HealingWell
Search Close Search
☰

looks like my inusrance is not paying my remicade? $40k so far

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 8/21/2011 1:09 PM (GMT 0)
Just got a letter in the mail yesterday telling me there was no additional funds available for my first of four infusions on the date of 4/26/11.  I had checked my account online previously and it had shown as paid and then I looked at the letters and in the place where it says amounts:

$10,733 total billed

$262 approved

$62 amount you may owe provider

and I noticed it totally disregards the $10,228 for the Injections (I am assuming the remicade)

I have bluecross blueshield of Illinois.

I am freaking out and can't' wait until tomororw to call my health insurance.  I thought it was all approved originally.......

I want to be on remicade and don't have $40k

anyone go through this?

Posted 8/21/2011 1:25 PM (GMT 0)
further down the letter it says the $10k, is denied. We have requested additional information from your provider in order to process this claim. Your claim will be processed when additional information is received. No payment can be made at this time.

WTH!
Posted 8/21/2011 1:45 PM (GMT 0)
I have blue cross blue shield and my remicade was covered. Although I was only on it for three infusions.
Posted 8/21/2011 1:56 PM (GMT 0)
I had to go through a special mail order pharmacy with my federal bcbs to get the remicade covered... my regular plan doesn't cover it unless I'm admitted in the hospital. There is Remistart and other helpers but I don't know if it works after the fact?
Posted 8/21/2011 2:28 PM (GMT 0)
Beth75,

Sorry.... ouch! That really sucks!

You have to speak to a supervisor and keep going up the chain of  command until you get the answers you need.

Did you have it in writing that they approved your remicade treatments?

If when you raise it  doesn't help, then tell them you'll  go to your state insurance commissioner and report them - that usually does the trick.

Let us know what happens. GOod luck.

Posted 8/21/2011 2:56 PM (GMT 0)
I wouldn't freak out yet. The claim could have just had some errors on it. Give them a call and find out what's going on. I have to ask, what would have cost $40K so far? My infusions are about $3000 each if I paid cash.
Posted 8/21/2011 3:05 PM (GMT 0)
I agree with Ugh, I don't think you should stress. Insurance companies seem to always want to scare us. Things will get straightened out and I am sure you will just owe your copay. I believe I have a $40 copay on Remicade, only $20 on Humira. Is it on the list of covered medications from your insurance company? I look online in my account with my insurance co. and it tells me exactly what I will pay for each medication.
Posted 8/21/2011 3:05 PM (GMT 0)
I have had 4 infusions of $10k each. I am hoping it is just an error in the processing.
Posted 8/21/2011 3:22 PM (GMT 0)
it's on the approved medication list and I buy the most expensive plan with the most coverage.........GRRR. Weird but it says my Rx is canclled when I log on but I just ordered through my mail order pharmacy and got my scripts two weeks ago........I hope it's covered, that was part of the process my GI's office checked before remi, but I never requested a letter (I feel stupid now). I hope I get helpful people on the phone, I will be crying my eyes out at work if I have to deal with idiots. I have a regular ob/gyn appt @ 8.30 tomororw, so I can't call immediately.
Posted 8/21/2011 3:42 PM (GMT 0)
Has Remicade proven to be a good med for you ? I would skip it unless it is the only solution. I had to drop VSL#DS after years of coverage because I simply cannot pay full price and feel good about it.

My hospital bill last year was $63,500.00 I got the 'adjustment' for using an insurance provider so it dropped to 24k but I still ended up paying 10k of that.

So this year I have good medical and skipped dental as I will be on a group plan in the fall. Ooops $2000.00 for broken crowns :(. I skipped vision so lets he my daughter and her mother both needed glasses this summer. Tough game to play.

On your taxes everything OVER 7.5% AGI is deductable. Given what I have paid out of pocket to that monster hospital bill and in dental work and vision this year I will have a ton I can write off. That might be your only upside to paying for Remi.
Posted 8/21/2011 4:22 PM (GMT 0)
I am at 85% with remicade, I go zero to 3 times a day, I have minor blood every couple of days (just a smear on my poo) and urgency is still an issue. I had great improvement immediately while on pred/remi, then got off pred and went to about 70% two months ago, I am better than I was a couple of months ago. I think this is helping my kidneys too, they are as close to remission I have ever gotten, I have had two days where there is no protiens in my urine (woo hoo!).

my only other solution is humira then surgery.

sorry about all your bills aguywithuc, at least they cut them down!!
Posted 8/21/2011 4:37 PM (GMT 0)

Beth75 said...
I have had 4 infusions of $10k each. I am hoping it is just an error in the processing.

This is why I did not go to the infusion center my 1st doc wanted me to go to... Would have been somewhere between $10-15,000 per infusion. I chose somewhere that I got the same service for $3,000.

You can get your infusion wherever you want. 2infuse.com is a site remistart has that lists alot of their approved infusion centers. Even the site I use now is not on there so you have to look around.
Posted 8/21/2011 6:18 PM (GMT 0)

Beth75 said...
I am at 85% with remicade, I go zero to 3 times a day, I have minor blood every couple of days (just a smear on my poo) and urgency is still an issue. I had great improvement immediately while on pred/remi, then got off pred and went to about 70% two months ago, I am better than I was a couple of months ago. I think this is helping my kidneys too, they are as close to remission I have ever gotten, I have had two days where there is no protiens in my urine (woo hoo!).

my only other solution is humira then surgery.

Too bad your not better on remi. Are you sure there are no other alternatives ? I am over a year with no blood with boswellia, curcumin, keefir, occasional sulfasalazine, natural food with quality cheats.
Posted 8/21/2011 6:29 PM (GMT 0)
That's insane. I have BCBS and I just pay $30 co-pay for the office visit and $50 for Remicade itself. Did your GI's office go through prior authorization before starting you on Remicade?
Posted 8/21/2011 10:29 PM (GMT 0)
My insurance wouldn't even cover Remicade at all, saying they don't cover infusions at all..it was my last chance before surgery as Humira didn't work, but my doc wants to give Cimzia a try.

Beth75, is that an option for you? Surely it has to be cheaper than Remicade as its a shot like Humira. I paid exactly nothing for it. Who knows if it will work though.
Posted 8/22/2011 12:41 AM (GMT 0)
thanks everyone, I will try to find a cheaper infusion center. 

aguywithuc, I can't take sulfasalazine, asacol or lialda I got kidney disease from taking those.

My GI's office said they had to go through the preapproval process but I did not get anything in writing from my insurance company (wish I did now). 

they covered the injections but not the remicade, but it is on an approved list.  I have a Dr. appt tmrw at the same office as my GI, so I will check the preapproval process with them, see if they got anything, then maybe stop by patient services and do a conference call with bluecross.

keep your fingers crossed for me please!

I think the remicade is helping me, I think I might need a higher dose and/or to be on the 6 week sched. Will be talking to GI first week of Oct.

Posted 8/22/2011 1:06 AM (GMT 0)
     At the time I went on Remicade, I had Personal Choice, Blue Cross and Blue Shield of PA.  All I had to pay was $5!  The infusions were given at the doctor's office but it is inside the Surgical Center where my GI doctors performed colonoscopies, etc..  I think it all boils down to how it is explained on the insurance form.  Talk to your insurance provider AND your GI doctor.  This should NOT be.  They should cover the cost and all you should have to pay is your usual co-pay.

     Get a load of this one.....I had a total colectomy with end ileostomy June 28th of last year.  I am now on Medicare with the 65 Special (PA BL CR and BS) as my secondary insurance.  Medicare has NOT approved my ostomy bags.  However....this is a hoot....they did approve the stoma powder, Reliamed odor eliminator...all the stuff that I use...but NOT the bag itself.  Now, does that make any sense???? rolleyes    Sometimes I just wonder how these people retain their jobs.

Posted 8/22/2011 1:30 PM (GMT 0)
Aha getting closer, ins says they need documentataion of conventional therapy, hope that's just a doctors note! I found out it lists me as regional interitis, which is chron's. Please keep your fingers crossed for me.

I am sorry to hear that Christine, my Mom get her supplies incl bags from liberty mail order. She is on medicaid and medicare and has another drug policy on top of that
Posted 8/22/2011 2:53 PM (GMT 0)
     Keeping my fingers crossed for ya Beth!  Shamefull all the red tape one has to go through in order for insurance to pay for things needed.  Shamefull due to the fact the high cost of insurance in the first place!!!

     Did your mom have Crohn's?  I hope and pray to God none of my children or grandchildren ever have to suffer like I did.  My paternal grandmother passed from cancer of the rectum back in 52.  At the time, no one knew too much about problems of the bowel and the patients were reluctant to seek out medical help for such conditions.  I was six years old at the time and can still see her lying in her upstairs bedroom suffering so.  My mom always told me she had hemorrhoids which were left untreated and became cancerous.  Since I suffered with ulcerative proctitis, I tend to believe she had the same thing as I.  Poor dear.

     I wish you and your mom much improvement in health.  God bless.

Posted 8/22/2011 3:05 PM (GMT 0)
Thanks Christine, my Mom had Ulcerative Colitis and so do I. They coded it wrong to say I had Chron's (they went to a new computer system).

I am sorry to hear your grandmother went through all of that, it must have been horrible!!
✚ New Topic ✚ Reply