1 more road block for over reacting! - My MSAA Community

My MSAA Community

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1 more road block for over reacting!

pamgarner profile image

orcrevus just called me and told me my portion will be 4900.00.She gave info for healthcare foundation which is closed today because of weather for help paying this..I asked my dr office 3 times if they talked to my insurance co,about this treatment since it was rolling over to a new year they said it was fine until june! now I have to ask for condiontioal approval and keep my fingers crossed, they approve me, I am starting to wonder, and I suppose to have this treatment this time,there has been a lot of roadblocks in my path.urrrggghhh!

15 Replies

I hear your frustration. The uncertainty about whether insurance will cover treatment, to which extend, etc, is incredibly stressful for us with MS. This often adds to our level of anxiety.

I've found that working with a neuro who's specialized in MS helps, because their office is used to the many loops needed to deal with insurance. But don't give up, keep asking. Some insurance just say no by default, without looking at the latest data that you might have provided them.

thanks for replying but my Neuro does do that but he sure dropped the ball big time this time

Jesmcd2 profile image

Ouch pamgarner 😟 I hope it all clears up for you soon! Have you checked out MSAAs Prescription Assistance Program? mymsaa.org/ms-information/p...

See if that can help you any.🤗💕


pamgarner profile image
pamgarner in reply to Jesmcd2

I should have an answer today.need to ask for conditional approval for treatment tomorrow down to the wire talk about stress

You are entitled to be frustrated but please don’t get too stressed, try and relax, try thinking positive and hopefully it will all turn out ok, keep us posted, blessings Jimeka 🙏

pamgarner profile image
pamgarner in reply to jimeka

I am keeping my fingers crossed, should have conditional approval today,treatment tomorrow,I truly believe that if I am not supposed to have this God puts roadblocks in my path.....we will see

carolek572 profile image

pamgarner , you are not over reacting. You experience is similar to mine. I was informed that my next infusion would have an OOP of over 4600, and that before shipping the meds to the infusion center, they need a guaranteed form of payment! That is just an estimate and they will not know true cost until they ship! My OOP for my first infusion was less than that and I didn’t need to pay prior to infusion. What gives? I am not sure if I should be upset at infusion center, the specialty pharmacy, or insurance company.

Same with me. It was the sales representatives assigned to my account from the drug company. They were clueless about deadlines and where they were supposed to send things.

pamgarner profile image
pamgarner in reply to carolek572

nothing like waiting until the last minute, the last time was so smooth this time not so much,I had asked my dr office 3 times if my financing was in order, they assured it was.It ain't over until it's over....

pamgarner profile image
pamgarner in reply to pamgarner

I don't know who to be upset with ......

So sorry you are having to deal with all this! I was on Aetna through my employer when I was switching to Ocrevus. I got the run around from them even though they had years and years of records on me. My neuro had to appeal and then I was approved. It took months and I had to cancel/reschedule the first 1/2 doses twice. Aetna also couldn't be bothered to coordinate with Genentech's reimbursement program that I'm in so I have to do that myself. Annoying.

pamgarner profile image
pamgarner in reply to Raingrrl

I think this is quandary for all of us

I am so sorry to hear this. Sometimes, I feel like the worst part of having MS is having to deal with all the treatment roadblocks set in our path. Doesn't seem fair when we are already dealing with so much physically to have to keep leaping these emotional and mental roadblocks.

Kenu profile image
Kenu in reply to Texandyroe

Totally agree with you, it seems like we have to do all the work 😡 Ken 🐾🐾

Fancy1959 profile image

Pam, there is more than one charitable foundation that will help with your co-pay. Don't stop calling just because the first one says no oŕ isn't open. It's important to do this early in the year as their money's run out. Contact me and I will give you the additional nonprofit organizations phone numbers and names that I have and perhaps one of them can help you out as I have several. Fancy.

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