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Thread: Check with Insurance Company before Rituxan Treatments

  1. #1
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    Default Check with Insurance Company before Rituxan Treatments

    Hi everyone! Just wanted to let you know that any of you that are considering Rituxan treatments should check with your insurance coompany regarding if they will cover it. I got a not so cheap bill from the hospital because my insurance denied coverage. They consider Rituxan experimental for lupus and would not cover it. And let's just say each treatment is a few thousand dollars each!!!! I'm going to my doctor tomorrow and I'm going to have him appeal it and if that doesn't work I'm going to see if gentech the pharm. co. that makes rituxan will give me some reimbursement. Wish me luck! :lol:
    Diagnosed in 1990 at age 11.
    Trust in the Lord with all of your heart!

  2. #2
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    Default Ouch!!!

    Did the hospital not check first about pre-authorization - the hospital here is fanatic about pre-authorization for expensive treatments or procedures. I was told by my insurer (BC/BS) that they would not authorize for lupus treatment because it was still in clinical trials since my lupus wasn't "life-threatening" at that point - even though the combination of pulse steroids, IV cytoxan, plasmaphoresis, IVIV and weekly blood transfusions for autoimmune anemia required at that point in my illness probably cost a lot more, and my insurer screamed bloody murder about the IVIG. It looks like insurers would realize that the cost of hospitalization is far more expensive in the long run.

    I know there are some clinical trials going on right now with this drug in lupus and lupus nephritis although I'm not sure where.
    maybe you could get in to one of these where the meds would be provided.

  3. #3
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    Default

    The hospital did not check into pre-authorization. At the same time I should have thought about that but I was too sick then to really think about it. But I put in an appeal and my doctor is wrting an appeal letter for me. He was very upset that they didn't cover it. So I'll keep you posted on what happens.
    Diagnosed in 1990 at age 11.
    Trust in the Lord with all of your heart!

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