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Crohn's Disease Forum » Parents of Kids with IBD » Remicade Program Question


05-04-2017, 04:15 PM   #1
Mehita
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Join Date: Nov 2011
Location: Minnesota

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Remicade Program Question

We submitted the EOB and itemized statement from the hospital for DS' last two infusions like I've always done in the past (but we have a new insurance company this year) for the Remi reimbursement program. I got a letter today saying Remi isn't able to process the request because the "document does not clearly define the out-of-pocket expense for Remicade." I'm supposed to submit an itemized statement for the date of service. Problem is, I did. I sent everything that I've always sent in the past, the difference is that the new insurance company's EOB is very vague. It only lists "OP MISC SERVICES" and "CHEMOTHERAPY".

I'm not sure what to do next?
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Mom of DS, age 17, dx Crohn's and Celiac Oct 2008
- Remicade, started Nov 2013, added Solumedrol June 2015
- added Methotrexate/Folate March 2016
- Multivitamins, Probiotics, Vit D
- Small bowel resection, Jan 2013
05-04-2017, 04:37 PM   #2
pdx
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Location: Portland, Oregon

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I would call Remistart first. I've had some questions for them in the past, and they've always been surprisingly helpful over the phone. Maybe they will even have past experience with your current insurance company and will be able to tell you exactly who you need to contact to get a more detailed EOB. Good luck--hope it turns out to be easy.
__________________
Daughter E (15) dx with Crohn's 12/18/14 at age 12

Current treatment:

Remicade started 12/24/14 (currently on 9 mg/kg every 6 weeks)
Oral methotrexate restarted 12/2/16 (15 mg weekly)
vitamin D, folic acid, multivitamin, Prozac

Past Treatment
90% EN via NG tube 2/9/15 - 4/2/15
50% EN via NG tube 4/3/15 - 4/18/15
Supplemental EN via NG tube 5/7/15-6/19/15
Budesonide 3/3/15-6/30/15
Oral methotrexate 3/13/15 - 5/14/16 (15 mg weekly)
Topical clobetasol for Remicade-induced psoriasis
05-04-2017, 05:10 PM   #3
Ladybug12
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Join Date: Jul 2016
We submitted the EOB and itemized statement from the hospital for DS' last two infusions like I've always done in the past (but we have a new insurance company this year) for the Remi reimbursement program. I got a letter today saying Remi isn't able to process the request because the "document does not clearly define the out-of-pocket expense for Remicade." I'm supposed to submit an itemized statement for the date of service. Problem is, I did. I sent everything that I've always sent in the past, the difference is that the new insurance company's EOB is very vague. It only lists "OP MISC SERVICES" and "CHEMOTHERAPY".

I'm not sure what to do next?
I went through the same thing after our health insurance changed. I called and spoke to customer service and the EOB was sent over again and approved.
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