I have aetna PPO open choice insurance through my work which also uses PCS for prescriptions. I have Chronic Hep C type 1a grade 2-3 stage 3-4. I have had a biopsy and my GI has suggested treatment. Last week I contacted Intracorp at the suggestion of company benefits which gets the ball rolling on pre certification for treatment. At this point I am scared silly. I have my mind in the right place to receive treatment take on the sides as they present themselves and get this behind me. My employer has made concessions from my normal fly around the country most every week job and agreed to let me work out of the local office at my same salary for the 48 weeks of treatment. I feel very good about that. Recently single and going from two incomes to one, money is tight. I have no idea what this will cost me out of pocket or if the meds will be covered at all. It would be devastating at this point to find out they would not. I am thankful I have insurance and income but the waiting game is driving me up a wall.. Has anyone had any dealings with aetna ppo or intracorp which is my case management people ? I have searched and found little information on either comapany when it comes to treatment.. Thanks in advance and this has been a very informative place to hang out.. Mark
Some Aetna polices will cover all your injectible medications with no deduction and the ribavirin with a small co-pay. The thing is all the polices are different.
What you gotta do is call Aetna directly and inquire about your specific plan. Make sure you're talking to the right department or they will give you wrong information.
First ask to speak to someone about "self-injectibles". Ask them specifically about Pegasys, Peg Intron, Procrit and Neupogen.
The first two are the basic drugs you will treat with and the last two are drugs you might need in the future to help with side effects. Then ask them about Copegus (ribavirin). That might be another department. These are the drugs that basically add up to most of your costs.
I'm glad you're getting this out of the way first. Some people ask these questions after they start treatment and by then it's too late.
I have my prescriptions under PCS, I pay a $40 co-pay/each a month for my pegasys and copegus. On your rx card there is probably a website that you can go to and plug in your info. From there you can look up each drug and they will tell you want your out of pocket will be. Good Luck
Thanks for the info... 40.00 copay would be great if it ends up being something like that. From what I understand without insurance it is very expensive and I'm sure financial assistance would be tons of paper work IF you could get it. I guess I'll find out soon enough but was just freaking out waiting while my head is in the lets get-r-done state of mind. I'm not sure which brand of combo I will be getting roche or schering but I do know all the info they sent home with me was from Schering. So I would imagine the Doctors office is partial to Peg-intron and rebetol. I'm not sure if the costs are the same and I guess I should do my own research on which has the best sucess. Peg-intron rebetol or Pegasys Copegus and the diffrence in the two. I'm sure if I look around there will be info on here for that from previous posts..
Welcome to the forum. Glad you found it. I think each insurance company has so many different plans that it is impossible to tell you what the terms of your plan are. If you cannot find the information on the web, perhaps you can call the agent locally who handles your policy. Our company policy comes with an approved drug list, so I could check before I began treating to see if all the meds would be covered under my copay (and they are).
Your employer sounds like a real champ and it sounds like you are really thinking this all out in advance. Smart move. I am on #10/48. Before I started, my plan was basically to lay low for 48 weeks - to continue working full time, but to slow down on other activities. I do believe the anxiety before beginning treatment is much worse than the shot itself. Might I suggest going to the Janis7hep c (http://janis7hepc.com/ ). I have found it most helpful. There is an excellent section there on the availability of help for meds if the insurance does not cover.
I have Aetna for medical, but someone else (Medco) for prescription drugs. There are many Aetna plans, but I remember with respect to Interferon and HCV they have some general guidelines (a 6-10 page document) posted on their web site. They follow the standard treatment protocol (24/48 weeks depending on genotype). For genotype 1 they require a 2 log10 drop at 3 months in order to continue paying for Interferon. Any treatment outside of this is labeled "experimental" (even though there is anecdotal evidence that extending tratement may be beneficial for some type 1 with significant fibrosis).
I don't know of any support groups in our area, however, I never really checked into because I live about an hour south of KC and don't much like the drive to the doc as it is! I go to St. Lukes South, currently very pleased with my doc, but ya never know. He pissed me off when tx was stopped mid July because (even tho I went from 1.9 to 44,000) said I was a non responder. Waiting to start Infergen tx...was hoping to have started already, but blood work results are slow in recooperating from initial tx. If you find a local support group, please let me know. The support here at MedHelp is great, I have learned a lot...someone is always quick to answer questions you may be concerned with. Keep in touch :)
I live kind of between Grain Valley and Blue Springs. I didnt have any idea where to go when this all came down so I serched for doc's in my plan. I go to J. Anthony Woltjen in Blue Springs which is who did my biopsy as well. They do it a St. Marys in Blue Springs which is pretty close to me so it's handy. So far they have all been great and when I first contacted them they got me right in so that was a bonus.. Do you know of any support or local groups in the KC area ??
Hi Mark, Iused to live in KC, still have family in that area. Intracorp is a company that many insurances use to do their medical necessity determinations and authorizations. Bottom line is what does your contract say? They have to follow those guidelines. In our case, there is nothing unusual about the tx for this disease but it is expensive so Aetna probably uses Intracorp as a way to track things and keep costs in check. Good luck with the meds! So many ins. co's try to weasel out of paying for expensive tests/drugs...When I worked for United HealthCare (medical portion of the NYS Empire Plan which is the NYS government employee plan) the motto (and I am not kidding) was 'When in doubt, don't pay out'...seriously...
Hi! I have Aetna PPO insurance (but we use Express Scripts for the prescription plan) and it is paying for everything except the copay (7.50). I just picked up my meds last night.
I think somehow though the prescription plan still runs through the Aetna because wheN i called about getting a replacement card they told me I had to call Aetna to get one (which makes no sense at all if they are not connected).
The best bet is have the Nurse Practitioner call the 800 number and check. That is what they did for me. They had to get the treatment approved...once it was it was not a worry any longer.
I am sure they will - this is a crucial life or death medication.
I suppose all the worry was for nothing... I got a call today from Caremark and they simply asked when do you want your shipment and what address do you want it sent to... Done deal both meds are 21.00 each copay for a total of 42.00 a month.. I can live with that or should I say maybe I can live longer with that.. LOL So looks like I will be starting the ride real soon.. Work and travel oblegations next week then most likely start next Friday night... Mark
Copyright 1994-2016 MedHelp International. All rights reserved.
MedHelp is a division of Aptus Health.
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.