Insurance review

[paris]

I got a letter today from the insurance company saying that the IVIg and Rituxin treatments are in "initial review".  Doctor wanted to start them ASAP, but there are always many hoops to jump through.  I wonder if the insurance will approve this.  We shall see. 

Thought I better add that this is to help with getting a transplant.

[Sunny]

I hope the treatment is approved for you Paris. Let's hope they don't come up wth some crazy reason not to cover it.

[chris73]

The  insurance  i  have was hard to deal with....I didnt get approved until one week before surgery , my Dr's had to send all my test and labs to my insurance company to make sure i needed a transplant..also i take cellcept they would only approve a 29 days supply but not a 30 day, go figure...Chris

[paris]

Good thing is, I have been on transplant list for 3 years and our coverage is very good.  Now we just need to see if they will cover these extra treatments to (hopefully) lower my PRA so I can accept a transplant.   The insurance company is now waiting for the surgeon's explanation of why the IVIg therapy and Rituxin is needed and how often/how many treatments there will be.  So, here is hoping the insurance gods smile on this request.   

[chris73]

hope that insurance covers them..its a shame they question wheather you need the treatment or not.. and decide wheather they pay for it or not...

[okarol]

As with nearly everything, it all boils down to $$$ and how much they are willing to spend.

Did they say how long the typical review might take?

Keep asking questions. Medicare should cover some of it - have you checked?

I hope you get the treatment soon!

 

[Rerun]

As with nearly everything, it all boils down to $$$ and how much they are willing to spend.

Did they say how long the typical review might take?

Keep asking questions. Medicare should cover some of it - have you checked?

I hope you get the treatment soon!

 

Paris is not on dialysis yet so she won't get Medicare.  How does that work when you get a transplant before you are on dialysis.  I guess Medicare would just pay for drugs for 3 years.   

[paris]

My primary insurance pays and fortunately, we have great coverage.  I think they just want the schedule of treatments, etc.  The treatments aren't new or experimental, so I am hoping their answer is yes.  They readily pay for all the repeated testing to stay on the list.   If someone says something needs to be done, I want to do it now.  I don't like waiting.  It gives me too much time to think!    I am on SS disability, so qualify for Medicare part B, but don't pay for that coverage yet.  I do have part A.   The surgeon has told me to "bug" transplant center every week until we get this started.    And regarding the meds post transplant: my primary insurance pays for the meds. I get a print out once a year about the actual costs of the drugs I would be on and how much my co-pays would be. I am not too stressed about that part.  Just waiting for approval for this new stuff drives me crazy. 

[rookiegirl]

Paris - wishing and praying all goes your way.  Thinking of you my friend.

[paris]

Got more paperwork from the insurance company today.  I guess they want to make sure no one else is going to be paying for this.  I realized I was getting stressed from the waiting, but just read a great post from Jill D and realize I can't worry about the insurance.  What ever happens, will happen.  So, not going to stress or worry.  Vandie and Wenchie have reassured me about the IVIG and Rituxin -- so I will put it aside and get on with other things.  Thanks everyone for always helping me move forward.

[kellyt]

Medicare A and B is what I have post transplant and it is secondary to my Humana for 30 out of the 36 months.  But it has picked up payment for everything so far except for stuff sent to my deductible.  I haven't come across anything that is deemed "not covered", so I can't help you there.

Paris, I would think that it would be to there advantage financially no matter how expensive the treatment may be, because the cost of dialysis is so darn expensive and there is no telling how long you will be on it.  That's why they love transplants.  Lots of money up front, but they save in the long run if all goes well!

I love you and I'm praying they don't deny.  Although, I think your doctor will go to bat for you.  Sometimes insurance companies need a little encouraging before they agree.  They want to know how "important" it is to the patient.  Will they fight for it, blah, blah, blah.

Love you!  Hang in there!

[paris]

Thanks sweet Kelly.      I think, in the long run, it will go through.   And I really like this surgeon.  I am hoping since he is the head of the department, he can help get this approved.   He appreciated that I knew so much about the treatments.  I even told him about IHD and his response was "we hate dialysis too-let's get a transplant".   But, I want mine to go as well as yours!  You have been the rock star of recovery!    I am going to focus on my son's wedding on May9th----that is all the drama I can handle!!   Thanks for you encouraging words   

[kellyt]

Yes, we'll hit the ground running after the wedding!   

[paris]

I have spent the past three days calling everyone who might be remotely connected with the insurance company or the transplant team.   Finally, this afternoon, my co-ordinator admitted that "she dropped the ball"!!  In the meantime, the insurance declared the review noncertified.  After hours of calls and taking names, the co-ordinator told me she had faxed all the info the insurance needed.  I decided to make one more call to the insurance people only to find out they had not received a fax.  Another call to the co-ordinator. I asked where she sent the fax--she told me. I tried to politely explain that wasn't the right place or person to send it to.  We had a little "come to Jesus moment" and I know she now thinks I am a pain.  This afternoon, she left me a message saying she had sent the fax to the person I told her to send it to and she had received a reply from them saying my case would go to the Board of Review next week.  Why did I know who needed the information and she didn't?  She did say that I needed to keep her on her toes and I needed to stay on top of things regarding my health.   Oh Lordy---she doesn't know me very well, does she?  I had a great relationship with my first co-ordinator.  She is now the supervisor over all the co-ordinators.  Guess who might be hearing from me on Monday?  Thanks for letting me     I'll keep you posted 

[willieandwinnie]

paris, Sorry you had to deal with the extra stress. I always jump the food chain when it comes to coordinators. I always go to the supervisor over them and I really don't care who I piss off. I'll say a pray that you hear good news next week and take Kits  to the coordinator. 

[paris]

Friday I called the insurance "powers that be" and actually talked to the nurse in charge of presenting my case. She told me that my case had gone before the board again (now with all the right information) and they approved the treatments.  Today (Monday) my co-ordinator called to tell me it was approved. The surgeon was out of his office today, but she will talk to him tomorrow and they will have a schedule for the treatments by the end of the week.   Progress----I haven't seen much of that for a long time.  My kids are so excited.  Things were so hectic with all the wedding events this weekend, that I never had time to tell my second son, Adam (it was his wedding).  So, during the Mother - Son dance, as " What a Wonderful World"  was playing, I looked at him as said "they approved the treatments"----he stopped dancing and hugged me and started crying.  I am sure the guest thought it was just a moment we were having and no one had any idea why we were both so emotional.  It was a perfect moment, and one I will cherish.   Now I wait for the schedule.   

[okarol]

OMG paris - I am crying too - so sweet to share that good news with Adam, and Susie was with you too.
Congrats on being approved - that's wonderful news!!

[kellyt]

   I'm also crying!  Tears of happiness and joy!  Praise the Lord!  You're on your way!!!  I'll bet that will be a moment he'll remember for a lifetime!  I can't wait to hear your schedule!

Don't relax for a moment!  Stay on their tales!  Do not let them drop the ball again!   

[David13]

What great news, Paris!  So glad to hear this is coming together for you!   

[lola]

  xoxoxoxo 2 u girlfriend!!!!!

[monrein]

What wonderful news (it is a wonderful world) Paris.  I'm so psyched for you.   

[Laurie]

What a sweet way to tell your son. I'm so happy they approved your treatments.

[rookiegirl]

Paris - I'm so excited for you. 

[willieandwinnie]

Oh paris, crying happy tears for you. Have they told you when they will start them. 

[Wenchie58]