Rituxan Question

[Sangye]

I'm relieved to hear your doc is helping. Someone must have talked some sense into him. Like Jan said, it's HIS job since he's the one who knows that you have no other options. At any rate, hang in there Stacy. None of the things you're afraid of have happened and it won't help you to focus on them. Glad you threw the pillows and not the tea!

[Sangye]

drz, I don't think there's justification for her to be hospitalized. And she'd have to be hospitalized for every infusion. Not a viable solution when one is already outpatient.

[drz]

drz, I don't think there's justification for her to be hospitalized. And she'd have to be hospitalized for every infusion. Not a viable solution when one is already outpatient.

If she hasn't had it before the doctor could request hospital admission for safety reasons to monitor for any reactions. When I was in a nursing home they transfered me to the hospital overnight for IV antibiotics and blood transfusions so I could have closer monitoring in case of a negative reaction. Later on I was able to get someof these in the ER room but it was still part of hospital but then I didn't have to pay for over night stay.

[me2]

That is a great point about the in patient coverage drz. The same is true for my insurance company. I recieved in patient treatment for IVIG that was covered and then later the insurance company refused to pay for additional out patient IVIG.
They did not balk at my Rituxan treatments. I too am surprised that Misskay is having trouble. I am so glad that your doctor is working hard on your behalf.
I wonder if your doctor could contact some of the Foundation consultants and find out if any of them has gotten Rituxan approval for WG from Cigna and ask what they submitted?

[me2]

Another thought. I was remembering when I got Rituxan that my doctor used all the info from one of his colleagues that had gotten Rituxan approved from my insurance company.

[Sangye]

Rtx infusions are done in infusion clinics where they are well-equipped to handle adverse reactions. There really is no justification to hospitalize someone just to have it done.

[drz]

Rtx infusions are done in infusion clinics where they are well-equipped to handle adverse reactions. There really is no justification to hospitalize someone just to have it done.

What if there is no infusion clinic in the area or near by?

[Sangye]

Every hospital has the ability to do infusions, even if someone has to go to an oncology unit. And if someone lives too far from one they'd have to get a hotel nearby. Insurance is very particular about paying for hospitalizations-- gotta prove medical necessity. A hospitalization is full-time nursing and physician care. Also, many hospitals have limited beds. It wouldn't be good to occupy the bed of someone who really needs it.

[TBulger]

Misskay,

I fought the same fight with a different insurance company. It is EXTREMELY frustrating, but it can be won with time and determination. Your doctor may be willing to fight, but in all honesty he has limited resources. I found that the insurance company was quite fond of dragging things out on the phone. I had a lot more time and motivation to stay on the phone than the staff at the doctors office. When I got an answer I didn't like, I would ask for someone else. Every time I spoke to the insurance company I would fax the info to the doctor and call his staff to let them know what had transpired.

I am preparing for my second round next month. My Prednisone is now down to 7.5 mg per day from 40.

[Sangye]

That's great info, TBulger. I did that when my insurance company wouldn't approve Cellcept. If I hadn't, it wouldn't have gotten approved. I was the one who realized there are no drugs that are FDA-approved for Wegs (they had denied coverage because cellcept wasn't FDA-approved for Wegs). I always asked for a supervisor, even when I was speaking to one. Everyone has a boss.