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Rituxin/insurance

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14 years 5 months ago #15010 by Dean
Rituxin/insurance was created by Dean
For those considering Rituxin treatment fot ITP. Be sure to check your insurance to be sure it will be covered. My first treatments I received no notice saying the treatments would not be covered. About 18mo later I had another treatment. The day before the last of 4 treatments I received a notice saying it was not covered. At aprox 8k per treatment, this was surely not the STRESS I needed. The Dr. and a rep form the hosp. sent a total of 3 appeals. Insurance still denied paying the treatment. Their Physician reviewer did not think it was medically necessary. If a count of 2k is not medically necessary then the insurance co. needs a new reviewer!!
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14 years 5 months ago #15018 by SteveC
Replied by SteveC on topic Re: Rituxin/insurance
UNBELIVEABLE!!!
Blessings of enough...
Faith to trust our Lord
Joy to share with others
Strength to help the weak
Love to share with the hurting

Steve C
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14 years 5 months ago #15019 by brishti
Replied by brishti on topic Re: Rituxin/insurance
My Insurance company also denied to pay anything :angry: But my hema reffered me to some company that helps the people who can't afford it. Not sure why this time so many things happening. Last time in year 2007 when i had Rituxan treatment i got it for free...We supposed to get the treatments for free here in Toronto. Anyways I am now approved for the Rituxan treatment & getting it for free soon...Thanks God!
Dream as if you'll live forever, live as if you'll die today.

Nowrin
  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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14 years 5 months ago - 14 years 5 months ago #15020 by Sandi
Replied by Sandi on topic Re: Rituxin/insurance
Dean - you'd think the doctors office would check that before starting the treatments. If it's not covered, they can get stuck with the cost. My doctors office certainly made sure it was covered (it wasn't the first time and Genentech did pay for all but the doctors charges for the infusions).

There used to be a program that helped pay the costs.

Try these:

www.genentechaccesssolutions.com/portal/site/AS/menuitem.7ef3b8542d7c63460313edacd79c23a0/?vgnextoid=6617071eef507210VgnVCM1000007dc9320aRCRD


Single Point of Contact (SPOC)
Monday–Friday, 6 am–5 pm PST
Phone: 888.249.4918
Fax: 888.249.4919
The following user(s) said Thank You: Dean
14 years 5 months ago #15022 by
Replied by on topic Re: Rituxin/insurance
I agree it was partly the doctor's office at fault. When my hematologist wanted to give me WinRho back in 2002 her office contacted my insurance company while I was in the exam room - came back with yes I could have it so we scheduled a date. After the first one all they required was the doctor's office to notify them in advance of the next treatment.

I'm not familiar with any other treatments you have had - could it be that your insurance company doesn't think Rituxan is a first-line treatment?

I'm sorry this happened Dean, I hope you can get something worked out.
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14 years 5 months ago #15030 by Dean
Replied by Dean on topic Re: Rituxin/insurance
I assumed that if the Dr. authorized the treatment, insurance would cover it. That is why I never thought twice about it. I have also had two Platelet transfussions, no problems there. According to this provider a spleenectomy is their first treatment for ITP. Hmmmmm lets see, I am paying this Company $500+ a month, $1,000 deductible to cover medical expenses, so basically they work for me!!! A Spleenectomy is not on my "to do" list anytime soon. Lesson learned. This definatly will not happen again. Has anyone read their policy word for word.
  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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14 years 5 months ago #15051 by Sandi
Replied by Sandi on topic Re: Rituxin/insurance
I have never read my policy. I've always been told when something wasn't covered. I have this happen all the time with medications. I've had three appeals in the past few years and won.

As for Rituxan - look into the site I gave you. They once paid for mine.
The following user(s) said Thank You: Dean
14 years 5 months ago #15069 by
Replied by on topic Re: Rituxin/insurance
Sandi do no assume something is covered just because you weren't told it was not! The lady who cuts my hair needed back surgery, she decided to have it done as day surgery instead of spending the night in the hospital - she called the hospital and registerd, giving all insurance info etc. Imagine her surprised a couple months later when she was billed for 10s of thousands of dollars for the surgery. Turns out the surgery was only covered by insurance if she spent the night - the person who registered her a couple weeks before the surgery & who contacted her insurance never told her that, and she never thought to contact her insurance about it.

No Dean, I've never read my policy - I have checked it to see if acupuncture is covered which isn't, and orthotics [no].
  • Sandi
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  • Sandi Forum Moderator Diagnosed in 1998, currently in remission. Diagnosed with Lupus in 2006. Last Count - 344k - 6-9-18
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14 years 5 months ago #15071 by Sandi
Replied by Sandi on topic Re: Rituxin/insurance
Melinda - don't worry. I know that my insurance is checked before I get things done. The only problems I've had have been with prescriptions. Lyrica, Cymbalta and an antibiotic weren't covered, so I just didn't pick them up and appealed. The insurance company agreed to cover them until 2099 (huh?), but I hated them anyway.
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14 years 3 months ago #16225 by alt8383
Replied by alt8383 on topic Re: Rituxin/insurance
We have companies here in the state of florida that help pay for medications for people who can not pay but what I found is if it is not indicated to the ITP condition it will not get paid for no matter who you contact. that happened to us with the IVIg infusions. and I beleive her Win Rho but the Clinic ate that one.
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14 years 3 months ago #16232 by Dean
Replied by Dean on topic Re: Rituxin/insurance
I think the Healthcare facility I was treated at ate all but 8k. What really ticks me off is that the Physician reviewer for the insurance company, did not feel it was Medically necessary to receive the Rituxin treatment. Well, the reviewer is not my Dr. so if my Dr. feels it is medically necessary then I feel the insurance company should cover it!!!
Also, for what I pay per month they should be covering it. I do not go in for every little ache/pain, which I see alot of working in a Healthcare facility. I will be darn sure insurance will cover the next line of treatment.
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The Platelet Disorder Support Association does not provide medical advice or endorse any medication, vitamins or herbs. The information contained herein is not intended nor implied to be a substitute for professional medical advice and is provided for educational purposes only. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment, discontinuing an existing treatment and to discuss any questions you may have regarding your unique medical condition.


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