Procrit and Insurance Coverage

[jrgordon]

I wrote in last week, and received many helpful replies.  I will be starting my battle against the HMO to cover the Procrit shots my wife has needed due to combo therapy.  I would like to have solid evidence of other Insurance companies covering this cost.  Or covering the cost when Hg levels fall below a certain level. Can anyone help me out?

[sfbaygirl]

I have an HMO and get Aranesp, peg form of Procrit paid for by the HMO. I also get Neulasta paid for. I am not sure if I could get the injections through a perscription or not. I have to go get these shots at the doctor's office. If the HMO won't give you a script, perhaps they will let your dr. give it to you.

You need to try and get the Procrit as soon as possible, as it takes several weeks to take effect. The waiting can be miserable!

[MrsOckert]

Not exactly sure what helpful ins co information your looking for here.  I have an HMO thru Healthlink and injections are not covered under my prescription plan, but they are covered under major medical.

If you look at an EOB (explanation of benefits) you've rec'd there should be the name and number of the person that processed that claim.  Calll them and ask how procrit is covered and what your doctor will need to send to the ins co.  After that it's a simple matter of a prescription.

By the way, free procrit is only available to those with NO insurance coverage at all.  They wouldn't help me a bit.

[bobbyullc]

SORRY BUT MY INS. CO WOULD NOT  PAY AS IT WAS "INJECTABLE",BUMMER.
GOOD LUCK AND TRY THE FREE LINE AS LAST RESORT.
BOBBY

[friole]

I hope your wife is able to obtain the Procrit she needs, but it is going to do you no good to find "solid evidence" that other insurance companies pay for it.  What do they care what other insurance companies do.  Besides insurance companies offer all levels of coverage and I am sure some plans within the same company cover it and some don't.

What you need is solid evidence that taking Procrit will allow your wife to stay on the treatment therapy without a dose reduction, in order for her to erradicate her hepatitis C.  You need to present evidence that will show the insurance company that this cost now may increase the chances that she may clear on this first treatment.

I think I suggested on that other thread that the doctor run the prescription back through using a oncology code.  Did he do that?

[Mister beagle bailey]

Sorry your having this problem, this should not be.  If your ins co will not pay for the procrit here is the ph# for free procrit direct from the drug co--  1-800-553-3851

Hope this helps, let us know how you make out.

Beagle