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just need to vent


Mon, January 17, 2011 12:32 AM

my 15 y/o son has crohn's. he's having a flare because dr. is changing treatment (remicade stopped working). humira is next agenda but med insurance is acting like they don't know what the deal is! pre-cert is required but although dr. office got pre-cert, insurance rejected it AGAIN! IDIOTS! look at the history HORIZON BLUE CROSS BLUE SHIELD! he was diagnosed with crohn's in july 2009 and humira is legit treatment! are there any easy routes? does my son have to STARVE until you get your sh*t together? he hasn't been able to eat for 2 weeks! gatorade diet is what he's on. luckily I have a good mind and don't walk into HBCBS office and punch them all in the face! 2 words: cronic illness! not everyone is trying to take advantage of the "system", any meds related to the illness shouldn't be questioned! well, i know i have a legit law suit, IDIOTS! IDIOTS IDIOTS! just needed to vent, very frustrated! thanks for reading! any advice is welcome!

 

 

 

FPO lisamc
Joined Jul 17, 2009

Tue, February 01, 2011 8:58 PM

 Reply posted for Monkii03.

Try going online to www.myhumira.com, and check their payment assistance program. Though I agree with the others, do get your doctor involved in an appeal. Make sure you document your dealings with the insurance office, who you spoke to, when, and briefly what was said. It helps if any questions arise later. Good luck!

FPO tahani
Joined Mar 7, 2008

Mon, January 24, 2011 7:41 PM

 Reply posted for LisaMc.

Try calling the Humira 1-800 number...you should be able to find it on the website.  I started taking Humira about 4 months ago and the cost was alot even with insurance.  Humira has a prescription program and now I only pay $5 a month for my Humira with the card they sent me.  So even if insurance doesn't cover it you still might be able to get what your son needs for a much lower cost (since it is about $1000 a pen).  I wish you luck, insurance people can be so uncaring.

Oh, I think you can sign up for the program on line too to try to get the card...my pharm told me they give it out to lots of people so it doesn't hurt to try.

FPO monkii03
Joined Jan 24, 2011

Sun, January 23, 2011 6:07 PM

 Reply posted for LisaMc.

I did medical insurance billing for 25 years mostly for an Intravenous Home Health Company so I know first hand how many IDIOTS process claims!  And yes, they do reject a certain percentage of claims just so they can hang on to their money longer SO DEFINATELY APPEAL THE CLAIM!  ALso, (and I cant stress this enough) ALWAYS get the name and phone number inc extension of the person you speak to at the insurance companies.  Sometimes they reference claims under the persons name who last worked on it.  When working for the IV Company, I often had insurance processors tell me that they couldn't find my claim unless I knew who I last spoke to regarding it.  This is time to get a manager on the phone. Good luck to you!

FPO nancyt
Joined Mar 26, 2010

Tue, January 18, 2011 10:49 AM

 Reply posted for LisaMc.

Whenever the insurance company rejects a pre-auth, there are appeal processes. Your doctor's office needs a copy of the rejection letter if you got it.You need to ask the doctor to write a brief letter of appeal that addresses the diagnosis, date of diagnosis, previous treatments tried and if they were helpful, and why he/she chose the current plan. The rejection letter should give the appeal process instructions. There should be research data from Humira to assist with that as well. If you can do the outline of the information to help save the doctor some time, it is good. Also, Humira may do the appeal for the doctor and you because you may end up applying for patient assistance from them to get the drug for free since your insurance refuses to cover it. Good luck. Takes time and effort, but worth it.

FPO mvictor
Joined Mar 5, 2010

Mon, January 17, 2011 11:30 AM

 Reply posted for LisaMc.

Vent away!!  Have you called the insurance yourself?  Sometimes and upset Momma gets further than the MD office staff.  Been there!!!!!!!

I hope you get answers SOON.

Claire's Mom

FPO azmom
Joined Jul 20, 2009

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