I started Remicade in January due to daily vomiting (which they assumed was due to a flare, but it looks like it's probably gastroparesis). There were a lot of calls to the insurance company prior to this, but long and short of it, it was approved. First infusion was covered 80% by my insurance company.
Then my jerk of a GI decided that I must never have had Crohn's, since the scope was clean after I'd already started Remicade. He didn't even bother to look at the pill cam footage (it's been three weeks), stating that it's "probably normal" (which makes no sense, since I was diagnosed through a pill cam!). Despite him coming to the non-Crohn's conclusion, he told me to have the second infusion (which I did) and third infusion (next week). Doesn't make sense to me. I've got an awesome internist, though, and he's trying to sort through Dr. Evil's notes to figure out why I'm supposed to continue Remicade.
Very frustrating to have the diagnosis I got in 2008 -- which was confirmed by a second opinion -- replaced with IBS. Especially now that I've gotten the EOB for the second Remicade infusion:
*Remark Code O8: Based On The Information Provided, This Service Is Unproven For The Diagnosis Billed And Is Not Covered. No Benefits Are Payable For This Expense.
So basically, I'm on the hook for $5,374.15, none of which is eligible to be applied to my out-of-pocket yearly max, because the stupid GI changed the diagnosis from Crohn's to IBS for no reason.
Diagnosed with Crohn's in 2008 at the age of 22.
Currently on: Remicade, Imuran, Pentasa, Zofran, Tramadol, Welchol, Phenergan, Ambien, Metoclopramide, Omeprazole, Hyoscyamine