Remicade denial

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MommaD
New Member


Date Joined Nov 2007
Total Posts : 8
   Posted 11/26/2007 7:49 PM (GMT -7)   
Has anyone been denied remicade payment from insurance? Was your appeal successful? Did you have to stop the remicade because of the lack of insurance denial?

Thanks so much

4Johanna
New Member


Date Joined Nov 2007
Total Posts : 10
   Posted 11/26/2007 9:30 PM (GMT -7)   
I'm curious about remicade too. I doubt that my insurance (United) will cover it, but I have a feeling I will need it someday. How much does an infusion cost?

MommaD
New Member


Date Joined Nov 2007
Total Posts : 8
   Posted 11/26/2007 9:33 PM (GMT -7)   
The infusion is $3500/treatment and the insurance is not paying at all. However if it works we will continue it.

jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10405
   Posted 11/27/2007 6:21 AM (GMT -7)   
The first time I was on Remicade, I got the three induction infusions, then got a letter from the insurance company denying payment. A nice match to the letter I had pre-authorizing the treatment. Mind, this was before Remi was FDA approved for UC. My policy specifically states it doesn't cover non-FDA approved drugs. Because I had the pre-auth, I was finally (after an incredible number of phone calls, crying, pleading, threatening, talking to six different offices in one day) able to coerce them into covering the treatments I'd already had. I had to discontinue the Remi, though, because they weren't about to pay for any more. Fortunately for me, the three treatments relieved my symptoms for about a year. When Remi was approved for UC, I went back on and was lucky enough not to have developed an allergic reaction.

My insurance is United also, but what matters is not the company but your specific policy and what it covers. Look carefully at that, then at the reason they gave for denying coverage. If the first appeal is denied, keep pushing them - be pleasant but assertive.

Good luck to you.
Judy
 
Moderate to severe left-sided UC diagnosed 2001.
 
Current meds are Colazal, Azathioprine and Remicade. Completely off steroids for more than a year now! In remission since April, 2006. Remicade has been my wonder drug.
 
Now tapering Azathioprine, please pray for me.
 
"If you spend your time second-guessing your past decisions, you'll never have time to enjoy today."


MommaD
New Member


Date Joined Nov 2007
Total Posts : 8
   Posted 11/27/2007 8:59 AM (GMT -7)   
Thanks for your response. So they are paying now for the treatment? That is great. Also very happy for you that you are in remission. Are you taking any fish oil or aloe?
I will pray for you. Good luck

gela
Regular Member


Date Joined Jun 2005
Total Posts : 133
   Posted 11/27/2007 9:52 AM (GMT -7)   
you need to ask about the rebate program remistart.  they reimurse you up to a year.

Diagnosed in 1999, hospitalized once.  Not responsive to meds.  Currently on 12 Asacol, , 8 ampules of Gastrocrom, 6 grams Colestid, flagyl, remicade for my UC.  Also have migraines and take B-4, B-2, for the prevention of them.
Deciding whether or not to have surgery at this time.


MommaD
New Member


Date Joined Nov 2007
Total Posts : 8
   Posted 11/27/2007 10:54 AM (GMT -7)   
Did you get denied? How is the Remi helping you?
Thanks and hope you are feeling better
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