Insurance Approval for Remicade

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jild783

Joined
May 16, 2012
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Hi, I was wondering how long it typically takes for insurance to approve Remicade? The receptionist at my dr's office told me that the nurse would call my insurance to get approval. That was on the 16th. It's the 21st now. I would like to start treatment asap, as I am in a lot of pain/discomfort. How long should I wait before calling my dr's office to find out what the hold up is? Should I give it a week?
 
I would call the doc office tomorrow. It just depends on the insurance company and how quickly the doctors office gets all the paperwork to them. I would just call and follow up, but I'm always the squeaky wheel when I need something from them!
 
Oh yeah. I use to just sit and wait for a call, but I learned really fast that I had to keep them on their toes! Because after you wait for the approval, then you have to wait for your appointment for the Remicade! I'd definitely bug them! It seems thats the only way to get things done for yourself :)

Good luck to you!! Remicade worked amazingly for me for a few years.
 
I would agree with Manzyb, in our case even though the dr. office was on top of things the insurance kept trying to send it over to our prescription coverage(which would've cost more). My husband called the dr. office to make sure they had sent everything and then the insurance company to see what they had recieved. It was then that they discovered the mistake and the Remi was covered right away. We still had to wait a week for an appt. So I would definitely stay on top of them. Hospitals and infusion labs can have a back up in appts, so the quicker approved the quicker the appt!! Hope it all gets on the way for you soon! Remicade is working well for my son so far although we are still only on the loading doses, he saw improvement quickly!
 
Thanks so much for ya'll's help and glad to hear positive things about Remicade. I called the dr's office and found out that all of my info (insurance, diagnosis, etc) is sent to a pre-certification office where it could take up to 3 weeks for me to get approved. In the meantime, hoping Entocort will hold me over! Clash, good luck to your son!
 
My insurance company approved it on the day the infusion center called for approval. I was shocked. Definitely keep following up on it. Good luck to you!!
 
jild, keeping my fingers crossed it doesn't take that long!! I hope the entocort holds you over, too!
 
2thfairy, that's awesome that you got approved so fast! Thanks Manzy, me too! Thankfully my boss has been very understanding, but I hate to keep taking off work due to pain, discomfort, etc. Are ya'll able to hold down full-time jobs during flare-ups? Also, I tend to feel worse when I'm on my period, which I am right now :/ It may be period cramps mixed w/ the inflammation, or change in hormones, maybe a little of both. Does anyone here have that problem?
 
My DRs office has had 3 weeks to to get an approval. It was all I could do to stay at work today and finish my shift. I am going to call my Dr tomorrow and follow up the Ins co if I need to. I need to start my treatmenats soon. I need to feel better soon!

I know its expensive but- they dont wait for my money- I shouldnt have to wait a month for approval!

Lauren

Lauren
 
Just got phone call from doc's office...I'm approved and covered 100%!!! Start my first treatment a week from now...wish me luck!
 
Last week there seem to be a little he said- she said between my Ins co and Drs office. I finally told the Ins co I was sick enough to be back in the hosp. I then asked if the hosp would need preapproval to start the Remicade. They said no, they would not. I got my approval the next day!


Lauren
:ycool:
 
Thanks, Clash! That's so awesome that your son saw improvement so quickly. Hey Lauren I guess you gotta do what you gotta do to get approved.
 
Remember, alot of those who use remicade are extremely tired after the infusion, have some one take you to the lab and home! Also, my son's lab is at his doc's office so it of course is geared to kids of all ages, they play a movie and provide snacks and drinks and such. But my son usually takes a good book, his Ipad, some chips, drinks and sweets in to pass the time. Oh and earphones a must he said because he can't sleep without with all the moving around of the nurses. Just a heads up! Hope the remicade does wonders for you!!
 
Thanks for the advice! I went to the infusion center yesterday to get my TB test done, so I got a feel of what to expect. The nurse told me they provide snacks, or I could bring my own, and they have a tv. I will definitely also bring a book and headphones. Neither my doc's office nor the infusion center warned me of needing someone to drive me there and back. It's about 10 minutes from my house and 5 minutes from my husband's work, so I can always get my husband to drive me if need be. Thanks for the heads up!

Has your son had any allergic reactions or side effects to Remicade?
 
You won't necessarily need someone to drive you unless they have you take an antihistamine before your infusion. Not all centers have you take them unless you have an allergic reaction after the first few infusions. You ought to call the infusion center and ask them about that.
 
I wasn't speaking of long term as far as having a ride, just the first time jitters and seeing how it is going to affect you, personally. But it sounds like you definitely have it covered if it is such a short trip to your house or husbands work. And admittedly, my son makes it through a huge lunch before crashing!! My son has allergies, but that not withstanding they general give everyone a dose of benadryl or such(which I think is where the really tired feeling may come from) through the IV before infusion starts. He hasn't had any reactions so far, fingers crossed! By the time we get home(2 and 1/2 hour trip) he usually up and raring to go. I will say that for a few days after the infusions he complains of hot flashes, but the GI said that could be due to the prednisone taper exclusively and not the infusion! Good luck!
 
2th fairy- Austin, you?

I'm going back there tomorrow for the TB test results, so I will ask what to expect for the first time...drowsiness, etc. Wow, Clash, that's quite a commute! Hearing about your son is making be very hopeful! Thanks again!
 
I'm near Dallas. I was excited at the idea that maybe you went to the same place I did, but I guess not. :)
 
The commute isn't warranted because we have an infusion lab at our local hospital but the GI sold my 15 year old son on the one at his office(teens only day, latest movies, snacks galore, plus the office is in Atlanta and my son can always find something he needs to buy, see, eat...etc. in the big city so we haven't pushed to have it moved yet.
 
Hey jil!! glad to hear that you finally got approved and will be starting soon! The best part is no out of pocket!!! :)
 
jild783-
Right across from Lowes?
Prob the same place. If so
I really like the Monday nurse.
Thats when I had my first treatment.

Good luck

Lauren
 

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