Insurance Company Rant - Anyone home at insurance companies

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Regular Member

Date Joined Mar 2005
Total Posts : 31
   Posted 10/9/2007 11:21 PM (GMT -6)   
I've been in the hospital for one week and was supposed to have my next infusion of Remicade today.   I was amazed when my docs told me that I'll have to wait for the day of my discharge (whenever that might be) to receive my second Remicade infusion.   I'll have to sign my discharge papers and walk over to the outpatient unit to receive my infusion.
The hope is that the Remicade will help quiet my current flare up which consists of a partial obstruction and fistula.
Somehow my policy will cover outpatient infusions but not inpatient infusions of Remicade.   Sure doesn't seem cost effective to me to have me stay as an inpatient for several more days until the docs are comfortable with releasing me as an inpatient.  I'm sure they're paying thousands of dollars a day with the possibility of paying for surgery of the another method doesn't help soon.
Is it me??  Should they have some exceptions for something that would cost shareholder's substantial money?  Since they have agreed to pay for the infusion as an outpatient, doesn't it make finanical sense to provide the infusion as an inpatient? 
Thanks for listening!

Veteran Member

Date Joined May 2005
Total Posts : 4219
   Posted 10/10/2007 9:25 AM (GMT -6)   
If you need it ASAP can you sign out, walk over and get it, walk back, and sign back in? I agree it is crazy but there HAS to be a way around it.  Id also try calling them yourself.  Your doctor doesnt always have the same incentive and persistence to get through to them.  Maybe since you are already in patient and not going in patient just to recieve the infusion there would be a way around it.  Let us know what happens!

25 Year old married female.  Diagnosed w/ CD 2 years ago, IBS for over 10 years before that, which was probably the CD.
I started getting a ton of junkmail after putting my myspace profile link on here.  Im taking it off but if you want to contact me just email me and Ill give you a link to my myspace.  Sorry!

Concerned mom!
New Member

Date Joined Jul 2007
Total Posts : 19
   Posted 10/10/2007 9:34 AM (GMT -6)   
Just a thought, remicade is such a high cost drug, that
they want to do it out patient, because as an inp the drug
would go under the inp claim and the hospital would not
get paid as much as if it were an out patient.

Hope you get feeling better.
God Bless
My daughter was just diagnosed w/CD on 7/12.
She is currently on predisone which Dr. is weaning
her off. Pentasa and Nexium.

Veteran Member

Date Joined Apr 2006
Total Posts : 1884
   Posted 10/10/2007 3:50 PM (GMT -6)   
Fitzy's idea sounds great! Don't let the @!##!! get in the way of what you need!  

Veteran Member

Date Joined Apr 2005
Total Posts : 3763
   Posted 10/10/2007 4:26 PM (GMT -6)   
Not quite the same thing but this is my current insurance rant. I was inpatient 5 times last year for gastritis. When it came back this year, my doctor wanted me to take Previcid 2X a day. My insurance company wouldn't pay for it. They will only pay for it 1X a day. I couldn't make them see that paying for the Rx for 2 months was cheaper than me being inpatient for treatment. Even with my doctor writing a letter, I couldn't get them to pay. I had the choice, pay out of pocket, about $300 for one month, or be admitted. I swear they just like to make our lives miserable.

CD 19 years offically, 29 unofficially. 3 resections '93, '95 '97
Symptoms constantly but all tests show only minor ulcerations. Currently having multiple episodes of gastritis with no known cause.

Prednisone, 6MP,Prevacid, B12 shots, Bentyl, Xifaxan.....

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