Insurance delaying Remicade

I really cannot wait until I'm married and I don't have to deal with this awful insurance anymore.

I started Remicade back in March of 2013 and in March and September, I got letters from my insurance company saying that I was authorized to receive Remicade treatments for the next 6 months. This March, I never got one. After a couple of weeks, I started making phone calls, and it took until the first week of April to find out that, no, I was not authorized because my provider never sent in the paperwork.

My doctor is awesome and experienced and wouldn't have just forgotten to send in the paperwork. After lots more phone calls, my insurance company said they'd fax the paperwork to my provider (again, they said; for the first time, my doctor said). Then, it took 2 more tries for my doctor to get the fax (I had to call and ask for them to re-fax because it never arrived), and yesterday, finally, my doctor got the paperwork, filled it out, and sent it back. Now I have to call on Monday and see how the paperwork is going.

The stressful thing (besides UGH INSURANCE)? My doctor has me on 6-week intervals for my infusions through my next infusion, and then after that, we'll switch to 8 weeks. However, I wasn't authorized by the time 6 weeks rolled around; this week would have been 7 weeks. So I really, really need my next infusion sometime next week to even stay on an 8-week schedule.

Has anyone had to delay Remicade infusions like this before? That is, wait an additional week or two after you're supposed to get an infusion? My remission has been going on for a while now (about 9 months) and it's a pretty complete remission, but I'm feeling stressed and panicked.

Unfortunately, the infusion center at the hospital is very strict. They're really awesome; if I call Monday, they will find a way to squeeze me in somewhere by the end of the week. But they will not make an appointment until there's authorization.

BCBS delayed mine about 5 months middle of last year. I NEEDed one every 6 weeks. After going through all that I developed antibodies and it quit working. I would like to choke the people responsible but hey they saved alot of money from doing that.

I went through induction back before Remi was approved for UC. My insurance company had given a pre-authorization, but then after three infusions I got a letter saying they would not pay because it was an unapproved "experimental" drug. After numerous calls capped by one full day on the phone talking to offices all over the country, they finally agreed to pay for what they had authorized, but would not cover any further infusions until it was approved by the FDA for UC.

It took me about six months to be able to tell I was slowly slipping back into the flare. Later, when Remi was approved, I was able to re-start the infusions with no problem.

I'm waiting for the insurance ball to drop. We may have a new record here...1st Remi loading dose delivered in hospital at a cost of 14k( just medicine at 10 mgs,6 vials), and the next 2 loading doses, same drug amt. were administered in adjacent clinic. $26,893 FOR each PLUS 2k for misc infusions related stuff. 2 infusions billed at $28,934 each!!! Even my 20% is absurd. Same university system, 2 billing offices,no logical explanation and no one who can answer why--truly I made 10 phone calls.
Delay is not an option. Hope you do not have to delay yours!

Are you in the US? Here in Canada, my GI said that regardless of which biologic I chose money/health benefits (or lack of) would never get in the way of treatment, meaning, if you couldn't afford it for whatever reason, Remicade or Humira would supply it for free.

We did consider getting married for insurance purposes a while back, when my insurance stopped paying for my prescriptions. At this point, since it's a paperwork issue, it looks like the delay might only be a week or so. I only will need one more authorization from my insurance company before the wedding.

Can we get someone to take care of Alexa48? They've posted the same post over and over, and it's unrelated to topics.

 

http://www.foxnews.com/health/2013/05/29/poop-transplants-how-well-do-really-work/

 I went to get more info  about Alexa48 and I got this some people has very little brain.

Mark was responding to the post that has been removed (from many threads).

ScienceGirl,

I'm so sorry to hear of your insurance troubles! Right before Christmas of this year, I got a bill for over $27,000 from the hospital which included 3 treatments that were not covered by insurance! I called my insurance company and found out that they denied my last 3 infusions (which I was unaware of) because they didn't have my records of my TB test (which I had done when I started the treatments) and also told me in writing "it wasn't medically necessary". Since when does an insurance company decide courses of treatment?!

Anyway, I contacted my insurance company, filed an appeal which they said they had 60 days before they needed to respond and I had a treatment coming in 2 weeks. Long short - my doctor's office faxed over my medical records stating Remicade had kept me in remission 5 years and it was imperative that I keep getting them. Conveniently they never received the paperwork. Stay persistent and keep everything in writing! I called my insurance commission and filed a complaint. Also, I contacted my human resources dept and they called on my behalf. Within 1 day, I had an extension for another year of treatments and they covered the other 3. They are bullying you and I would imagine somewhere along the way it's illegal. If contacting your local insurance commission doesn't work, get a lawyer. You need your treatments! Good luck and all the best!

To me that's total bullcrap. The doctors should be deciding the course of treatment, not insurance companies. Maybe this will turn into Obamacare Part II. I feel sorry for doctors who have to treat several different ways due to having to mess around with several different insurance companies, and then they get the blame if a treatment doens't work.

On a side note, I used to know someone who worked for a well known health insurance company (this was several years ago). They were actually paid bonuses to deny treatments, even if they knew the treatment was actually covered by the policy. Anything even close to a gray area was automatically denied. Even though they knew that if people fought it, appealed, and won, the insurance company would still save millions of dollars every year from those they could intimidate and didn't fight or appeal.

I feel so bad for people experiencing a delay.
my insurance required my nurse to send one extra thing over and my whole approval process took 48hrs.

We just sent my Remi-start info in though... so im curious to see how that goes....