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insurance question
ok this is my luck here.Some of you have talked to me and know I am going to wait for the new meds to come out next year(hopefully)
This is my dilemma.....
I currently have Blue Cross and Blue Shield insurance and found out that if I were to treat now that my copays would be low.This is my husbands insurance and weve had it for 15 years through his job.Now they are telling him that they might be switching companies sometime next year.
Now the questions.....If the new meds come out say in June do they bill for the entire tx?Or is it a month to month thing?And if it is month to month and the new insurance kicks in are they gonna kick in and continue where i left off with previous tx ?Or are they gonna make me wait for a year before they will pay?Will they even insure me ? Idont want to be in the middle of tx and this comes up!!!!!
Has anybody been where I am????? cindy
This is my dilemma.....
I currently have Blue Cross and Blue Shield insurance and found out that if I were to treat now that my copays would be low.This is my husbands insurance and weve had it for 15 years through his job.Now they are telling him that they might be switching companies sometime next year.
Now the questions.....If the new meds come out say in June do they bill for the entire tx?Or is it a month to month thing?And if it is month to month and the new insurance kicks in are they gonna kick in and continue where i left off with previous tx ?Or are they gonna make me wait for a year before they will pay?Will they even insure me ? Idont want to be in the middle of tx and this comes up!!!!!
Has anybody been where I am????? cindy
Hi,
If an employer changes who they use for insurance there is no waiting period or pre existing. Only when you start a new job can there be a wait period. I have read articles that quote pharmacy directors of insurance plans stating 90% will cover the new meds, both of the new PIs with a small group saying they will cover only 1 PI (17%). So the meds being covered when they come out should not be a worry for people.
My meds were auth'd for 1 yr. I pd on a monthly basis as they were delivered from a special pharmacy. I couldn't go to Walgreens for the meds.
I really can't advise you as to whether you should start now or wait. That's between you and your doctor. Who know? Maybe if you're undected at 4 wks you can discuss a 24 wk treatment instead of 48. That would be 2 drugs instead of 3 (with new PIs) and the same tx time, less sx. Worth thinking about. Don't worry about the insurance, it will be covered.
Judy
If an employer changes who they use for insurance there is no waiting period or pre existing. Only when you start a new job can there be a wait period. I have read articles that quote pharmacy directors of insurance plans stating 90% will cover the new meds, both of the new PIs with a small group saying they will cover only 1 PI (17%). So the meds being covered when they come out should not be a worry for people.
My meds were auth'd for 1 yr. I pd on a monthly basis as they were delivered from a special pharmacy. I couldn't go to Walgreens for the meds.
I really can't advise you as to whether you should start now or wait. That's between you and your doctor. Who know? Maybe if you're undected at 4 wks you can discuss a 24 wk treatment instead of 48. That would be 2 drugs instead of 3 (with new PIs) and the same tx time, less sx. Worth thinking about. Don't worry about the insurance, it will be covered.
Judy
With group insurance if there is no break in coverage regardless of any pre-exisiting illness they cannot deny coverage. That is the law.
You could be treating for cancer and having regular chemo sessions and as long as your policy is intact the new insurance company must pay the cost. What they pay may be different due to the terms of the new policy but they are required by law to pay for pre-exisiting and future illnesses. However, you will be required to list any illness you have been treated for or are currently being treated for. I don't know how far they go back, I think when my employer changed to BCBS it was 5 years.
Trinity
You could be treating for cancer and having regular chemo sessions and as long as your policy is intact the new insurance company must pay the cost. What they pay may be different due to the terms of the new policy but they are required by law to pay for pre-exisiting and future illnesses. However, you will be required to list any illness you have been treated for or are currently being treated for. I don't know how far they go back, I think when my employer changed to BCBS it was 5 years.
Trinity
Yeah just another thing to ponder on!!Maybe I should go ahead and do what pcs did and see where Im at at 12 wks?But being g1 I am not too thrilled with the odds of SVR.
It doesnt make sense that the ins co"s would want g1's to treat with SOC with those odds(unless they are looking at ALL that money) Right now Im confused about the insurance thing.Think Ill go sit in my Jacuzzi for awile.Like its not hot enough here!!!! cindy
It doesnt make sense that the ins co"s would want g1's to treat with SOC with those odds(unless they are looking at ALL that money) Right now Im confused about the insurance thing.Think Ill go sit in my Jacuzzi for awile.Like its not hot enough here!!!! cindy
Hi Cindy,
I don’t think any of us know beyond conjecture and speculation how any new HCV drugs will be allocated by insurance companies. They may decide to limit them to those that haven’t previously responded to traditional interferon therapy, they might limit them to less responsive genotypes; the list could go on and on. Or, the increased efficacy might inspire them to pay for them across all sorts of treatment scenarios.
It’s hard to think like an insurance actuary (my apologies to any actuaries that might be reading this :o)).
We pay for interferon/ribavirin on a monthly basis, just like you would any other drug, if that helps.
You’re doctor might be talking with drug reps, and have more solid info; I really don’t know. Hard decisions, huh?
Good luck—
Bill
I don’t think any of us know beyond conjecture and speculation how any new HCV drugs will be allocated by insurance companies. They may decide to limit them to those that haven’t previously responded to traditional interferon therapy, they might limit them to less responsive genotypes; the list could go on and on. Or, the increased efficacy might inspire them to pay for them across all sorts of treatment scenarios.
It’s hard to think like an insurance actuary (my apologies to any actuaries that might be reading this :o)).
We pay for interferon/ribavirin on a monthly basis, just like you would any other drug, if that helps.
You’re doctor might be talking with drug reps, and have more solid info; I really don’t know. Hard decisions, huh?
Good luck—
Bill
Wont it be considered a preexisting condition?My sis in law switched cos and they wouldnt approve her for a surgery for a pre existing condition until she had the ins for a year.
they cannot deny you insurance if you just switch companies. The only way they can deny because of existing conditions is if you let the policy lapse more then 30 days.
I think they bill monthly because the doctor only writes the scrip for a month or at the most 3 months. This guarantees you will go back for appointments to get checked out, i.e. blood work, exams, etc.
I think they bill monthly because the doctor only writes the scrip for a month or at the most 3 months. This guarantees you will go back for appointments to get checked out, i.e. blood work, exams, etc.
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