Jump to content


Congrats to Margaret, Platinum Member with 1,000 posts and 10 Years of Forums Membership!


Photo

Need Advice / Help for Infusion Therapy


  • Please log in to reply
7 replies to this topic

#1 Peggy

Peggy

    Gold Member

  • Members
  • PipPipPipPipPipPip
  • 635 posts
  • Location:Minnesota

Posted 26 March 2008 - 10:44 AM

I have been approved by a drug company in that they will pay for the drug Rituxan but I don't know how to get my insurance company to pay for the cost of the infusion which is $166 per hour and it takes over 4 hours a time to infuse. My insurer said being they denied the coverage of the Rituxan it also denies any costs/charges associated with the treatment. To me this makes no sense as all I'm asking for is coverage for the nurses and infusion. Does anyone have any ideas how this works? Has anyone else experienced this where they had the drug paid for by the drug company. Any advice would be appreciated.

Thanks.

Peggy

#2 janey

janey

    Platinum Member

  • ISN Support Specialists
  • PipPipPipPipPipPipPipPipPipPip
  • 2,118 posts
  • Location:New Mexico

Posted 26 March 2008 - 03:28 PM

WOW - This doesn't make any sense. You would think that the insurance company would look at this as a partnership with the drug company and pitch in. Sorry - to idealist I guess.

Does your insurance company offer case managers? Mine started offering them about a year ago. My case manager has been great. She fought for payment on one issue (and won) and then a few months ago, she approved a procedure right there while we we on the phone. The procedure had been denied through the main channel. You might checkon this.

The only other suggestion I can come up with is to have the drug company contact the insurance company and try to "work out a deal". It's a stretch, but at this point it sounds like anything is worth a try.

I'll keep my fingers crossed for you.
Janey Willis
ISN Support Specialist
(Retired) ISN Assistant Webmaster
(Retired) ISN News Director
(Retired) ISN Technical Writer for Training Manuals
International Scleroderma Network (ISN)

#3 Sweet

Sweet

    Platinum Member

  • ISN Support Specialists
  • PipPipPipPipPipPipPipPipPipPipPip
  • 2,892 posts

Posted 28 March 2008 - 03:38 AM

Peggy,

What a mess. What's the latest on this situation? I hope by now your insurance company has come to their senses!
Warm and gentle hugs,

Pamela
ISN Support Specialist
International Scleroderma Network (ISN)

#4 Peggy

Peggy

    Gold Member

  • Topic Starter
  • Members
  • PipPipPipPipPipPip
  • 635 posts
  • Location:Minnesota

Posted 28 March 2008 - 05:57 AM

So far I have not gotten anywhere with the insurance company. I took the advice of people on this panel and contacted my health partner that has been assigned to me with the insurance company and asked if she could help. We went around and around with different people in the company and the said "due to the fact that Rituxan has been denied any costs, charges, or services for the infusion are also denied". What I plan to do is when I get the actual paperwork or word from the pharmaceutical company that they are paying for the drug I am going to call them and see if they maybe pay for the infusion to or have some answers on how to do this. When I called the hopsital to find out how much the infusion cost it was at least $200.00 an hour just for the nurse, not couting what they charge for all of the other things such as the room use, etc. If a person doesn't have insurance you can't afford all of these things. I am also still holding out some hope that maybe my appeal for the IVIG will go through and then I'll do that treatment. I know my doctor would prefer the Rituxan if she had a choice though.

Thanks for all of the ideas and help.

Warm hugs.

Peggy

#5 Sweet

Sweet

    Platinum Member

  • ISN Support Specialists
  • PipPipPipPipPipPipPipPipPipPipPip
  • 2,892 posts

Posted 28 March 2008 - 08:04 AM

Peggy, thanks for the update. What is the possiblity of a home health nurse doing it in your home?
Warm and gentle hugs,

Pamela
ISN Support Specialist
International Scleroderma Network (ISN)

#6 kellyA

kellyA

    Senior Bronze Member

  • Members
  • PipPipPip
  • 73 posts

Posted 28 March 2008 - 11:20 AM

I feel really stupid but what is the drug for? what does it do?

#7 Peggy

Peggy

    Gold Member

  • Topic Starter
  • Members
  • PipPipPipPipPipPip
  • 635 posts
  • Location:Minnesota

Posted 29 March 2008 - 04:46 AM

Rituxan in my case will be used for my sclero/sjogren's. If I understand correctly though it is only FDA approved for rheumotoid arthritis and due to it not being FDA approved for my diseases that's why my insurance is denying coverage. My doctor though said she is using it for a lot of her patients and is having really good results and that's why she wants it in my case. If someone from the Forum has better info on this drug please chime in.

Wish me luck as I hope to hear something this next week on either the Rituxan or my IVIG appeal.

Warm hugs.

Peggy

#8 janey

janey

    Platinum Member

  • ISN Support Specialists
  • PipPipPipPipPipPipPipPipPipPip
  • 2,118 posts
  • Location:New Mexico

Posted 29 March 2008 - 07:02 AM

We do have a little information on Rituxan on our biologics medication page. Rituxan is one of the new biological agents that are being designed to target specific cells, in this case. CD20-positive B-cells.

Peggy,
I'm sorry I didn't work out with the insurance company. UGH! Hopefully, the IVIg infusion will come through because it's an off-label use for polymyositis, which is a little easies to get approved. Unfortunately, it is even more expensive than rituxan which might make it harder. What a ride! cool.gif

Big Hugs,


Janey Willis
ISN Support Specialist
(Retired) ISN Assistant Webmaster
(Retired) ISN News Director
(Retired) ISN Technical Writer for Training Manuals
International Scleroderma Network (ISN)