Insuranc advice please....

[BEWELL*SWEETIE]

i live in new york and i'm looking to switch over to insurance like united healthcare or empire bcbs, does anyone know how the insurance covers remicade????if it requires auth do they easily approve it??

 

[Lisa]

Hi - I have United Healthcare (through work for the last 8 years), and my remicade is covered 100%.....the doctors office usually tries to tell me I have a co-pay, but there IS NONE for the treatment....I confirmed it with UHC.....

BC/BS is the hospital coverage, I've had no complaints with that either.

What part of NY are you in?

I forgot to add - the approval for me was pretty easy - doctors' office did all the work.....and as for getting approval for each treatment - they do it on a YEARLY basis - doctors office writes a letter explaining why it is needed...I've had no problems.

 

[mom2twogr8tkids]

It also depends on the type of policy you get, so be sure you fully research your policy and understand it. I use to do inusrance billing and there were several patients who misunderstood their policy and was stuck with a bill. As far as just the medicine it should be pretty easy, just go over the prescription plan.

 

[BEWELL*SWEETIE]

thanks for the information!

the only reason why i'm so worried is because i spoke to the billing at my doc's office and she said with oxford i'll have to have it at the hosp and with bcbs i could have it at the doc's office just theygive you a very hard time with approval.........

 

[Lisa]

Usually the infusion is done at a clinic.....remember it takes hours to do.....

I did not have a hard time with approval at all - all my bills are through UHC, NOT bc/bs.....

And make sure that your doctors office is a participating provider!!!!!

 

[BEWELL*SWEETIE]

it's not my first infusion, it'll be my 5th already- i basically adjusted to the hours......it takes!!
but i'm really nervous as to which health ins carrier i should jump into- i'm just owndering which one will give me an easier time with bills and approval......

 

[Lisa]

Gotcha!.....where are you located? In NYC or other?....

 

[BEWELL*SWEETIE]

i live in NYC, i have to decide tomorrow which carrier to choose......

 

[Jennifer]

I'd call the insurance company you have and the one you're thinking of switching to and talk to someone about all of your questions. I don't have either insurance company so I can't help you there, sorry.

 

[outlier]

I am on empire bcbs in NYC and am about to change to United. I am on humira and i need a my doc to call them and get it. Since remicade is infusion i guess this is different. I have to get it via mail order.

 

[BEWELL*SWEETIE]

why do you have to do it through mail order??why are you changing insurance?

 

[Lisa]

remicade through mail order????......never heard of that as it has to be administered under supervision - unlike humira.....

Outlier - are you a NYS employee by any chance?

 

[BEWELL*SWEETIE]

seems like outlier is receiving humira through mail order!!

 

[outlier]

yep humira through mail order.

 

[BEWELL*SWEETIE]

While searching about plans.....i found the remistart program!Does anyone have experience with it and if so how do you go about applying???