Insurance companies are evil

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mcleaver1969
Regular Member


Date Joined Jun 2006
Total Posts : 267
   Posted 1/6/2009 1:02 PM (GMT -7)   
smhair  I started a new job which came with new insurance, Blue Cross. I have been taking Humira for over a year now with really great results, my bm's went from a dozen times per day to 2-3x per day, allowing  me to gain some much needed weight and feel better overall. BUT...having said that, Blue Cross won't cover my Humira as a Rx, only as a "medical procedure", which means I must meet my $2500 deductible before they will pay for any portion of my Humira injections. I don't have $2500 to pay upfront for my Humira Rx so I'm hosed. It just always feels like I'm pushing a huge boulder up a hill when dealing with all of these darned Dr's and insurance companies!! Why does it have to be this difficult?? One more thing to stress about right? I moved to a new state, new job, new life basically...now this. Does anyone else hate insurance companies as much as I do?
The appearance of a disease is swift as an arrow;
its disappearance slow, like a thread.  ~Chinese Proverb<!--DCMOO-->
Marci, 39 years young, Rockledge, FL
Dx with Crohn's disease March 2006
Currently on bi-weekly Humira, daily 6mg Entocort, daily 2-3x 5mg hydrocodone (for pain), and daily 75mg Effexor,
plus 2x per day heavy iron supplements for anemia,
calcium supplement, daily multi-vitamin,
 


belleenstein
Veteran Member


Date Joined Feb 2007
Total Posts : 1010
   Posted 1/6/2009 1:55 PM (GMT -7)   
Don't take no as an answer, rather view it as the first step in a negotiation. Go up the supervisory ladder in writing. Enlist the help of your GI
Belleenstein:

30+ years living with Crohn's.


Kaycie
Regular Member


Date Joined Jan 2006
Total Posts : 449
   Posted 1/6/2009 4:27 PM (GMT -7)   
I feel you. My Remicade was the same way. It was NOT a prescription drug to them, it was a "medical procedure" I can see that, but with Humira it's an injection you do YOURSELF. So, I don't see how they CAN view it as a medical procedure.

How's your prescription plan? Be careful, it could actually cost you MORE on your prescription plan unless you are locked in at a flat rate on your drugs. At one point I spent $300/month on 2 Crohn's drugs. A full year would of cost me $3600, but my max payout is $1500. So obviously, I felt slighted then and Remicade became CHEAPER. Humira is not going to be a generic drug. On my old insurance plan I paid flat $10 on Generics, $25 on Tier 2 drugs, and $40 on Tier 3 drugs (which this would HAVE to be at the BARE minimum a tier 3 drug). But, on my new one, it's a percentage. So, if Humira were to run through my prescription, I'd likely be paying something like $500-$1000/month.
Kaycie - Age: 26
Crohn's - Dx Nov 05
Failed Remicade, moving onto a Clinical Trial called ABT-874 - Tentative start date - 10/2/08 - 10/16/08  - Infusion, every 4 weeks.
IVF #1 (In-Vitro Fertilization) - Failed
IVF #2 - IVIg, Heparin, Baby Aspirin - TWIN GIRLS!!!
Reagan Dawn - 8/2/07 - Lived 1 hour 27 minutes due to Cloaca, NOT affiliated with my Crohn's
Addison Maria - 8/2/07 - 13 months old


Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 1/6/2009 4:29 PM (GMT -7)   
Could you possibly contact the maker of Humira and see if they have some kind of payment assistance program? Just a thought!!!
Gail*Nanners* Co-Moderator for Anxiety/Panic Forum
Been living with Crohn's Disease for 33 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, and Calcium and Xanax as needed. Resections in 2002 and 2005. Also diagnosed with Fibromyalgia and Osteoarthritis and Anxiety. Currently my Crohns is in remission.
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

Sniper
Veteran Member


Date Joined Feb 2004
Total Posts : 6518
   Posted 1/6/2009 4:41 PM (GMT -7)   
I think the name blue cross is very fitting. They dont come across with any money till you turn blue..
If we would read the secret history of our enemies,we would find in each mans life sorrow and suffering enough to disarm all hostility.


HannieBell
New Member


Date Joined Jan 2009
Total Posts : 11
   Posted 1/6/2009 4:53 PM (GMT -7)   
Screw them. I hate all of them. You need to get your GI to write a letter to the company. My mom's friend worked in claims at CB and she told us that they automatically deny everyone coverage. You have to keep sending letters. The doctors note should do the trick.

LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 1/6/2009 5:04 PM (GMT -7)   
Talk to your GI as the others said and try calling 1-800-448-6472 for the copay assistance and other financial programs implemented in order to aid with humira costs. I believe I had to dial the numbers 1, 3, and 1 in order to reach the proper person to talk to(that being an insurance counselor). I just did this today and will not have to worry about copays for six months.
Just make sure to speak with everyone you can i.e. GI, insurance company, humira employees, etc. and more than once if necessary. You might try looking into your state's medication assistance programs as well. My aunt signed up with one in Ohio and pays literally nothing for any of her medication or doctor appointments.
Anyway, I hope you find something to help you..I know paying for medication can really burn a hole in your wallet.
20 years old, Diagnosed with moderate to severe Crohn's and Colitis in May of 2008.
Currently taking:
Prednisone 20 mg, pentasa 2 pills 4x a day, bentyl as needed, omeprazole in the morning, multivitamin, humira every other week, and good probiotics.
Surgery for ectopic pregnancy most likely the result of severe Crohn's inflammation in July of 2008.
Attempting a diet without refined sugars, high fat content, bleached or bromated flour, most dairy, red meat, and avoiding anything spicy like the plague. Also refuse to eat anything with trans fat or high fructose/corn syrup.
"He who has a why to live for can bear with almost any how."


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 1/6/2009 8:11 PM (GMT -7)   
I'm going to play devils advocate here. $2500, 1 time for a year, is WAY less than a fraction of the cost of Humira. I understand if you don't have it you don't have it but it may be cheaper than a 20% copay. I hate insurance companies too. But considering the drug that might not be that much to expect you to contribute. I would also recommend contacting humira, trying a payment plan with your doctor, etc. But if all else fails, throw it on a credit card and pay it in 12 increments over the year. It would be a little over $200 a month. Yes it sucks. But it is WAY better than being sick.
27 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 1/6/2009 8:12 PM (GMT -7)   
I'm thinking about that more now - $200 a month is a LOT! I hope you find a way around it!!
27 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.


Joie1
Regular Member


Date Joined Oct 2008
Total Posts : 376
   Posted 1/7/2009 9:39 PM (GMT -7)   
I didn't have insurance when I got sick. I have it now but they won't cover the Crohns for a year. So, twelve more months of paying $230 on just Pentasa. I'm willing to wait. I'll do what I can.
27/f/CD. 4 CD related surgeries: 2 resections, 2 JP drains, 3 NG tubes, many absesses (including the one my most recent surgery scraped off my ovary) and fistulas.
Currently trying to figure out hip and knee joint pain.
Have lost in these surgeries: appendix, 8 in. intestine, R fallopian tube, gallbladder, 10 in. intestine
Crohns Dx'd: February 2008.
Pentasa (and much mental screaming)

Trying to hang in there until January so I'll have some insurance and can visit a rheumy, neuro, GI, primary, pain control, and possibly a shrink so I could stop crying and living in my own lil pity party. :-P


bluemoon7
Regular Member


Date Joined Sep 2007
Total Posts : 62
   Posted 1/12/2009 9:02 PM (GMT -7)   
I'm not sure how many people know this, but the companies Like Humaria, and Pentasa will help you if you can't afford your meds. I'm self employed and can't afford all the med's I take and I was advised to contact the company direct. I completed an application form and now receive my med's for free..It's based on your income. Good luck

xraygrrl
Regular Member


Date Joined Aug 2004
Total Posts : 102
   Posted 1/13/2009 1:51 PM (GMT -7)   
I was supposed to receive my monthly shipment of Cimzia today but the pharmacy left me a message last night saying they couldn't ship it because my insurance company has decided I didn't need it. I wonder if the person who made that decision has ever run to the bathroom 13 times a day?

inflamed
Veteran Member


Date Joined Nov 2005
Total Posts : 1340
   Posted 1/13/2009 2:22 PM (GMT -7)   
I would definitely call to fight this. A couple years ago I was told I had a separate deductible for my colonoscopy b/c it was a procedure or surgical or something. I accepted it and coughed up the money. Last month I got a refund, b/c lo and behold the insurance paid the whole thing but a $20 copay. My GI's office finally caught the difference or I never would have known.
Hoping to stay in remission after the birth of a healthy baby girl. On Pentasa during my pregnancy, went med-free 2 months to nurse (stupid), but back on Pentasa and still nursing.

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