So annoyed with my insurance

I started Remicade little over 5 years ago. I used to have it done at the hospital with no insurance issues. But than switched to a cancer infusion center because I moved and it was closer. Even tho it's an infusion center it's still attached to the hospital and once again no insurance issues. I than received a letter from the insurance company that I now have to have it done at an ambulatory infusion center, at a doctor's office or at home. Due to cost issues.

I had my Remicade today and talked to the coordinator and she said that most insurances are doing this now and if it's a medical necessity they will allow infusions done in hospitals but the GI doc has to appeal it.

I called my GI's office today and they are going to set me up at an ambulatory infusion center. But here's my problem....when I moved and requested a center closer to me, my GI was adamant about me being infused with a full staff hospital unit. I had a bad reaction after my 3rd infusion and now require pre-meds of Benedryl and Solumedrol not to mention that body was chaotic and I needed close monitoring due to my past BP spikes, breathlessness and chest pain.

I haven't had an issue in 2 years tho - so my question is...should I just see how I do at the ambulatory infusion center or demand my GI appeal? I don't know what to do.

How long do you have until your next infusion is due? I'd start the appeal and maybe it might go through in time. If you end up going to the ambulatory infusion center then just give the monitoring nurse the heads up about possible reactions and make sure they can have the benadryl and Solumedrol ready for you there. Always good to research both sides and see what ends up working for ya.

Incredibly I had to read your post three times before I got it...that's what Prednisone does to you!!

Honestly, in your case, even though you have been fine for a couple of years I would opt for the hospital. Allergies are unpredictable and wouldn't you feel more relaxed knowing that your in the best place if something should occur.

Can you say what happened on your third infusion? I do worry about the same happening to me.

Are you a redhead with really white skin? ....cos often with that kind of colouring we are prone to allergies.

Make sure there will not be a greater cost to you with a non hospital setting. I don't know how your insurance works but my medical and prescription are separate. In a hospital setting my entyvio is covered under the medical side but if it was in the drs office the cost of the medication would be covered under the prescription side with a much higher cost to me. Something to check into! Remember ins is looking out for their costs, not your welfare or pocketbook