Remicade insurance question

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Regular Member

Date Joined Dec 2008
Total Posts : 38
   Posted 1/12/2009 4:24 PM (GMT -7)   
Is there a way to find out how much insurance is going to pay for before I start the treatment? I'm assuming I can ask the Dr. office and they can find out for me. I go for TB test tomorrow, so I'll ask then. I just did a quick search on my insurance website and it said they don't cover it. I have BCBS Illinois. I don't want to call and ask the insurance company, and tip them off that I'm going to start it.
Rachael - 24 years old, diagnosed with CD in Dec. of 2004.

Currently on 20 mg of Prednisone, 2.4mg Lialda, and 100mg Azathioprine. Also multi-vitamins, and Anti-D when necessary. 1/2 tablet of 5MG-325 MG pain pill when needed

I thank God every day for an amazing support network of family, my boyfriend who has been there since the beginning, and my friends who never waver.

Regular Member

Date Joined Nov 2007
Total Posts : 497
   Posted 1/12/2009 4:39 PM (GMT -7)   

I would have your doctor's office find out.  Before I had my first treatment, my doctor's office found out what the copay or percentage would be and found the least expensive place for me to have the infusions. 

When I looked up Remicade online for my insurance, it also said it was not covered but then in the "nitty gritty" details, I found out that certain conditions needed to be met before it was covered. I don't know if BCBS is set up the same way online as my insurance is, but when I looked under RX for Remicade, it said not covered, but I did a search on their website and found a document stating it would be covered, and for the reasons.   

Keep us updated on what you find out and best of luck!

Veteran Member

Date Joined May 2007
Total Posts : 1220
   Posted 1/12/2009 4:47 PM (GMT -7)   
Hello Rachael,

I have Federal BCBS and they covered it. My doctor filled out the form and they accepted it right away. He said some insurance plans squawk, but not Fed BCBS. And I never had a problem, except that my cost was about $400 per infusion. The insurance statement showed the infusion center charged BCBS between 6 - 7 thousand. I would not conclude that your insurance doesn't pay for remi from their website. Let your Doctor submit the paperwork. You will know if they will pay for it because I doubt the doctor or infusion center will administer it unless you have insurance or cold hard cash! I asked the billing department of the infusion center how much I would pay under my insurance they knew the answer in advance.

I hope it works out for you!!
Diagnosed early 2007 with rectal Crohn's.  Several peri-rectal abscesses and two fistulas with setons.  Allergic to Remicade and Humira.  Currently on 6MP.

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