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New Remicade requirement

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Ulcerative Colitis
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Posted 7/17/2014 2:47 AM (GMT 0)
I have been in remission for about 5 years with Remicade. In that period, I only have had two colonoscopies which came back good. Now my GI says that in order for insurance to cover Remicade, it has to be proven that the Remicade is working and a colonoscopy is required every year now. Does anyone know if there is any truth to this? I have SUCH difficulty with the prep that this will be difficult for me. I'm only 29 years old and can't imagine having to get a colonoscopy once a year for the rest of my life, especially since I have been in remission.
Posted 7/17/2014 2:56 AM (GMT 0)
What insurance company are you with? Maybe its a new thing, but I never had a colonoscopy while I was on Remicade
Posted 7/17/2014 3:00 AM (GMT 0)
New news to me, I don't buy it.
Posted 7/17/2014 3:03 AM (GMT 0)
Its just not safe to require one every year. Not only does it increase the chances of serious complications, but for many people it can induce a flare. If your insurance company is making you do it, have your doctor write them a letter telling them to get educated and use their heads a little
Posted 7/17/2014 3:07 AM (GMT 0)
I am on Horizon Blue Cross Blue Shield. Do you think I should contact them?
Posted 7/17/2014 3:08 AM (GMT 0)
Also, he said every year and a half originally. 6 months later he said a year and when I told him he originally said a year and a half, he acted surprised and said "ok, I'll let you go for a year and a half." That seemed a little skeptical to me. The thing is I've been with him since I was diagnosed in 2005, but this whole thing seems unnecessary to me..

Post Edited (trixi491) : 7/16/2014 9:18:04 PM (GMT-6)

Posted 7/17/2014 4:34 AM (GMT 0)
have not heard of any such requirement.  I would call insurance and ask them.  Is it possible doc is just wanting more business?
Posted 7/17/2014 4:46 AM (GMT 0)

happyday said...
have not heard of any such requirement. I would call insurance and ask them. Is it possible doc is just wanting more business?

This was my thought as well
Posted 7/17/2014 5:08 AM (GMT 0)
Yeah, this sounds sketchy to me, especially considering you have Blue Cross. I've only been on Remicade 16 months, but I haven't had a colonoscopy during that time, nor has my GI suggested I need one because of the Remicade.
Posted 7/17/2014 12:24 PM (GMT 0)
It sounds like the insurance company wants to ensure that the Remicade is effective, and the only way your doc will sign off on it is through a scope (rather than by symptoms). I ran into this sort of thing with a former GI.

Symptoms is the way to go.

Posted 7/17/2014 12:28 PM (GMT 0)
I would definitely contact your insurance company directly.
Posted 7/17/2014 12:52 PM (GMT 0)
Ditto contacting the insurance company. You need to hear it straight from the horse's mouth and I doubt you will.
Posted 7/17/2014 11:41 PM (GMT 0)
Contacted Blue Cross Blue Shield who kept contacting different people in different departments and I couldn't get a direct response from anyone. The final person they talked to said they couldn't give an exact answer, that it depended on certain factors. I have no idea what that even means. UGH
Posted 7/18/2014 12:28 AM (GMT 0)
In Canada, it's common here for our GI's (most of them at least) to scope IBD patients at least once a yr, every GI here has their own protocol...it doesn't sound suspicious to me at all.
Posted 7/18/2014 12:29 AM (GMT 0)

trixi491 said...
Contacted Blue Cross Blue Shield who kept contacting different people in different departments and I couldn't get a direct response from anyone. The final person they talked to said they couldn't give an exact answer, that it depended on certain factors. I have no idea what that even means. UGH

Well if its not clear on their end then it shouldnt be an issue; they cant make you do something this invasive if they cant even give you a conclusive answer.

Did they say what factors? You should call back and ask them to elaborate so that there are no surprises.
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