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Need help. Remicade Infusion delayed due to new insurance

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Ulcerative Colitis
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Posted 1/31/2016 4:42 PM (GMT 0)
I've been successfully using Remicade to control my UC for the past seven years. The last 3 years since I moved I've been having it administered at a hospital. This year I had to change my insurance due to my COBRA expiring and the new insurance is giving me a hassle. After much back and forth I finally got a letter denying me, saying they will not cover it in a hospital setting and they MIGHT cover it at a center or an at home infusion. Meanwhile while trying to get this approved and now looking into an infusion center (and the insurance is still dragging it's feet), I'm getting way overdue for my infusion and my symptoms although not terrible yet, are starting to creep back. How long can I go before I develop antibodies? Maybe I should look into another drug. Has anyone successfully switched from Remicade to something else? What can I do in the meantime before I go into a full blown flare? Any help appreciated.
Posted 1/31/2016 5:12 PM (GMT 0)
Is traveling to another area an option? It took a lot for my insurance to cover my first infusion in the hospital, so the hospital covered the cost for me. Now I go to an infusion center. Are you in a major city or close to one? I'd think you could find a center if that's the case. Best of luck!
Posted 1/31/2016 5:26 PM (GMT 0)
Call your doc and have them advocate for you. While you can always develop antibodies
Once the levels of remicade get low you can develop antibodies more easily. When treatments are episodic then this occurs

https://www.2infuse.com

This site shows infusion centers near you. Keep calling insurance and don't give up
Posted 2/1/2016 3:27 AM (GMT 0)
Thanks, I finally found an infusion center but the insurance is still referring to the letter that said I was denied. I faxed it over to the infusion center where it specifically says they may cover me if it is not in a hospital setting and the advocate is sending it along. It's the waiting that's killing me. The wheels are turning very slowly and I'm afraid I don't know exactly how long I can wait until this is resolved without causing major problems with my remission. Remistat has always helped me in the past paying for my deductible and then I was free and clear after that for the remainder of the year. I just wonder how long I can wait until it does major damage and what if anything I can do medically or supplementary in the meantime.
Posted 2/1/2016 4:26 AM (GMT 0)
call the insurance company and explain what is going on. if you are not given instant approval ask to speak to a manager.
I dont know if you are on twitter buts sometimes tweeting the insurance company helps. especially if others like and retweet. in the days of PR they want to look good and sometimes it will make them work quicker
Posted 2/1/2016 12:49 PM (GMT 0)
at one point when I was having insurance issues with Remicade my doc got on the phone and raised hell with them and got it approved
Posted 2/1/2016 1:33 PM (GMT 0)
Have you spoken with the Remicad Support helpline? Remistart.

Are you taking 6-mp/imuran? That can help you from developing Antibodies.
Posted 2/1/2016 3:42 PM (GMT 0)
I had flu like symptoms when I tried the Imuran way back when before starting Remicade so they dropped it. I'm not sure what Remistart can do about this but I can call them. I'm getting in contact with the new infusion center today and seeing if they responded to them yet but I'm told the insurance can take at least another 3-5 days if I'm lucky. Unfortunately, for a fairy large city, there is only one group of gastroenterologists in my area and they have so many patients they don't take a personal interest in you to fight for you (if you can even weed through their phone trees and get a hold of anybody).
Posted 2/1/2016 3:46 PM (GMT 0)
Ugh that is frustrating. You need to fall enough to bug them into getting you your medicine. It is their job. You pay them big bucks to do so
Posted 2/1/2016 7:28 PM (GMT 0)
GDfairy,

Remistart wants you to continue on their product, maybe they can facilitate getting your insurance approved or even give you a free dose.

I go to a large GI practice, they have a nurse who coordinates the infusions and approvals with the insurance companies. They handle all of that stuff for me.
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