After lots of prayers to the insurance coverage gods, I got my answer. Melanie from BioScrip pharmacy called to let me know that my insurance (United Healthcare) WILL cover the thyrogen shots at 100% once my $250 deductible is met. What? What? YAYYYY!!! WOOHOOOO!! Paying $250 is much better than having to pay $2,400 which is what it would have cost for two thyrogen shots without insurance coverage. What a relief!
I started asking Melanie some questions so I could update my blog readers. She was more than happy to give me some of the “inside scoop” and I am happy to share it with all of you. I hope it saves many other people thousands of dollars and many phone calls to the insurance company. (Please read my last post Thyrogen Shots and Insurance Coverage – Not? for information about thyrogen and to to hear about my first round of calls with the pharmacy and insurance company.) My conversation with Melanie from BioScrip went a little bit like this:
Me: Is BioScrip pharmacy part of ThyrogenOne?
Melanie: We are one of the approved pharmaceutical companies that supplies the doctors with thyrogen.
Me: How did you manage to get it covered by my insurance company? Last week I was told it was not covered.
Melanie: I went through the medical side of your insurance coverage. It is not covered under your prescription plan. So when your local pharmacy called it into the prescription side of United Healthcare, the coverage was denied. It has to be called in and billed through the medical side.
Me: Ohhhhh. That is good information Melanie. Thank you! It really upsets me to think about all of the people who are trying to beat cancer or stay in remission and are told that the thyrogen shots are not covered by insurance simply because it was put through on the prescription side instead of the medical side. It is tiring enough to live with cancer and go through all of the time-consuming, energy draining things we need to do to fight cancer. If more people knew about ways to get their treatment covered by their insurance company, then it would make a positive difference. I’m gonna blog about this!
Melanie: I understand. That is a good point. I hope it helps other people when you blog about it.
Me: I hope so to. I really appreciate you taking the time to talk with me.
There you have it. That is how my conversation went with Melanie from BioScrip. She was very knowledgeable and took time to explain things to me. But I also asked the questions. It is so important to speak up. I didn’t go to school and take Cancer 101 classes. This is not something that I had planned for my future a couple of years ago. There is a lot to learn and it all starts the moment we are diagnosed with having cancer. So learn all that you can. Make sure you get your information from reliable resources. Ask all the questions you want to. If something is not covered by insurance, fight for it. This is your body, your health and your life.