Never assume (insurance related)...

[{lisa}]

Never assume that the people who are put in charge of getting your Remicade (or any drug for that matter) preauthorized from your insurance company will in fact do their job! The pre-auth lady (I'm holding back what I'd really like to call her) assumed that my insurance would preauthorize my meds because she's never had one denied (because she never calls them?!) Well, guess what, it was rejected! Now before you make out the insurance company to be evil, we have a special clause that requires the actual drug to be supplied by my husband's employer since he is employed by a major retail pharmacy. Apparently they can get the drug for cheaper which in turn makes it cheaper for me. We are aware of this special clause now, because they were happy to tell us this when WE called. It would have taken one extra phone call on our part to remedy the problem. So you'd think before the first infusion the MD would tell me this. Oops! They never called the insurance! They were not notified of the rejection until 4 weeks after my 3rd infusion! And they (the MDs office) decided to solve the problem by just sending me the bill for $15,000 hoping I wouldn't notice! Seriously! So the moral of this story (which doesn't end here) is to never assume that the people you pay to care for your phyical needs will actually do the job they are paid to do. Be your own advocate and follow up on everything so you are not screwed in the end. (pun intended)

 

[EthanPSU]

I'm with you. I had to wait 4 weeks to get my Humira after the date I was suppose to get it because my GI had "forgot" to send in the blood tests and stuff to the pharmacy clearing me for it.

 

[Jennifer]

In a way I'm sort of lucky because Medi-Cal doesn't allow procedures to be done or meds prescribed unless they are authorized. Its slower care but cheap and by cheap I mean free.

 

[Tenacity]

Hi Lisa,

I also learned the hard way, to take care of medical insurance related requirements myself.

I just wanted to say that if you have no re-course for the doctor's office mistake, you should apply to the Remistart Patient Rebate Program for reimbursement of your monthly payments to get rid of this bill.

I myself personally do not belong to the program, but have heard about it from various infusion nurses. You qualify if:

You are beginning or are currently receiving treatment with Remicade.
Are being treated for an FDA approved indication for Remicade.
Currently have commercial insurance that covers medication costs for Remicade.
Have a medication out-of-pocket expense greater than $50.

I had a look online, and their phone number is 1-888-222-3771.

Hope this helps!!

 

[moogie]

Wow that's hard.

On my side the women that takes care of my insurance makes all the necessary steps. However before I get my medicine I get a letter from both my insurance companies that confirms if I am accepted or not. No misunderstanding possible. This time around one company confirms acceptance for 2 years the other for one year.

I guess you got a bad rep. There are incompetent people in all fields of work.