Insurance pre-approval for remicade.

[moogie]

Good morning,

I was wondereing if it's pretty much the same procedure with other insuracne companies out there.

Every year I have to get pre-approved for Remi with my two insurance companies. I cannot get the medication without this approval. Meaning The company that gives me Remi is caled Bioadvance. They call my insurance company and coordinate with my doctor to get Remi set up. When the rep from Bioadvance gets approval fropm my insurance, the insurance company sends me a letter confirimg my acceptance and until when this is approved. In my case one of my insurance Desjardins convers me for 1 year after which I have to re-apply, and my second insurance SSQ covers me for 2 years.

I just renewed this month and got my letters yesterday. I was wondering if it's the same with other companies or if it's just here in Quebec.

Thanks

 

[SarahAnne]

Not sure if it's a difference in countries or insurance companies.

I don't have to get pre-approved yearly, I am on my husband's insurance plan through his work. We have a deductible to meet at the beginning of the year, and then we pay a co-payment for every visit. The cost is different depending on what it is, I pay $50 to see my GI or any other specialist, $30 for GP, $100 for hospital stays, etc.

Insurance companies in the States are vastly different, I'm sure there are people who pay much more and much less than I do.

 

[chrisnsteph1022]

I'm in the US and have group health insurance. We (me and my GI) had to fight tooth and nail to get Remi covered. They kept insisting I try Humira first (already failed Cimzia). Once they finally approved it, it was approved for a year. After a year, I'll have to resubmit for approval, but I believe it's an automatic approval once you're already on it.

 

[littlemissh]

In the UK, for Humira and Remicade you have to be reassessed yearly by the GI, though strangely it is only continued if you still have active disease (if the gi follows NICE guidance). If you are in remission then it is often stopped but restarted if symptoms recur.

 

[moogie]

In the UK, for Humira and Remicade you have to be reassessed yearly by the GI, though strangely it is only continued if you still have active disease (if the gi follows NICE guidance). If you are in remission then it is often stopped but restarted if symptoms recur.

Now that is strange especially with Remi when you re-start it's very probable that you will have a reaction to it.

I discussed this with my GI last time. I'm on a six week regiment and he was telling me that since I am doing well we will stretch the medication back to 8 weeks. I told him I do not want to stop and he says of course not once you stop you are not going back on. But we do want to try and space them out as much as possible because who knows what will be the long terms effect.

I never want to stop it works way to good to stop it now.

 

[Manatey]

Working for a Doctors office I can tell you it is not uncommon for medications to have to be pre approved again. Specially when it is an expensive medication. They want to make sure the medication is helping the person if they are paying for it. You should make sure the doctors office starts the prior auth well before you are due for your next treatment because it takes time to get through the process. If the office is on top of it you should not have to worry about it.

 

[Lisa]

I have a yearly approval for Remicade - my doctors' office takes care of it automatically for me.....no co-pay either...

 

[System-X]

I'm paying about $10,000 a year, out of pocket, for my insurance in the 'high-risk' market (that includes both deductibles and annual premiums). My employer doesn't offer medical insurance. *cries*

 

[moogie]

I'm paying about $10,000 a year, out of pocket, for my insurance in the 'high-risk' market (that includes both deductibles and annual premiums). My employer doesn't offer medical insurance. *cries*

OUch that's hard