Medicare Reimbursement amount for infusion center

Yesterday I received a telephone call from my infusion center--

July 1st Original Medicare reduced the reimbursement being paid to infusion centers for Remicade. My infusion center called to tell me that due to this they would no longer be accepting Medicare patients.

I'm frantically looking for another infusion center.
Anyone else having this issue? And just in case---call your infusion center.

Clo

Call your drs office first thing in the morning. They should be able to assist you in finding someone, if nothing else go as an OP at your local hospital.

This is such a frustrating mess.

I called my doctor. They said they'd get me in at his office on the day I was supposed to get Remicade. They do not want to switch me to anything else. So I thought I was good.... Until Friday afternoon. The office called to tell me they don't do ports... And since my veins are so brittle they don't want to even try. We have to find another clinic.

Then the infusion manager called me at 5. She apologized. She was upset. They shouldn't have made this mistake on one of their sickest patients. When she said that I started crying because although I have struggles I don't think of myself that way. She gave me the names of the clinics shed reached out to and none of them are showing up in my insurance bases.....

It's got me so upset I have started to slip into a flare.

Darn insurance. Crossing my fingers today is a better day.

What a nightmare! Can maybe the doc arrange for you to have the infusion in the hospital?

So, my doctor's infusion nurse called and wants me to use Medix. They weren't listed on my insurance... Even the insurance agent could not find it.

So I've spent 2 days trying to get tax ID numbers and their doctor numbers. The numbers they finally gave me popped up under an individual doctor with my insurance company. His different addresses are listed under his tax ID number not his ein and some of his addresses are not listed as preferred in the insurance database. He has a main office 30 minutes away... But they won't talk to me until BCBS approves of them..... And then we have to try to get a new pre approval. BCBS said 30 days for that... Unless we can prove a delay will endanger my life .. and they argued with me because I am now stable. I'm so frustrated. Since there are issues with the addresses and I have to use a preferred physician supposedly at his listed address, I'm gonna have to try to get into the main office and there's a waiting list.

I'm still researching though. And my nurse/office manager didn't fax my docs in until today.

Clo

My next infusion is supposed to happen on August 23. I don't see that happening.

I'll see what I can try to push thru today.

But last night..... No sleep thinking about this.... And today is going to be a Zofran day with Milk of Magnesia chasers. I'm so nauseous and I'm starting to have other symptoms... I'm going to stress myself into a flare......

Clo

Today was a baaaaad day! I drove my doctor's office and the infusion place wild calling them trying to get the referral to them. I don't know why they can't just call my doctor directly. Then it took 4 times to get it to go thru. First 3 went thru fax machine. Last time I got the appointments person and she decided to send it thru her computer. Thank God for her. Now the management at the infusion place will have to decide if they are doing that medication any longer and if they can accommodate all my issues. I don't know what I am going to do if they can't help me.

And for some reason... Stress .. I've lost 4 pounds but my shorts are so tight around my tummy I can't breathe.... And my output... Which is always thick is now fluctuating between thin and constipation. I don't know if I should take milk of magnesia or fiber......., Plus...this is really bothering me...my fingernails are severely ridged from psoriasis. I've been babying them but today they really hurt...and I noticed they are sorta separating from the nail base at the tip of my fingers...and my psoriasis broke out on my scalp and my leg .... I'm so disappointed. I resent my body reacting like this to a little stress.

Tomorrow begins SCD until I sorta settle.

Clo

No infusion yet.

The new infusion place is working out details with my local GI and my Dallas GI...in case things go wrong. They have gone ahead and applied to BCBS for an urgent pre approval. BCBS is disputing the need for it being marked urgent since it's not life threatening.... So next week they are scheduled for a peer to peer with a BCBS doctor. They've arranged for all my doctors to be available for the call. They had to do this last time too. I don't know what's changed for BCBS but gosh.... I digress....

So if everything goes thru next week they think I'll be able to come in the week after. They have to work things out so we have enough time since we run it so slow.

All I can do is wait.

Clo

So pre-approval is not needed but in order to get something in writing that says that you have to submit a request for pre-approval. Sure, that makes sense (not). Hope this gets straightened out soon.

During next open enrollment, you might want to look for new insurance. You've had a lot of problems with them.

I'm the same way, Clo. Every time I have to get a new pre-authorization I do the same as you. Call, follow-up, escalate the process, call, call, call. It's exhausting. With my current insurance they only do PAs for 6 months at a time so I get to go through this twice a year. The one I got in June was particularly frustrating because my provider group has outsourced all PA requests to a separate company who never answered the phone or returned my calls. The nurse at my GI office who handled it before really helped me and got them to give me a call, but getting that approval was really tough. Part of the problem is that my infusions are every 4 weeks so they don't have a lot of time to work on the PA. It shouldn't have to be this hard.

Right now I am trying the hands off approach to trying to get my insurance to cover Dexilant (my acid reflux med). For some reason insurance companies are allowed to change their formularies in the middle of a year (that's so unfair especially since we can only change insurance once a year!). Insurance removed Dexilant from their formulary and when I went to get a refill they said it wasn't covered and wanted me to pay over $1000 or change to a different med. The meds they wanted me to change to were all ones I had tried before Dexilant finally worked. They did this same thing a couple years ago and my doc's office was able to get them to make a formulary exception and it was covered. I just don't have the time or energy to do all the fighting for Dexilant like I do for Inflectra. I have a stash stored up for Dexilant so I am good for probably close to a year without the refill. I am going to sit back and let this process move at it's own pace with my doc's office trying to get the approval and hope for the best. I do have a Plan B if they refuse to cover Dexilant. I did some research and there is price assistance through the pharmaceutical company so I will go that route if necessary. That will be some work too, though, since it's income based and I have to submit copies of tax returns. Hopefully insurance will cover it.

Insurance is so exhausting and stressful. I often wonder if I am the only one who goes through this, too. Inflectra is so essential for my life that's the one I spend my energy on, but it makes me crazy that I have to.

I received the BCBS verification letters stating that the medication and procedure codes do not require pre-approval. MedIx got me right in. I was only about a week late on my infusion. Infusion was 3 hours 15 minutes. Not too bad of a headache or nausea. I thought it would be manageable. Went home and that night from my knees to my feet I broke out in red flat spots. Dr Google had me scared to death it was my liver.... I decided to take a Benadryl that night at 1030 pm.... It knocked me out and when I woke up the spots were gone by half. I took one the next day and they reduced by half again and got lighter....but I still have them just a little.

I contacted my doctors and I have appointments for middle of September. I also called my old infusion place and discovered the infusion there averaged 4.5 hours. So I called the new infusion place and they requested updated doctor orders. Called the GI office and they said the clinic could adjust it on their own and an order is not required because the billing code allows for 2 to 6 hour infusions. I called the infusion place back and she said they'd just extend it on paper but after I saw the doctors in September the infusion clinic needed an updated doctor's order. I am going to request a saline bag along with the Remicade going forward. It seems like I felt much better after the infusions when we did that.

I'm a little concerned because my asthma and alt were a little elevated the last 2 times but my CRP was in the normal range - first time in years and years. It's usually at 11 and it was 9. . The only thing I've been doing different is... Well I've not been taking my supplements except my estrogen, potassium and CQ10, and I have been using rub in pain cream (prescription) for my knees every day. I need to get the AST down.... It was 15 points high and then the next month it was 8 or 9 points too high. The ALT dropped down to the recommended level.

I guess I'll add the vitamin D, turmeric, and start back in with more flaxseed smoothies again. I'm just so tired of taking all these supplements. I was off all supplements except the ones listed for 3 months, plus on an every third day previously ... And my AST and ALT levels were high on both my blood tests so I guess the supplements may have been helping--unless the pain cream is causing higher ALT/AST?

Clo

CLO: Dr. Google is bad.......

Heads up everyone that uses Diclofenac Sodium Topical Gel--I was able to find some studies regarding usage and increased ALT and AST numbers.... Not only that but a friend said the company was changing brochure information indicating that with regular use it can be toxic for your liver.

Aggggh!!!!!! Freaking out. Head spinning. Holy Cow!

And I can't find anything on if your liver will heal if that happens......😭

Clo