Just need to vent--insurance issues

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Chasity102304
Regular Member


Date Joined Nov 2007
Total Posts : 165
   Posted 2/10/2009 7:46 PM (GMT -7)   
Today I got an EOB in the mail from my last remicade treatment on 12/29. Apparently something in our coverage changed because I am now responsible for 10% of each treatment which is a little less than $500. I get the treatments every 8 weeks and right now I'm at the standard dosage. I don't work because I hadn't been able to keep a job when I was very sick and since I had my resection, hadn't been able to find a job that paid well enough to cover childcare and gas expenses. We can not afford the $500/8 weeks. I am in a PANIC!!! to say the least. I have been sick for about 2 months ... I'm guessing this is a flare but I have only been really sick or pretty healthy so I've not experienced this before. I can't get in to see my GI until March 5th because he is covering patients for a dr that left the practice and is booked solid. There have been 2 times where I wanted to go the ER I was in so much pain and have no pain meds in my house. My GI won't prescribe any until he sees me in March. I can't be upset about that as I have been healthy since my resection and I understand that he wants to see what's going on before he gives me anything. I have a 3 year old and a 5 month old baby. All I can think is I can not be sick again! I just can't. I wouldn't be able to take care of my girls if I was as bad as I was 18 months ago. Luckily at that time my mom was babysitting from her home so I had a sitter whenever I needed anything. My mom now works full time and I have no one to call if something would arise. I know the stress isn't good but that's easier said than done ... let's be honest. I did read about the RemiStart and after I verify with insurance tomorrow what the deal is, I'll probably call them to see if I could qualify. I am just so freaked out that I won't be able to get remicade anymore and it has given me my life back - both before and after the resection. If I hadn't gone 10 years un-dx'd I probably wouldn't have had to have the resection but the damage was too far gone. I'm just worried...trying to think positively though, at least until I know for sure what my options are. I just know that I can't go back to where I was at my worst.
 
Thanks for listening.. I know people here understand where I am coming from. I have a very supportive husband and family but they haven't lived with this disease or understand what I deal with. Thanks again!
Fibromyalgia DX March 2003
Crohn's DX Jan 2006 (Symptoms since 96-Misdiagnosed as "female" problems-Major flare during pregnancy in 05 which lead to DX)
1st resection July 2007
Currently on Remicade/8 weeks


inflamed
Veteran Member


Date Joined Nov 2005
Total Posts : 1340
   Posted 2/10/2009 7:58 PM (GMT -7)   
Chastity, I TOTALLY understand. I am fighting an insurance battle over an out of state insurance issue right now too. AND I also have a 5 month old at home. I'm currently doing better and just thinking positive and healthy thoughts over and over. We have no family in the state, so if I'm sick there's no one to help.

Hang in there and vent all you want!
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.


survivor49
Regular Member


Date Joined Oct 2007
Total Posts : 241
   Posted 2/10/2009 8:10 PM (GMT -7)   
whAT about PAIN MANAGEMENT

FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 2/10/2009 8:31 PM (GMT -7)   
That really sucks that you are in this position. I would recommend that you try to pay the $500 and see if you can arrange your finances to make it work. Maybe you can get a part time job when your husband is home to make just enough to cover that. As you know your health is your most important thing. I work about 16 hours a week while I am in school and that is enough to cover what I have to pay on my student loans while I am in school. If you need $500 every 8 weeks, at $10/hour that would be 50 hours every 8 weeks or just SIX hours per week of work. Maybe you can offer to babysit someone's kid or something. I'm sure you could line something up! I hope you work it out.
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.


LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 2/10/2009 8:49 PM (GMT -7)   
Good grief...I don't know what to think about insurance companies right now. Sometimes I love the kind that I have, but then they pull stunts like this and it just makes me so MAD.
I hope you get all of this sorted out..I still wonder what people like us are supposed to do where we can't work, can't find work, and can't afford our medicine even if we could so just get sicker and less able to do any job let alone function normally.
Keep us updated on how you work this out?
20 years old, Diagnosed with moderate to severe Crohn's and Colitis in May of 2008.
Currently taking:
Prednisone 5 mg, pentasa 2 pills 4x a day, bentyl as needed, omeprazole in the morning, prenatal 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."


Ides
Forum Moderator


Date Joined Nov 2003
Total Posts : 7077
   Posted 2/10/2009 10:15 PM (GMT -7)   
Please call 1-888-ACCESS-1 [222-3771] between 8 AM and 8:30 PM EST. Access One is an assistance program offered by the manufacturer of Remicade. There are restrictions but many that have co-pays greater than $100 per infusion get financial assistance for the co-pays.
Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, lupus, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, degenerative disc disease, and a host of other medical problems.
 


Chasity102304
Regular Member


Date Joined Nov 2007
Total Posts : 165
   Posted 2/13/2009 6:23 AM (GMT -7)   
Update: I have been on the phone with insurance companies, drs and hospitals for the last 2 days. Come to find out, my insurance had been "coding" my treatments incorrectly for 18 months and I should been paying the 10% all along. My GI is in their 2nd tier network and they were paying as if he was in 1st tier. They said they found the mistake in Oct 08. No one ever contacted me though to let me know what was going on and the Nov 9 treatment I had was paid in full. The Dec 29 treatment was only paid 90% though. When I was explaining to the insurance lady about how expensive these are and that now I have a huge bill that I wasn't expecting she very rudely said to me, "I'm not sure what you want me to do abou it Ma'm. You were getting more coverage then you should have all along. You should be thankful." HOW RUDE~!! I'm not saying that it shouldn't have been corrected, but some notice would have been nice. Now I have a $500 bill on top of what I was already paying on for my GI. UGH!

The suggestion was to go to a different location for the treatments. My options were 90 miles away, 87 miles away or the local hospital (10 miles) that I HATE! I went to this hospital for 10 years and was misdiagnosed the entire time. I had over $250,000 in medical bills for "female problems" that was crohn's all along. I have some very negative feelings towards this place as you can tell. I called around and found out that they don't actually do remicade at the main hospital but they do at another branch about 20 miles from me. I called and got everything set up to go to this new place that is local. There were about 50 phone calls back and forth to all the places because of some issues (my dr is in IN and I live in OH so they were trying to make sure there were no legal issues because he isn't licensed in OH but that's where I will be getting the treatments) but FINALLY we have it on track! At least I hope so. I got everything verified and changed with my insurance as well. They wanted me to "re-certify" the treatments but I pitched a little fit (LOL) because they are the ones that told me I needed to change places because of their error and it's the same dr so I didn't understand what the deal was. They eventually agreed that there was no need to re-certify. I was glad because it's a 2-3 week process and I am scheduled for my next treatment on 2/26. There is a bonus about the new place though! They do infusions from 7am to 1:30am so I don't have to find a babysitter and all that mess like I used to. My GI is an hour away from where I live so it was 6-7 hours of being gone with traveling and taking the kids to a sitter. Now I can wait till my husband is home from work and go in the evenings! YAY! Anyways, I'm GLAD it got worked out and I don't have to stress.
Fibromyalgia DX March 2003
Crohn's DX Jan 2006 (Symptoms since 96-Misdiagnosed as "female" problems-Major flare during pregnancy in 05 which lead to DX)
1st resection July 2007
Currently on Remicade/8 weeks


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 2/13/2009 7:22 AM (GMT -7)   
Chasity - that is GREAT! I know what you mean about the unexpected bill. Once I received a surprise bill for something I had previously been told would be covered. I called and they said well we messed up when we said it was covered, according to your contract you still owe. Granted it was only a $200 bill. But, at the time, that was a lot of money. So I said, "look, if I knew I would have been charged $200, I would have known I could not have afforded it at this time and would not have had the procedure done." To which she responded something to the effect of "ma'am we only pay for medically necessary procedures. If you say you wouldn't have it done than it doesn't sound like it was necessary." Oy vey - YES it was necessary but if you can't pay you can't pay. Luckily I WAS able to pay but I learned my lesson about arguing "if I had known I wouldn't have done 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.


Chasity102304
Regular Member


Date Joined Nov 2007
Total Posts : 165
   Posted 5/3/2009 3:20 PM (GMT -7)   
UPDATE:
The most annoying thing about this situation is that the reason I had to change locations was because my insurance would only cover 90% at my old location which meant I had to pay $460 every 8 weeks up front. Obvsiouly I couldn't afford that so I agreed to go to a closer hospital (where I normally WOULD NOT GO) so that they would pay 100% after my intial $100 co-pay. I got my first EOB for my treatment in Feb and this new place charged more than TWICE what they paid at the old place. WHAT?!?! How can the EXACT same thing cost $5600 at one hospital and $13,000 at another? I was temped to call my insurance and try to get them to waive my 10% at the old place to save them money but decided against it. In my opinion insurance companies should check on PRICING instead of networks for situations like this.

INSURANCE IS CRAZY SOMETIMES!! I'm glad I have but it sure is a pain in the butt!!
Fibromyalgia DX March 2003
Crohn's DX Jan 2006 (Symptoms since 96-Misdiagnosed as "female" problems-Major flare during pregnancy in 05 which lead to DX)
1st resection July 2007
Currently on Remicade/8 weeks


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 5/3/2009 5:21 PM (GMT -7)   
Oh, that's just wrong. They shouldn't be making it so hard for you.

I.
Co-Moderator Crohn's Forum.


CrohnnieMan
Regular Member


Date Joined Aug 2008
Total Posts : 190
   Posted 5/3/2009 7:18 PM (GMT -7)   
Wow, the insurance companies are out of wack. But I wouldn't care since they are the ones who made you change, they should have to pay the difference. But its stuff like this that makes insurance unbelievable.
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