Angry with insurance

[kirkland]

I hate insurance companies. :ymad: For some reason my insurance wants pre-determination as to why I need my remicade treatments. Even though I have been receiving them for over two years now. I didnt find out until the day of my infusion when my infusion center called me and told me they had to cancel my appointment because of this issue and they didnt want me to end up with a 15,000 dollar bill if my insurance would not cover it. They said there was nothing they could do but wait until my insurance gave them the ok for the treatments. They are trying to push this through, but the insurance told them it could take thirty days! They said that this was not acceptable. I get my infusions every six weeks and I was due today. I am just praying that this doesnt take that long to resolve this issue. I dont understand why they are doing this. I just hate how these insurance companies treat people. Earlier this year I was on asacol and had to switch to balsalazide because my insurance would not cover asacol anymore. I just hate how they dictate which drugs you should be taking without even knowing how it affects the person. They either have know idea what they are doing or they dont care, I believe it is the latter of the two. I think insurance companies see people like me and how much I am costing them and probably wish that i would just die. They probably only want healthy people or people who are on very low cost drugs. I dont know, I am just venting and very upset about this. I just want this approved and take my treatments. I didnt ask for this disease, none of us did, we shouldnt have to deal with this stuff either.

 

[Cosmojo]

Totally valid, I think most of us have had some terrible insurance experience along the way, normally if you talk to a customer service rep and explain that this is an emergency situation they can push it through faster than a month, depending on what you have I suppose.

My insurance was pretty terrible for a few months and suddenly someone realized after my complaining that I was falling through the gaps so now I have an insurance rep who calls all my doctors offices and gets all my stuff expedited, she has honestly made my life so much easier- a lot of places have started this for those with chronic or severe issues.

 

[Axelfl3333]

I thought obamacare was supposed to sort these issues out.it seems very strange to us that the wealthiest nation in the world can,t look after the health of its citiziens,by the way I,me we'll aware that at times the nhs isn't,t to shiny but at least the patients ability to pay doesn't,t come into it.

 

[2thFairy]

I thought obamacare was supposed to sort these issues out.it seems very strange to us that the wealthiest nation in the world can,t look after the health of its citiziens,by the way I,me we'll aware that at times the nhs isn't,t to shiny but at least the patients ability to pay doesn't,t come into it.

You are slamming on something you know nothing about. Tread carefully, my friend.

 

[Axelfl3333]

possibly but it is interesting from across the pond

 

[bloke]

You are slamming on something you know nothing about. Tread carefully, my friend.

As someone also from outside the states I would be interested to know what your thoughts on obamacare are. Like previously stated we have nhs and although not perfect it seems fantastic compared to having to put up with issues such as mentioned above.

 

[Axelfl3333]

I think watching it from a distance it's worth a pop and will evolve and improve over time hopefully,I lived in Colorado for a short time about 20 years ago,long story love don,t live there anymore.the lady I was with needed major knee surgery and couldn't,t afford it,she,s still the same now it's a lot worse so anything that helps some one with a chronic health condition can,t be bad.the surgery is now well into 6 figures!

 

[Axelfl3333]

The charges for meds that are mentioned on here are staggering,pentasa which isn't,t the most effective seems really expensive I asked my chemist how it costs for a box here if you were to buy it,£38.or if you live in Scotland it's free

 

[mseve]

I am having a similar problem with my insurance. Prior to Obamacare they refused to pay for Dr visits/tests due to pre-existing conditions. Now that Obamacare has kicked in they have to pay for it. However they switched my policy to something that covers none of my medications and it's really frustrating. I am on old school (cheap) meds as a result. I take sulphsalazine instead of modern 5ASAs. The Welchol I mostly pay out of pocket for.

Methinks is just the insurance company way of cutting costs even though it has negative impact on patients. It makes me angry.

I do wonder if big pharma will lower their prices because ins simply won't cover it otherwise.

I am self employed and pay for individual ins if it matters. My ins company is Cigna.

 

[Axelfl3333]

It's interesting how these big pharma companies work and how do they work out the cost of drugs?theres a big debate in the uk just know about a cancer treatment which extends life by 6months clinical committee called Nice has refused to pay for it as it costs a about a quarter of a million pounds,but it will be available sometime after all no one pays list price for a car and it's the same for drugs it's a bad analogy but probably accurate.i,d love to know how they justify that sort of price though.

 

[afidz]

Kirkland, I am going through the exact same thing but with Humira. The week I was supposed to get my prescription mailed to me, the pharmacy called and said that my insurance won't pay them anymore and my rx was sent to the company that they would pay. Now, the new company doesn't accept the humira card so I can't afford my meds. Luckily my GI gave me2 doses for free until I can figure this whole thing out

 

[nogutsnoglory]

I'm going to make a generic statement based on my own experience. I needed pre-auth for Cimzia and Humira, not sure about Remicade because I never did anything for that. Once that was in place for the mail order, my insurance mandated I use a specialty pharmacy of their choice. I think there is no way around that but other than that appeal, appeal, appeal any decision where they don't want to pay. You gotta be a pain in their ass to get anything done. Take names, keep your contact with them filed so you build a case.

 

[Lisa]

I needed pre-auth to start Remicade too, and have to get that renewed every 6 months...my GI's office takes care of it though, all I get is a copy of hte letter from the insurance company with the receipt for authorization and then the approval...

I'm wondering if your provider dropped the ball on this one...

 

[M West]

All,

The squeaky wheel gets the grease.

If you in the US need help and your insurance, doctor, hospital, or anyone else will not provide it, scream like hell and don't let up. I can't speak to those of you in the UK or Canada. I don't know your system.

The current insurance program(s) in the US is a fiasco. I am taking advantage of the confusion. After enough phone calls to the rep, then I talk to their manager then their supervisor, then the VP. I walk the ladder until I get the answer I need.

You'll be surprised what kind of discounts from bills you can receive by bothering the big boys on top of the food chain. This applies to Drs., hospitals,
insurance companies, and drug companies. Their time is more valuable than talking with YOU!!

Happy Friday,
Miles