Ok, so I was informed about two weeks ago that my RD is losing money on my Remicade. That will especially be true when they raise it to700mg on the 12th of Dec. So, we were going to try to get it through the Military Mail in pharmacy and they have denied it completely.
The nurse informs me today that this will be my last infusion at the doctor's office. They are going to try to get some other company to do the infusions here in Cheyenne. I see a nightmare coming and me not getting my infusions. I already have substantial damage, and do not want anymore. Do I have a reason to worry, and are my worries founded? Has anyone else had this problem? I just find it strange that a doctor can stop treatment, b/c he is losing money.
Oh Shel, I seriously hope a nightmare is not coming your way, honey. I know nothing about the US system so, of course, I can't be any help with your questions but I am sure others will.Shelly, does the manufacturer have an assistance program like Humra and Enbrel do? Maybe you could look into that. I dont know how a dr can ethicly stop doing the procedure because he isnt making enough money. But in all honesty w/ all the messed up drs there are it really wouldnt surprise me. Hopefully you can get it straightned out so you can continue on it.
And all the anger leaves me in a *poof!*
I am so sorry to hear this news. Upon informing you that Remicade wasn't allowing him to purchase the yacht he wanted (ok, still a little peeved
My husband thought maybe you could drive in to National Jewish in Denver. They've got awesome rheumatologists. I know it's a hike and a half, but do you think maybe that's something you could look into? Or are there other RDs available in your area?
So sorry to hear this! Did I read it right, are you military? Maybe tricare? You can contact an ombudsmen or case manager to help with care via civilian docs. What about a hospital or home health for the infusion? Is it just the meds or is it the actual procedure that is causing them the extra cost. Let us know.
yes it is Tricare, and they have approved and have been paying for my three infusions, but the stickler came when they tried to order it from Express Pharmacy. Express Pharmacy denied it. I don't know why...the doctors office just said they would not provide it to them.
My doctor is in Ft. Collins...because the Doctor in Cheyenne told me three years ago, when I was having lighter symptoms to "come back when I was sick". Yep, left me for three and a half years, because I did not fit the RA or Lupus catagory. So, I guess my next step if I have to change doctors is National Jewish.
He wants to keep me as a patient, but will not continue to do the infusions in his office. I am going to make them figure out where I am going to go. This is THEIR problem not mine. I know he is getting benefits for me to get my infusions there, and yes it is about a thousand dollars, but he also signed the contract with Tricare to provide this service. I don't understand how he can just say....oh we are finding a different place.
Hubby is trying to see both sides, but I am devasted. Especially being that I am feeling so rotten and hurting so badly today. This is my first six week wait...I hate it!
Hi Shelly. I'm sorry your RD is doing this to you. Is there any way you can have the treatments done on the base? Isn't there an Air Force base in Cheyenne? I have Tri-Care also, and it's pretty darn scary that your insurance can just out of the blue not cover your meds anymore.
I cannot get the treatments on base, because it is just a clinic. I may ask even though I know the answer. I would feel comfortable with the doc I have now asking him to follow up with the treatments, but they are not set up for infusions. That would be the easy answer.
Tricare has not denied to cover the meds...the problem is they don't cover enough. There is about a thousand dollar gap between what they pay, and what the doc charges. The mail in pharmacy is the only one that said they would not ship Remicade to my doctor in Colorado.
Tricare has been great covering things and getting referrals through, it is the doctor that has decided he is losing too much money on my infusions.
I do know that the hospital I work for loses money every time they infuseany hospital infusion (chemo therapy) cenetr should be able to administer the remicade.
I know its frustrating that you doctor has chosen not to continue to subsidize your medication but unfortunatley it is within his rights not to offer ancillary services. Obviously he has made adjustments in his 2008 Tricare contract to eliminate infusion services
Out of curiousity is this change for all infusion patients or just those covered by Tricare
Buckeye~that is a good question, and I will find out the answer. I would believe it would only lend itself to Tricare patients, but I will see.