xolair insurance problems. please help....

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desperate_husband
New Member


Date Joined May 2008
Total Posts : 3
   Posted 5/14/2008 12:59 PM (GMT -6)   

I’m new to this forum, and I’m at wits end. My wife has terrible allergies, to the point where she can’t function, and she was prescribed Xolair a few years ago while she was under her parents insurance. Xolair is a once a month shot that is about $1000 a go. We just got married in February and switched her over to my insurance plan. We have been trying to get her xolair covered ever since our marriage and have been getting the run around by my insurance. We have tried everything from special pharmacies to our county health help hotline to Medicaid..... We’re running out of options, and she is running out of her medicine. We need to order her medicine by the end of the month and we have no idea where to even go anymore. Hence my desperation.

Is there anyone out there who can give us any advice or point us in the right direction so my wife can stay healthy?

 

Thank you

-desperate husband


Razzle
Veteran Member


Date Joined Aug 2007
Total Posts : 4389
   Posted 5/14/2008 7:16 PM (GMT -6)   
Call your state insurance commissioner's office. They may be able to help you with your insurance company.

Also, check out https://www.pparx.org/Intro.php and see if they list a patient assistance program that may be available to help with the cost of the medication.

Call the manufacturer of Xolair ~ they may have some ideas for how to talk to your insurance company more effectively.

Insurance through an Employer necessitates a benefits coordinater at your workplace. Talk with this person (usually in the HR department) and see if they can leverage something to help you with this situation. Maybe they have a different insurance option that would cover the Xolair that you could switch to in order to be able to get coverage for the medication.

And sometimes social workers at a local hospital are aware of other programs available in your area that can help with the cost of expensive medications such as Xolair.

Since the Xolair is administered in the doctor's office, it is possible that it could be billed as a Medical benefit instead of a Prescription benefit ~ talk with your doctor's insurance billing specialist about this.

Just some ideas...I hope this helps - take care,
-Razzle
Gluten & Sulfite Sensitivity, Many Food/Inhalant/Medication Allergies & Intolerances, Asthma, Gut issues (dysmotility, non-specific inflammation), UCTD (Lupus?), Osteoporosis, Anemia, T- & B-Cell Lymphopenia, malabsorption/malnutrition, Lyme Disease (Igenex Lab IgM WesternBlot positive/CDC negative), etc.
Meds:  Pulmicort, Injectable Vitamin B12, Herbs, Nutritional Supplements, Homeopathy.


Another Day
Veteran Member


Date Joined Mar 2007
Total Posts : 1055
   Posted 5/14/2008 7:48 PM (GMT -6)   
Desperate,
 
I want to welcome you to HealingWell.  Does your wife have insurance coverage now?  Has she gone without coverage for more than six months?  Do you have coverage where you work?  If so, could she added to your plan?  I'm concerned that if she had to take out an individual policy, her premiums would be rather expensive because of her asthma history and the fact that she is already taking Xolair, a $10,000 per year medication.  In my opinion, insurance companies punish us for being sick.
 
I take Xolair injections monthly and understand how important they are.
 
Please keep us posted.  I wish the best for you and your wife.
 
Take care!
 
Carla

Moderator, Allergies/Asthma
 
Help support the forums so we can support you:  http://www.healingwell.com/donate
 
 
Epilepsy, asthma, fibromyalgia, GERD, depression, hypothyroidism, tinnitus


desperate_husband
New Member


Date Joined May 2008
Total Posts : 3
   Posted 6/4/2008 5:26 PM (GMT -6)   

well i have updates, and they arent good. i thought i was at witts end before... our health insurance dropped us completely because of my wifes asthma history, they said they wont cover anything. asthma, allergies, xolair, nothing. so we're without insurance now and are looking for an insurance company that'll cover my wife and her conditions. please if someone has any ideas or knows of an insurance commpany that will cover this let me know as soon as you can. i'm literally desperate at this point.

 

thankyou


Another Day
Veteran Member


Date Joined Mar 2007
Total Posts : 1055
   Posted 6/4/2008 5:44 PM (GMT -6)   
I am so sorry to hear this.  As far as the Xolair coverage, my allergist mentioned to me recently that they had been getting the Xolair reps to  go to battle for the patients since it is so expensive, but now you have no insurance at all.  Have you gone in and talked to anyone in your wife's doctor's office and explained your situation and asked if they have any answers for you?  I also take Xolair and I know she doesn't need to miss her injections.
 
Is there a Medicaid program where you live?  Was your insurance coverage through your employment?  How was your wife covered before.  The reason I am asking these questions is because I take my next Xolair injection on Monday and see my allergist and would not mind at all to ask her for advice.
 
Take care!
 
Carla

Moderator, Allergies/Asthma
 
Help support the forums so we can support you:  http://www.healingwell.com/donate
 
 
Epilepsy, asthma, fibromyalgia, GERD, depression, hypothyroidism, tinnitus


desperate_husband
New Member


Date Joined May 2008
Total Posts : 3
   Posted 6/4/2008 6:07 PM (GMT -6)   

My wife is pretty close with the doctor’s office she goes through. She’s been going through them her entire life and they've done all they can do for us as well. They were trying to work with our insurance and kept getting the run around like us. They’ve pretty much exhausted their options as have we.

I called Medicaid and was told we don’t qualify for it. I also went to the state for help/advice and was told to go through the county I live in, who told me to go through the city I live in, who told me we again don’t qualify.

My insurance was not through my employment; the insurance my work offered was ridiculously expensive and only covered up to $5000 a year (not a joke). So I went through a private insurance United Health Care and they're the ones who just dropped us.

My wife was covered through her parents before, and went through clinical testing to be on it at first, and her parents took care of the rest. When we got married she was taken off that insurance to be put on mine, consequently she lost all coverage.

 

If you could talk to your allergist Monday and give us any feed back at all that would amazing. Thank you so much.

 

-Ryan & Maggie


Fribster
New Member


Date Joined May 2008
Total Posts : 14
   Posted 6/4/2008 6:56 PM (GMT -6)   
Desperate Husband - I too am new to the forums but I want to tell you to look at youngliving.com essential oils.  The problem with any alternative therapy is money but I have seen some very positive results from these and the testimonials make so much sense too.  Good luck, never give up and never give in.
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