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Changing Entyvio interval and insurance coverage

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Ulcerative Colitis
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Posted 7/28/2022 6:52 PM (GMT 0)
My doctor wants to reduce the interval for my Entyvio infusions from every 8 wks to every 6 wks. Have any of you had to have another PA submitted to get your biologics more often? If so, how did you find that out? My insurance company is telling me that no authorization is needed for this, but I don’t believe them and I don’t want to get a surprise bill in the mail for $25,000 when they decide they won’t pay for it. Thanks.
Posted 7/28/2022 8:51 PM (GMT 0)
I would have my drs office to contact your insurance company for approval. There should be an individual in the office that makes these requests, I would call & speak with that person. You need a paper trail to protect yourself from being hit with a huge bill.

Good luck.
Posted 7/28/2022 10:07 PM (GMT 0)
Thanks Susie. The problem is that the nurses are the ones who got the original PA, and when I call to ask them, they whine about how every time they have to call my insurance company, they have to wait on hold. Well, so do I. What I’m trying to find out is if anybody has had the experience of going through the PA process again to get their medicine more often? And if so, did they get turned down?
Posted 7/29/2022 1:23 AM (GMT 0)
You will need a PA from insurance and your doctor's office is who will need to contact insurance to get it. They will have to give a reason for the change. Patient's can't do it themselves. I've had to go through this process many times including moving to 6 weeks when I was on Entyvio.

With the biologics every change has to get a new PA from insurance. You would be stuck with the bill without getting the approval. The customer service reps we talk to when we call insurance don't know a lot about infused medications.

Contact your doctor's office and get them moving smile
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