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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Remicade - insurance coverage?


11-15-2015, 05:24 PM   #1
earthshine
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Join Date: Jun 2015
Remicade - insurance coverage?

Hi,
I am in the midst of determining whether my insurance (Blue Cross Blue Shield) will cover the Remicade injection.

The provider said they provide the injection in a hospital outpatient facility.

But BCBS says they only cover this procedure code (J1745 which is specific to remicade i think based on google) for remicade in a doctor's office, patients' home or a nursing home.

Where do you receiving your injection?

I am wondering whether I will be able to find a doctors office to receive it. Or if my doctor can prescribe it via home health care.
11-15-2015, 05:42 PM   #2
Clash
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Remicade is an infusion. Some GIs use the IV or infusion clinics at hospitals, others have infusion clinics at their office or use stand alone infusion clinics. There is also the possibility of having home infusions in some areas with some insurance carriers.

When my son was on Remicade we recieved them at his GIs office because his GI group had an in office infusion clinic.

My son is now on Humira instead of remicade. Humira is a biologic also but it is a self injection. So a humira nurse came out and showed him how to perform the injections and he self injects every 14 days.
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Clash
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara


Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
11-15-2015, 05:50 PM   #3
my little penguin
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Ds had remicade at a hospital infusion clinic.
Due to the risk of anaphylaxis it was required to be given there
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DS - -Crohn's -Stelara -mtx-IVIG
11-15-2015, 08:04 PM   #4
earthshine
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Join Date: Jun 2015
Thanks for all the feedback.

Guess I need to find a Drs office that does this to be on the safer side
11-15-2015, 08:31 PM   #5
Justanothercp
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Join Date: Aug 2013
Location: Sacramento

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I get mine in infusion clinic at hospital, it is covered by insurance.
11-15-2015, 09:53 PM   #6
Lisa
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Join Date: Apr 2010
Location: New York

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Infusion clinic at a hospital here too, with full coverage. It is billed as chemotherapy also, with no co-pay.
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30 plus years and counting with UC/Crohn's!
on remicade since 11/05

While my experiences may not be what everyone has had- I feel it is worthwhile to share any and all experiences that may be beneficial to others.
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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Remicade - insurance coverage?
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