anyone have BCBS insurance & take Remicade

well does anyone have BCBS insurance

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Diagonsed with UC in about 99 - 

Started new GI 9-25-07

Lialda 2.4 in AM(started 9-26-07) canasa 1000mg  2xs per day(started 9-26-07)
Probiotics, calcium with Vitamin D, slow release Iron, Psyllium Husk Fiber. 

Post Edited (okiemom) : 10/19/2007 1:11:45 PM (GMT-6)

I did until mid-August. Then we moved. Now with Cigna.

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Pan-colitis and GERD diagnosed May 2003

 

Asacol 12 per day,  Azathioprine 75mg, Rowasa and Canasa as needed

Aciphex, Effexor XR, BCP, Rhinocort nasal spray

Forvia and a Probiotic

 

Osteopenia (hip and spine) from prednisone use.  Started Azathioprine because I was steroid dependent.

 

Co-Mod for the UC forum

Keep HealingWell running smoothly:  www.healingwell.com/donate

yes, I have BCBS New England but I live in NH and it goes through BCBS Anthem and I have the HMO not the PPO. I had the PPO until 2 yrs ago when they cost of the plans were about the same and then the PPO went to the 80/20 scheme.

What's your question?

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Beth, 32

I just applied for a BCBS plan.  I hope I get accepted with the IBD diagnosis and all.  It seemed like the best coverage out of all the plans.  Have any of you had problems?

I was wanting to know about the drug coverage.

I was told on one plan that they have 50% copay on meds on the one plan.

The other way I can have a higher premium and then have a better copay on drugs, but then some are only at 30% copay


I just need to wait and see what the doc calls and tells me I was wanting to know how BCBS covers Remicade

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Diagonsed with UC in about 99 - 

Started new GI 9-25-07

Lialda 2.4 in AM(started 9-26-07) canasa 1000mg  2xs per day(started 9-26-07)
Probiotics, calcium with Vitamin D, slow release Iron, Psyllium Husk Fiber. 

aha, sorry missed the top part of your post, on auto pilot today.

with BCBS each plan is different for each company or each individual (if you are purchasing it from BCBS directly). For the plan that my company has they told me remicade is 100% covered if done at a hospital and a $20 copay if done at the Dr's. office. (My Dr's office does do remicade)

However, before I was married my husband had BCBS and he had a $1,500 yearly deductible and paid out of pocket $300 a month to BCBS and his employer (small business) paid $300 a month, basically it was to cover a catastrophe and it did not include prescriptions.

Just because I also have BCBS does not mean that your coverage plan will be the same as mine. I know our HR has to re-negotiate every year and our prices go up each year. I pay $150 each month through my company for myself and my husband's health benefits....well worth it! Also, the company pays a lot of money to BCBS too.

It all depends what kind of plan you are on. For instance if my company wanted to pay more money we could have a cheaper PPO plan but they do not want to so we have the HMO and option of the PPO with the 80/20 (meaning I would pay 20% of all my medical costs).

I hope your benefits cover it! If not look into purchasing addtional coverage, not sure how to go about that but may be an option??? I had no idea how expensive it is.

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Beth, 32

so Remicade is not treated as a pharmacy copay - it goes towards major medical end and deductible? or does that vary by insurance plan.

I am suppose to pick a new insurance under a small group plan because we now qualify to go on a group plan due to the fact that my husband is self employed and if we are partners in the business we qualify as a group. Crazy I know -
anyway the state will pay 60% of the premium for our health insurance because we are a small business of less than 50 employees -
but I dont know or understand how they cover all of the different drugs.

I mean I would have never thought the canasa 1000mg 2xs per day would be almost $800 per month -


then this Remicade to be like $7000 a time - but then it is not a drug it goes to the medical end on some insurance plans.

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Diagonsed with UC in about 99 - 

Started new GI 9-25-07

Lialda 2.4 in AM(started 9-26-07) canasa 1000mg  2xs per day(started 9-26-07)
Probiotics, calcium with Vitamin D, slow release Iron, Psyllium Husk Fiber. 

the way it was explained to me and the way I understood it, because the hospital or the Dr's office would be giving me the remicade and I would not be giving it to myself it was not considered a prescription. Though I would get something in writing before choosing a policy, so that way you know what you are covered for.

Whenever I contact BCBS, they give me a confirmation number, not sure what recourse there is for that but hopefully they are logging what they tell me and also my Doc's office called to confirm as well.

Even w/the plan I have my kidney doc wanted to prescribe Diovan and BCBS made him write them a letter, prescribe me something else first (he ended up giving me a 4 week supply of samples) b/c it was called a step plan drug and they wanted me to try cheaper stuff first, then they approved it. I was like c'mon don't screw w/my kidney's give me what the doc says!!!

Let me know how it goes w/the insurance. I hope you can find a plan to meet your needs and your budget!!

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Beth, 32

I have BCBS and take Remicade.  It shows up on my statements as "chemotherapy" and is covered at 80/20.  It is not treated as a pharmaceutical because the plan I have - I pay for drugs out of pocket and then submit a claim and get reimbursed.  Remicade is paid for straight out like any other doctors visit or hospital stay.  I have the standard personal comp plan that covers everything at 80/20 until the out of pocket max and then everything is covered at 100% - prescription drugs too.