

Thank you Gardenerjames!! I knew it wasn't going to be cheap. I noticed your on your 12th. Does your insurance cover it? I'm still in a the shock stage cause i only found out about my insurance situation a half hour ago via their website and confirmed by my hospital billing agent our friend since we talk to each other so much fighting billings. I suppose i can wait til monday and ask my dr. but do you have any idea about the determination of remicade amounts and or # of infusions?

I have received Remicade via 3 different insurance companies. All of them paid 80% until I had reached my yearly maximum out of pocket (between 1,000 and $2,500). I would have your GI look into preauthorization. That's usually what you need to get your Remicade covered. Don't count on what you read on their website, I'm pretty sure it's meant to make you think they won't pay for anything.
I now have insurance through the Washington State Health Insurance Pool, which provides coverage for individuals who have been denied coverage by a provider. it's a little expensive but the coverage is GREAT. I am allowed 8 infusions per year by my insurance (I only need 6)
When I get my Remicade at my GIs office it is billed at $5,000 and insurance negotiates it down to about $3,000. When i have it at the hospital (due to some scheduling conflict at the GIs or whatever) they bill at $8,000 and insurance negotiates it down to 4 or 5,000. There was a thread on the bulletin board here sometime in the last week about the makers of Remicade helping to pay for your first year of treatments. I would try to find that post cause there was good information about that.
James

I just got OK'd for the Remistart program, but its a short term solution. If only covers you for a year than you SOL

Be sure your doctor has appealed the insurance company's decision. Then call customer service yourself and ask why, what clause in your policy excludes it. I have UHC also, but probably the policy coverages are different. What I have found is that they have a tendency to deny things that are expensive, but sometimes if you appeal and ask for explanations, etc, it helps. The cost of Remi private pay is just prohibitive. Mine is over $8000 including all of the charges.

I hope you can find a way to get this covered. Not many of us could afford $30 - 50K a year for treatment.

Newby here.

Its a shame that remicade is so expensive in the US.

I am a canadian living in england and all medication administered in hospitals here is free on the NHS.  I have now had 5 remicade infusions and not paid a penny. Im not gloating, its just shocking how expensive it is for you.

On the down side, I havent seen the light of remission for the entirety of the three years I have been diagnosed, though I have managed to get my weight back up to 180lbs by going to the gym.  It seems the only way for me to keep weight on is to work out hard.

Mine inusrance is the same way but my out of pocket is 10000. One infusion takes care of my year. I"m planning of taking full advantage. I'm going to see every doctor I can! I even have a EGD scheduled cause it's been 18 years since my GERD dx.

I totally agree with Judilyn. She said, "Be sure your doctor has appealed the insurance company's decision. Then call customer service yourself and ask why, what clause in your policy excludes it."

If your insurance has denied the treatment, talk to your doctor (more than once if necessary) and contact the insurance company. If the treatment is medically necessary and you have insurance, then they should help pay for it. I have independent health and they wouldn't cover one of my prescriptions until I called the doctor 2-3 times and they explained that it was a medically necessary treatment. Good luck!

No. Nothing. I don't have copays. Once i reach 5000 we pay 20% til we reach 10000, then nothing. It sucks and yet is good. It's bad when I am in remission and have to pay almost 800 a month for my prescriptions but the years where ther is a colonoscopy thrown in and it's not so bad. Add an infusion and i'm visiting every doctor i can find. But seeing as how the 10,000 is a fourth of our income....not good. this plan also costs about 5000 a year in premiums (and that's just for me, my husband is compd by his work). Thank God I have parents that can help. I hate asking them but they love me and have the cushion to be able to help. Someday I will write a book, make millions, and buy them everything they could want.

Gardener James

Is there any way I can e-mail or private message you? (you will have to tell me how to private message, but I know about e-mail). I am dependant on my son. He needs to be able to move to Washington state for his work but my health insurance problems have kept him from moving ahead. We have heard about the high risk pool, but there is another thing for even lower income, under $1700 a month, Basic Health or something. We have been trying to find out about it. On the internet it seems too good to be true. I am trying to find out what the catch is. Maybe it is being poor enough to qualify for it! I am eligible for it.

ktownharry -- I have been on Remicade for years now (at least 3, maybe more, I can't remember when I started). At first they were about 5,000 - 6,000 a pop. Now they are over 10K! Its outrageous to think that even an extremely wealthy person would have no problems paying this. Your situation is a bit different than mine, however, but I think you will nevertheless benefit from this info.

There is a program, funded by the government (through tobacco taxes, believe it or not) called the "Major Risk Medical Insurance Program" http://www.mrmib.ca.gov/mrmib/MRMIP.shtml . It is specifically for people who have been denied health insurance due to a pre-existing condition. Once you "graduate", insurance companies must accept you at a price no more than a 10% higher from the MrMIP fee. I'm not sure how it works for people who have insurance, and have been denied particular coverage -- that you'll have to look into -- I would think it would relate to a Dr's pre-authorization. Its not cheap, I pay around $500 a month, but the alternative is simply not an option.

Its been a blessing for me, as I have not had to be roped to a job in order to keep health insurance. Anyway, as screwy as our country is, I would not want to have Crohn's Disease in too many other places.

atom

Post Edited (atom12) : 11/23/2008 3:39:49 PM (GMT-7)

I think the remistart program pays for all but $150 of it. And they sent me a thing to renew this year, so it sounds like you can use it more than one year. There was also another program that I didn't use and can't remember the name of. I got lucky with my ins and am SO thankful for it. It is so expensive.
So sorry you have to deal with this.