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Insurance is stupid (a rant)

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Ulcerative Colitis
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tiredofallthispoop
Regular Member
Joined : Jan 2017
Posts : 208
Posted 2/13/2020 12:04 PM (GMT -7)
We switched to Aetna from United Health Care as of Jan 1st, because my husband's employer decided to change.

Up until last Friday I was supposed to be on monthly Entyvio infusions. (nb. Entyvio is only given by infusion) I was due over two weeks ago and just heard from a nurse at my doctor's office who said the insurance company is saying that while they will cover the drug they won't cover infusing it. WTAF?! Is this their way of trying to screw us? On the up side, I met with my GI last Friday and we decided to switch to Stelara so f.u. Aetna, enjoy that almost threefold increase in cost.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 2/13/2020 12:09 PM (GMT -7)
Hahahaha! I love your last sentence. And that is absolutely ridiculous they said they would cover the medicine but not the infusion itself!!! My insurance company recently sent some form to my GI asking if I could take generic Delzicol. The doctor's office called to ask me if this is okay. I've already been taking the generic Delzicol for over a year, probably over two years now, so I don't know what my insurance company is up to or if they were just confused. Who I absolutely despise dealing with is Walgreens Alliance Rx -- the specialty pharmacy my insurance requires I go through. They are the most incompetent people to work with. You can call and one person will tell you something and then it never happens so you have to call back and you speak to another person who acts like you had never called the first time. And it's like that almost every single time I have to call to get my meds refilled.
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ks1905
Veteran Member
Joined : Sep 2005
Posts : 5857
Posted 2/13/2020 12:10 PM (GMT -7)
Without more information it’s hard to know the exact reason for the denial. Could have been the infusion center was not in-network. Could be they wanted you to do an infusion at home with a nurse. Could have been that you need a different insurance approval for the infusion and another one for medicine.

Your GI’s office should be able to work all of this out for you; it’s their job!!

I wouldn’t switch to Stelara just because of an insurance issue if Entyvio is working for you. I’d try to fight it before moving on.
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tiredofallthispoop
Regular Member
Joined : Jan 2017
Posts : 208
Posted 2/13/2020 12:58 PM (GMT -7)
Keith - I'm switching because Entyvio just wasn't doing much, except making me hurt all over.

The infusion center was at my Dr.'s office, who is definitely in network.

I wouldn't just kick it to the curb vindictively (nor would I think any decent doctor would approve that) as there aren't that many options left to try. I gave Entyvio a year and half run but happy to be done. My last infusion was the end of December so I am 6+ weeks out and I feel better now than I have in years!

Post Edited (tiredofallthispoop) : 2/13/2020 1:01:19 PM (GMT-7)

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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 2/13/2020 1:11 PM (GMT -7)
Let us know how the Stelara goes. I'm probably going to be starting it next month, too!
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geezernow
Regular Member
Joined : Nov 2017
Posts : 211
Posted 2/15/2020 5:51 AM (GMT -7)
I must agree....insurance offer some crazy 'solutions' to our med. needs. I still think that the insurance companies should stick with insurance and not practicing medicine. Just my opinion
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