Health Insurance

[dyce]

Ha everybody,

             I am wondering,the n.p. told me she put in pre-approval for the pegintron ,riba and blood boosters. How long does this usually take the insurance companies to respond or approve it. they put in for it about a week ago.

             Mr.BB, I was wondering, how did your 6th shot go?

Dyce

[Mister beagle bailey]

Hi,
My shot went well, just a headache and sx's are better then they have been.

What kind of insurance do you have?  I think you should have heard back by now.  Have you called the Dr to see if they heard?
Maybe give the ins. co a call they like to drag the feet when they have to pay for something, you really have to keep on top of it.

Let me know how you make out.

  The Beagle

[NYgirl]

I have both meds now approved through the end of my treatment (anticipated Sept. 06).  At first they only approved it for a month at a time or something like that.

Depending on how hard it was to get different meds through...it took only a few hours to get the Peg/Riba approved tops.  The Epogen was a bit of a fight but they finally got that one in.

Honestly it shouldn't take you longer than the NP making a phone call to the customer service - mine did it only in a very short amount of time.

[NYgirl]

Hey sometimes it takes FIGHTING with them to get the blood boosters. If for some reason you get a negative answer (I did at first) don't give up.....they wiggled mine through - the pharmacist did it for me and got it to go through.

[dyce]

Beagel I have Health Assurance. I pulled up thier web site and the hep. pegs and riba must be pre approved. This sucks, I have to pay for this insurance and still get a song and dance .I think I'll call the np tomarrow and see whats going on.

   Beagel by the way, how did the wedding go?

Dyce

[dyce]

Ha  I just got a hold of the n.p. and she said it usually takes 2 or 3 weeks. It seems the ins. needs copies of all my blood work,bx report and so forth. I just hope it doesn't take to long I'm tired of waiting .

Beamishboy ,Rocker,jmjm ,chevy and everyone ,how are you all doing?

Dyce

[Mister beagle bailey]

just keep on top of it, it should not take three weeks to be approved.  Like I said their dragging their feet.

The wedding is not until Oct, 28th.  They changed the date to make sure I'm over meds and feeling good.  We will stay in California an extra week after the wedding. We rented a condo at the marriott resort in Newport Beach, over looking the Pacific.  Can't wait it will be like a vacation.  After all I'm going through it will be much to look forward to.

let me know how you make out with the ins. co.,


   The Beagle

[cquest]

Be a squeaky wheel...I know I've heard people say sometimes they just replace the wheel but they can't in this case so go ahead and make their lives more miserable than your own...works for me and I do this all day long so just keep at them...they'll cave...if you have to, threaten them with the Attorney General or State Insurance or whatever entity there is available in your state to regulate the insurance industry...don't be afraid of them, they will try to wear you down but don't let them!
Cin

[beamishboy]

good afternoon all..Dr just wrote me a script for Procrit-i stopped at pharmacy& they called my ins co. got a "need pre=approval".. i called dr's office gave them the pre-approval phone #;nurse called insurance co & got preapproval;i told them which pharm& then called pharm back..they ordered procrit(a big bottle-my insurance may drop me end of march).....soo,good question for today Dyce!! told me may have procrit in tomorrow.....Got my lab results,would appreciate any insights,concerns or wry comments.......thank you All.
wbc-2.4     rbc-3.27     hgb-10.6   hct-30.6   mcv-93.8   mch-32.4    mchc-34.6    rdw-13.6   plt-132  mpv-9.3  ne%69.5    ly%21   mo%7.8  eo%1.3  ba%0.4  ne# 1.5  ly# 0.5  mo# 0,2  eo# .0 ba# .0       creatinine-0.8       ALT-24 AST-23  
hope thats all you need to congratulate me-lol.....no results on 12 wk vl for probably 10 days.....i am kinda concerned w/ my need for blood booster-whatwith med. insurance shake-up.......anyone try qualifyin for free procrit?? seems to me -as i'm not workin-if program is income-based(not asset) i would qualify??

[Upbeat]

Do you know what the hgb is?

                                 Ron

[beamishboy]

my hgb-hemoglobin level- started at 16.2 was 12.1 at 4 weeks now is 10.6 -hence script for procrit...

[Upbeat]

    Thanks.  Thats what I thought. Just making sure.
                                                       Ron

[fishdoc]

Just went through the same hoops.  Script called in on the 9th, and last thursday I finally got it all taken care of.  I was dealing with some kind of middle man to the insurance, they were telling me I owed 10%, had approval, how was I going to pay.  I fired them, called my specialty pharmacy and spoke with the rep, and I have my meds on ice, first shot this thursday.  I guess it took almost three weeks for approval.... oh, they also cost me $45 for three months supply- moral to the story, nice doesn't get you anywhere...

[dyce]

Fish,do you have insurance thru your work? What is the special pharmacy your talking about?

any imput will be appreciated.

Dyce

[fishdoc]

I just switched from my husbands to mine- blue cross blue shield, and the preferred specialty pharmacy is Caremark.  Others here told me you had to contact them yourself, and it went really well after I did that-but the approval was almost three weeks...and it was a REALLY stressful three weeks at that, especially when they started telling me 10% instead of a flat rate for mail order- and I kept saying if it comes in the mail, thats mail order!!  Good luck, I hope your goes OK.  I think in most cases the "approval" is just a formality, after all we either got it or we don't...

[TheFalcon]

Hi, I'm having a heck of a time with the insurance. I thought everything was going to be OK last week when I posted. We have United Medical Resources & we need to go thru a "Speciality Pharmacy" in which we were lead to call Caremark & caremark called back today & said the Pegasys is not covered thru them. I called Axium, they tried to help & lead me back to Caremark. The Dr's office called Caremark & faxed over the Rx's & paperwork. I will call UMR back tomorrow. Everyday I start over & over. I need to call our HR dept. Gets a little dis-heartening, at least for us.

[dyce]

Ha my friend,
            Sorry to hear your having to suffer thru. a delay like that. It's b.s. people have to wait like this! It takes a lot of thought and sifering to weigh the odds out for considering the tx in the first place. By the way Fishdoc got her meds. thru caremark' her insurance specialty pharmacy, so I don't know whats up with your problem with them. It all seems to boil down to the almighty dollar.

Thanks for your post,
                     Dyce

[fishdoc]

BTW, my meds are Peg-Intron, but pegasys was listed on the insurance plan also.  I called and spoke directly to Sheila, who is the one that handles the interferon stuff I think...don't have the number here, but if you call the specialty pharmacy, and ask for her, they should be able to send you directly to her..

[friole]

Neupogen and Procrit sources
Amgen, Inc.
Contact: Amgen Safety Net Programs
Medical Technology Hotlines:
1-800-272-9376 (202-637-6698 in Washington, D.C.)
Drugs Available


That is the info on help for Procrit, but I have no idea if it is asset based or income based financial info they need.  I can only imagine how you feel with a 6 point drop in hgb.  So will you do the shot tonight?  I am curious about the "big bottle".  Mine come in teeny individual vials of 40,000 units each.  Are they providing you with a 3 month supply?

Hints on injecting the procrit -- Let it warm up - at least 1/2 hour before injecting.  Inject slowly, very slowly -- it burns.  I usually keep pinching my flesh while injecting instead of releasing the flesh like the inf. Both Goof and I have described an interesting phenomemon whereby the Procrit seems to meet resistance with the body (doesn't want to go in????)I have never had to change injection sites during a shot but Goof has.  That 40,000 is a lot of fluid, and I just think it takes time to filter into the fat. I use a 28 ga (bigger the gauge, smaller the circumference) 1/2" syringe used for allergy shots. (Duh, maybe that is part of my problem, maybe I should start using a 27 or something). Make sure the pharmacy doesn't give you big long needles! Also, I was doing it in the abdomen/belly and saving my legs for the Peg, but recently switched to the thigh because I think it is less sensitive than the belly.  Now don't let my scare you.  As NYgirl is found of saying, the shot is a B**** but the benifit is well worth it.

good luck tonight, friole bean

[NYgirl]

Considering there is so little difference really in SVR rate...why not see if they will put through PegIntron?  You haven't started tx yet have you?

[MrsOckert]

Sometimes it isn't the ins co dragging their feet.  After seeing my hep dr it took his staff 1 week to fill out the paperwork and send it in.  Another week for the people on the other end to realize a problem.  3rd week to get that straightened out.  4th week for me to get involved.  Then finally approval.  The ins co didn't receive the info for 4 weeks.  They would have approved it within 2 days.

Just remember this is the time to be patient.  Your going to have to work with this Dr staff for a long time on TX.

[honey11]

Hey,,,,I agree with Chev,,,,your lab results,,,overall are looking great for the tx!  You did have quite a drop in hemoglobin from 16 but 10.6 is still not too bad.  Glad you got it straightened out and hope first shot goes well.  It does sting a little but Friole has some great advice there to help prevent.  Congratulations for making it to the 3 month mark,,,You are doing great!

[NYgirl]

RE Procrit or Epogen I TOTALLY think this is the only way you can do it with the least amount of pain

SLOWLY - start and stop start and stop.  Also I take it and roll it in my hands for about five minutes to get it warmer...the stuff is a killer but so so so so so so so SO worth taking. My GOD it is a miracle drug.  While I hate the shot I LOVE the medication!

Also make sure they give you VERY SMALL NEEDLES.  The last time they gave me 3s.........what FOOLS!  1s are the biggest you should get and if you CAN find a 1/2 get that!

[GoofyDad]

As friole was moving towards the flesh of her thighs, I was fucussing on the smooth area of the lower belly. Meaning, of course, that I switched procrit injection site to the belly area. That seemed to do better for me.

Note that the procrit is syrupy thick - that's not completely obvious at first.

Jim posted an instructional post on procrit a while back, I'll see if I can't find it.

[mikesimon]

They look good to me also. Your Hmgb has dropped significantly so the Procrit is timely. Best of luck to you Tommy. Mike