hi everyone! Sooo.... my insurance has changed! Which is enough to stress out a "healthy" person, what with all the associated paperwork & phone calls. Since I take a boatload of super expensive meds, it has stressed me out majorly. What I have found though- my previous insurer, Harvard Pilgrim HMO- my remicade infusions were part of my medical benefit- not prescript
ion drug coverage, as the method of administration is in a hospital setting. So, they covered my infusions in full- not one dime did I spend on remicade over the past year & a half. My new insurer, BlueCross Blue Shield HMO- they consider remicade infusions part of the outpatient/day surgery benefit- which means I would be paying $250 per infusion, with a max of $1000 per calendar year. Bummer! Although the total cost of my yearly infusions are well over $10,000... so $1000 should not bum me out. Now here is the interesting insurance part- the hospital that I get my infusions at bills them as chemotherapy/radiology, becaussue they are administered in the same fashion as chemo drugs. Under pretty much any insurer, chemo treatments are covered in full!!!! My BlueCross Blue Shield insurance only has a $1000 deductible for inpatient chemo treatments- not outpatient! SO- it looks like I will once again have my infusions covered in full! YAY!!!! So if anyone on here is having issues with remicade & insurance- check how the administrating party is billing it- maybe they can bill it as chemo, in which case most co-pays will not apply. It's sort of like pulling one over on the insurance companies- I'm all for that. Of course, I'll let you know if I do incur a charge- my next infusion is the end of August, & I have to go thru the hoops to submit prior auth.'s for that & my Imuran. Such a hassle.... I always fear that an insurer will deny the remicade outright.
diagnosed with UC '02
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07