Insurance and Crohn's Treatments

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indigosunrise
Regular Member


Date Joined Nov 2007
Total Posts : 497
   Posted 9/17/2008 8:56 PM (GMT -7)   
Does anyone here have trouble with their Health Insurance?  I am just a little concerned because I have and I may be starting on Remicade soon and there have been some things related to my Crohn's that they have not covered.  sad
 
My health insurance is Aetna--I hope it is ok to mention them on here.
 
Any thoughts, anyone?
 
Thanks!

tsitodawg
Veteran Member


Date Joined Sep 2006
Total Posts : 845
   Posted 9/18/2008 12:43 AM (GMT -7)   
While I am not completely educated on your personal insurance plan, I would not be too worried about the majority of your tests being covered. Remicade on the other hand, may be little harder to get approved if you have not tried and failed on all of the lower classes of medications. Most doctors offices will make sure that your insurance will approve it before they actually prescribe it. I was in the hospital and be being diagnosed with Crohn's when I was approved for Remicade. It was actually my first real crohn's medication that I ever used. When I changed insurance companies a year later, I had no problem getting approved for continued use because I had been on it for so long. Make sure that you find out how much your insurance will cover before you receive your first infusion. It all depends on your dose and how much you weigh, but my remicade was really expensive for my insurance company. It ranged anywhere from $10,000 to $17,000 an infusion because I was on the 10 dose every 4 weeks. Luckily, I only had to pay $25 for the hospital IV Therapy and the medication was completely covered. I have seen many posts on here about people have to cover 10% to 20% which can get very expensive.

randynoguts
Veteran Member


Date Joined Jan 2003
Total Posts : 6049
   Posted 9/18/2008 2:12 AM (GMT -7)   
never had a problem with mine... if they turn down something, be sure to appeal and make the case that in the long run it will save them money.. by maybe keeping you out of the hospital and surgeries etc...
randynoguts 



     http://www.geocities.com/randynogutsweb/


LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 9/18/2008 5:17 AM (GMT -7)   
I did when I was trying to get approval for humira, but they accepted it in the end. Probably for the very reason randy mentioned and the fact that my doctor was very persistent in the case.
If you have any problems just keep trying and make sure you have a doctor that is wiling to fight for you.
Best of luck!!
20 years old, Diagnosed with severe Crohn's and colitis in May of 2008.
Currently taking:
Prednisone, pentasa, alinia, bentyl, prilosec, tandem plus, and the occasional ultracet
Surgery for ectopic pregnancy(very possibly due to Crohn's inflammation) in July of 2008.
Due to start Imuran September 17 depending on blood results.


LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 9/18/2008 5:19 AM (GMT -7)   
Just going to say also, as far as things not being covered goes, insurance companies are so nice that way. I'll have probably about 20 grand in things they decided they didn't have to cover from stipulation or other.
Apparently pregnancy isn't covered until you've had this insurance for a year. Makes you wonder what the point is of having it for some people. "You can have us for a year but we won't do anything until that year is up. You can still give us your money though." your money being taxpayers' money in this case..
20 years old, Diagnosed with severe Crohn's and colitis in May of 2008.
Currently taking:
Prednisone, pentasa, alinia, bentyl, prilosec, tandem plus, and the occasional ultracet
Surgery for ectopic pregnancy(very possibly due to Crohn's inflammation) in July of 2008.
Due to start Imuran September 17 depending on blood results.


Gracie Girl
New Member


Date Joined Jun 2008
Total Posts : 16
   Posted 9/18/2008 10:29 AM (GMT -7)   

Hi there Indigo,

I have the same insurance as you and actually I had to postpone a capsule endoscopy I had scheduled for yesterday for next Tuesday because they were dragging their feet on pre-authorizing the procedure.  With that being said even with all of the roadblocks they throw in the way the insurance company eventually approves what is needed.  Often times it just takes a savvy doctor or office staff to reword the prescription or orders so that it will get their approval. 

Good luck with the remicade... 

 


Linjade7
New Member


Date Joined Sep 2008
Total Posts : 11
   Posted 9/18/2008 1:17 PM (GMT -7)   
Insurance companies are tricky, My sister owns her own business and they lost their healthcare a couple of years back and now she cannot get anyone to cover her because of her remicade and crohns. She is too high risk and the companies know that will not make money from her. So if you have insurance make sure you keep it! I just make sure that I "cross all the t's" and just through the insurance companies hoops before I have a treatment done.
Diagnosed with Crohns May of 2008. Still in the experimental stage of drugs. Currently on Lialda and hopefull.


indigosunrise
Regular Member


Date Joined Nov 2007
Total Posts : 497
   Posted 9/18/2008 9:10 PM (GMT -7)   

Thanks for your replies!

Gracie, I had the very same issue before my small capsule was done a few months ago!!  Thank goodness they approved it and I was able to get the procedure done!

I get nervous because my Serology 7 test was not covered and I worry about other things not getting covered that I might need.  sad

Great point though, Linjade.  I am very thankful I have insurance.  Just disappointed I ended up with such a dang expensive disease!

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