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Denied coverage for Remicade Aug. 2021

My daughter has had Crohns for 20 years and fortunately few complications; however, she developed Spondylitis as a result from the Crohns and had received the Remicade drip for years which has been a lifesaver for her pain. Suddenly, last month, the insurance company denied the continued coverage for the Remicade which is $2400 a treatment every 2 months. Her doctors are submitting appeals and she has filed a complaint with the Texas Insurance Board. Has anyone else had this happen and does anyone know of a possible class action suit to get the insurance company to back off this decision? Thanks, Bette

my little penguin

Staff member
Confused ?
She was only denied once and hadn’t had to appeal yet ?
Normal process is appeal
Then second appeal and then peer to peer review
If all of those are denied then you would have a issue but not until then .
even then you can appeal to the state at that time for a third party review in most states and most insurances
After so many years it is common to require more info from the doc which is where the appeal comes in - they require more updated info for the review .

We had to appeal Stelara for my kiddo after 4 years of rubber stamp approval - but eventually it was approved
I agree on the appeal. Oftentimes, the first bean counter that a claim lands in front of sees the number and has sticker shock. I had to do this with one of my endoscopies a few years back.