Patient don’t get a say in treatment course with insurance

Patient don’t get a say in treatment course with insurance

After I spent hours on the phone getting my van taken care of, they finally came to tow it to a place on Long Island instead of New Jersey. I was mentally exhausted. As I am coming back into my condo the phone is ringing. It was my infusion place. The authorization for Rituxan isn’t going to be overnight and my infusion scheduled for Wednesday was canceled. All I could do was laugh.

One problem solved another one starts. This one I at least expected. I may have to stay on Ocrevus if the authorization becomes an issue. I just feel safer with a drug that has a 15 year history and doesn’t link even the slightest to breast cancer. Call me crazy. The two drugs are very similar. I just felt more comfortable with Rituxan. I have enough on my plate dealing with MS. It is just one way I feel I have some degree of control is by choosing the drug. Rituxan also costs much less than Ocrevus. However to prove to the insurance company why I’m taking a drug that isn’t approved for MS is an uphill battle I may not win. I may be taking Ocrevus anyway.

It is unfortunate that after 21 years a patient can’t have any say with an insurance company of how to treat their disease. I’ve done my research. My doctor is okay with my decision. Yet it won’t be approved because the FDA didn’t approve it for MS. There is a lot of documentation on Rituxan for MS but it probably won’t matter. I don’t have time to put things into appeals. If they can’t get the authorization I will have my doctor change the orders back to Ocrevus. Just sucks that the patient wishes don’t matter.

4 thoughts on “Patient don’t get a say in treatment course with insurance

  1. Insurers aren’t in the business of being sympathetic or listening to their policy holders. Their goal is to spend as little as possible. I’ve worked in the healthcare revenue cycle industry for decades, and know how to play their game. Still, the stuff they pull even makes me shake my head sometimes. The key is to be persistent, but smart as well. Appealing their decisions can takes weeks or months, so you are better off doing something instead of nothing while waiting for them to reconsider

    1. I know I did medical billing myself. It’s amazing because rituxan costs considerably less. I’m still waiting to hear if they made any progress otherwise I will be doing Ocrevus

      1. I tried to get approved for Ritauxan but it was denied as experimental. Ocrevus wasn’t so I got approved for that instead. When I saw the cost of it I almost shit! Shortly before I received my first infusion, I saw Anthem approved Ritauxan, but didn’t want to derail the process, so I stuck with what was authorized. I ran into situations before where they had changed their minds about coverage, so I figured I better be happy with a bird in the hand.

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