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4 yrs of successful Remicade treatments and now my insurance won't cover.

Thu, December 12, 2013 11:09 PM

I was diagnosed with UC in November of 2008 and tried anti inflammatories, steroids and cort enemas with no success of putting me in remission. It was a terrible year of managing symptoms and meds. That's not including the years before where I went undiagnosed....When I switched doctors, my new doctor suggested Remicade treatments. For 4 years I have had treatments with no flare-ups. It was almost immediate remission and I have my life back. I received a letter today that my insurance would no longer cover my treatments because these "treatments are not medically necessary" for me. I have had 2 treatments since they refused coverage and am in limbo on what to do now. Of course I'm filing for an appeal but I'm wondering if anyone else has had this issue? Since when can an insurance company decide what's medically necessary and change courses of treatment and coverage? I'm on a group plan with my company and don't know what to do. HELP! Is this even legal?

vbrasseale
Joined May 12, 2011

Mon, December 23, 2013 4:48 PM

Reply posted for kristibeaner.

Thank you for your advice! I contacted the Human Resources department at my company and let them know what was going on and they said they would contact the insurance company on my behalf. I am glad that someone who knows how to handle these types of situations is willing to step in and offer help. My first couple of faxes of my paperwork to the insurance company have been unsuccessful... I was given a fax # that led to nowhere. I also called my local state Insurance Commission who said I needed to check to make sure that everything was "coded" the same way to make sure that they didn't put the wrong #'s on my claim. Now I feel like I opened a new can of worms... If I send over this paperwork to HR at my company, do you think they'll see how expensive I am and get rid of me? I know I worry too much but when I received information from my hospital where I get treatments, I have 3 treatments that are not covered totaling almost $21,000. My next treatment is supposed to be in January but I'm not going to get it if it's not covered. It sounds like my company will handle this but is it common that they will now see how expensive I am and get rid of me? Thanks so much,

vbrasseale
Joined May 12, 2011

Tue, December 17, 2013 7:22 PM

Reply posted for vbrasseale.

Try contacting the remistart program... I just found out about them through my infusion center: http://www.remistart.com/

Not sure if they can help or not but its a place to start! Force it to go into physician review - do NOT allow them to make this decision for you! Stand up for your rights!!!

kristibeaner
Joined Dec 21, 2011

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