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Remicade infusion timing ?

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Ulcerative Colitis
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Posted 5/1/2009 2:38 PM (GMT 0)
For those of you experienced with Remicade, how exact does the timing of the infusions have to be?

I am due for my 2nd infusion next Wednesday but insurance still hasn't approved it. Is there flexibility or does it have
to be exact? I"m feeling better and assuming its the Remicade so I don't want to mess with the dose timing!
Posted 5/1/2009 3:03 PM (GMT 0)
Especially during the induction phase it's important to have them as close to on time as possible. That said, I wouldn't take a chance on insurance denying it, because of the expense. I'd get on the phone and try to prod the insurance company.
Posted 5/1/2009 3:12 PM (GMT 0)

Judilyn said...
Especially during the induction phase it's important to have them as close to on time as possible. That said, I wouldn't take a chance on insurance denying it, because of the expense. I'd get on the phone and try to prod the insurance company.

I did yesterday and they said it was just called in Monday and they have 5 days so I don't even have an appointment yet for the next infusion! I'm wondering about the approval - could they possibly say no, surgery is cheaper! That would be terrible!
Posted 5/1/2009 3:24 PM (GMT 0)
If it's covered by your policy, they can't deny payment. Unfortunately they sometimes find ways to delay it. Since it is FDA approved, their ability to delay is limited. Call them again next Monday, but if your doctor's office is like mine, they won't schedule until they have the written approval. I have asked the insurance company to fax me a copy of the letter, then in turn I've faxed it to the doctor's office (or driven by and given it to them) before. That can save you a day or two.

Don't panic, I feel sure if you have it a week late it won't have a huge effect. I've had my 8-week infusion as much as 2 weeks late with no problems. I'll get a little more frequency just before, but it clears up after my infusion.
Posted 5/1/2009 3:43 PM (GMT 0)
Well at least I feel better that they can't make the decision (to approve or not) based on whether they think it would be cheaper for me to have surgery! I'll call them again on Monday, that will be their "5 days".
Posted 5/1/2009 3:56 PM (GMT 0)
I don't think it'll matter too much either- my loading doses were all screwed up also (not due to insurance), something like week zero, week two, then not again 'til week 8! & I've still had good luck with Remicade. What's confusing though, do you have to get approval every infusion? My GI has a woman in his office who handles all the Remicade insurance paperwork- they submit the request to use it AS THE DOCTOR PRESCRIBES, & the whole thing is either approved or denied, not on a dose-by-dose schedule. Know what I mean? Once the approval was set, the insurer sends confirmation to the doctor, then it's up to me to make the infusion appointments at whatever intervals. I haven't actually spoken to my insurer at all since before my first dose.

Posted 5/1/2009 6:43 PM (GMT 0)
Mine is approved for a year at a time. Yours probably needs approval because an outpatient infusion is a different procedure than inpatient. They have to keep those rules complicated enough to make it tough for us to be sure what's covered!
Posted 5/1/2009 8:58 PM (GMT 0)
My second infusion was two weeks and three days after the first, because I was traveling.

The doc's office (where I get the infusion) handled the approval, it only took about a week, maybe less. That was after the denial of Humira took more than a month.
Posted 5/1/2009 11:54 PM (GMT 0)
I'm surprised they didn't approve you for the entire induction period, the several you'll need in quick succession.

My GI did NOT have me get the infusions that way. I don't know why. So you shouldn't fret TOO much over the timing. I had my first one, and my second one was eight weeks later. For the last year though I have been getting my infusions every six weeks as they weren't lasting the two months. In fact, mid-way through the fifth week I am starting to bleed and get some urgency, but I am keeping with the six week schedule.

My insurance company generally approves three or four infusions at a time.

While I am feeling a helluva lot better on the Remicade, I think I want the surgery and not have to take all these meds. I still don't ever feel 100% anymore. If I thought it would get me anywhere I'd ask my insurance company if they'd give me any $$ to keep me going while I am recovering -- in the long run they'd save a lot of money over having to pay for my infusions, only I know it doesn't work that way. So, I am sticking with the Remicade for now while I save my money to cover my expenses while I'd be out of work recovering (self-employed, no workee no money). If I flare while on Remi out goes the colon. First (and last) flare was almost two years before I got it under control. NOT going through that again!!

Meesh
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