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Update on Remicade

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Posted 2/25/2010 6:39 PM (GMT 0)
So I applied for the RemiStart program a week ago. Today they called me and said that I'm not eligible for the program. Why? Because when they talked to Aetna, they said that all I would have to pay is $50 which would cover the infusion, etc. AND if I get Remicade via the Aetna pharmacy they would completely cover the cost of remicade for 30 days (the only downside is the second infusion which is 2 weeks after the first one).

But, I'm going to call and confirm this (I got the reference number that they used when they were talking with Aetna from the Remistart rep) and if what they say is true then a world of stress has been relieved.
Posted 2/25/2010 7:07 PM (GMT 0)
I had Aetna when I was on Remicade. Think I paid like $50 for the actual medicine (I was on the maximum dose) and like $75 for the infusion at the hospital. I thought about calling about the Remistart but I was thinking your out-of-pocket costs had to be at least $100 for the medicine alone and I didn't meet that so I didn't bother.
Posted 2/25/2010 10:10 PM (GMT 0)
I was on Remicade for a long time and never had to pay a thing -- hospital medications are covered 100% by my insurance, so it was actually cheaper than my other meds I had to get from the drug store.
Posted 2/26/2010 3:21 AM (GMT 0)
Ya'll have really good insurance. I have to pay my entire deductible and out of pocket before I can order my meds. I started Remi last oct and had to pay. $4400 up front. Luckily I did qualify for Remistart. I was refunded about $1100.

Bad news is I have to start all over this year. Paid my $1875 deductible before my infusion January 25. (I ordered the meds the last week of 2009 to avoid having to pay that right away) My next infusion is March 11 and I am about $900 short of my $1600 out-of-pocket.

The upside is once this is paid I don't have to pay any more on doctor visits, procedures or Remi the rest of the year, not even co-pay.

Just a lot to pay at once.
Posted 2/26/2010 8:49 PM (GMT 0)
Nevermind. Called my insurance and they confirmed it (sorta I would have to meet my pharmacy deductible of $500 and then Aetna would pay for the medicine itself).
Called the place that I would have my infusion at and they told me that they are only able to bill the insurance company via major medical (which my deductible is $5000) instead of just the pharmacy deductible.

Now I don't know what to do :(
Posted 2/26/2010 9:59 PM (GMT 0)
Still a good deal, for a year. But those high deductible plans are tough (and dumb if you can't pay it).

It's your choice where you have your infusions, call around to hospitals, GI offices, infusion (chemo) centers, etc. Comparison shop, it's allowed! Just because your doctor says go someplace doesn't mean that's your only choice.
Posted 2/27/2010 12:40 AM (GMT 0)
Yea I'm trying to find a different plan with Aetna or I'm going to try and go to a different company. The only thing I'm worried about is pre existing condition. I've never had a lapse in converage so if I switch companies can they get me for pre existing condition?

Edit: btw, I have an individual health insurance plan, not one via employer or group.
Posted 2/27/2010 12:45 AM (GMT 0)

MACGIRL said...
Ya'll have really good insurance. I have to pay my entire deductible and out of pocket before I can order my meds. I started Remi last oct and had to pay. $4400 up front. Luckily I did qualify for Remistart. I was refunded about $1100.

Bad news is I have to start all over this year. Paid my $1875 deductible before my infusion January 25. (I ordered the meds the last week of 2009 to avoid having to pay that right away) My next infusion is March 11 and I am about $900 short of my $1600 out-of-pocket.

The upside is once this is paid I don't have to pay any more on doctor visits, procedures or Remi the rest of the year, not even co-pay.

Just a lot to pay at once.

wow thats a huge deductible. whats your monthly payment? Im getting my insurance through state and pay $350ish but my deductible is 500$. Surprisingly my remicade is fully covered by kaiser and i dont even have to pay for the infusion clinic visit. Im not sure what Id do if I had to pay $4500 upfront every year.
Posted 2/27/2010 6:25 PM (GMT 0)
Last year I was paying about $70 a month through my work. I changed my plan to the lowest out of pocket this year and now I am paying about $150 a month.

Doz79 said...

MACGIRL said...
Ya'll have really good insurance. I have to pay my entire deductible and out of pocket before I can order my meds. I started Remi last oct and had to pay. $4400 up front. Luckily I did qualify for Remistart. I was refunded about $1100.

Bad news is I have to start all over this year. Paid my $1875 deductible before my infusion January 25. (I ordered the meds the last week of 2009 to avoid having to pay that right away) My next infusion is March 11 and I am about $900 short of my $1600 out-of-pocket.

The upside is once this is paid I don't have to pay any more on doctor visits, procedures or Remi the rest of the year, not even co-pay.

Just a lot to pay at once.

wow thats a huge deductible. whats your monthly payment? Im getting my insurance through state and pay $350ish but my deductible is 500$. Surprisingly my remicade is fully covered by kaiser and i dont even have to pay for the infusion clinic visit. Im not sure what Id do if I had to pay $4500 upfront every year.

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