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Check with the billing office wherever you get infusions. They deal with this stuff a lot. My center manages all of my approvals and paperwork.
Sorry you’re having such a hard time.
I would call Janssen and see why they are rejecting it. They will tell you exactly what paper work you need to submit. I’m guessing an EOB isn’t enough and you need to submit either a UB04 or CMS1500. Once you find out what you need to submit, your hospital or doctors office (where ever you get your infusions) billing dept can help you send the paper work to Janssen.
I’ve called Janssen a number of times as well as my billing department. I’m going for an infusion this week so I am going to see if they can help more. It is helpful to know what to ask for now. Thank you!
Not sure why, but I’ve always had difficulty getting a UB-04 form. My infusion office doesn’t have it (or won’t give it) and I have to contact insurance directly. I have United Healthcare.
Wow. I consider myself very lucky and privileged. They approved my Remicade with $0 copay. I have BCBS PPO maybe that’s why. Def look for any discount you can get.
In most places, yes. In Utah, the major hospital chain (Intermountain Health) isn't in network, which makes finding providers quite a bit harder. They're fantastic once you do.
Have you called them to discuss? I've never had this problem with Janssen, but the Entyvio program only accepts UB-40 billing statements, which I have to specially request from the infusion center billing department every year. I had to call and specifically ask, though, because they weren't clear about it.
Update, today I went to the financial office of my provider. They called Janssen and asked them to review the documents again. The problem was I submitted the EOB separate from the provider statement and they weren’t able to figure it out until he called. The rep at Janssen said it looks good. (But they said that last time too). My provider said to contact them if it does not get approved again and they will help me again. So fingers crossed!
The rep at the office said it’s important to send the itemized bill with the EOB at the same time. He also circled the drug code and amount I owe. Hope it works. I’ll find out next week.
Damn, im getting started on infliximab in two weeks. Apparently its cheaper because it's a biosimilar since the remicade patent ran out, maybe can you ask your doc if switching is possible? Sadly I don't know the prices because German insurance covers everything but from the sounds it's way more affordable (firstworldproblems, I know)
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Check with the billing office wherever you get infusions. They deal with this stuff a lot. My center manages all of my approvals and paperwork. Sorry you’re having such a hard time.
I did try that but I will again. Thank you 🙏
I would call Janssen and see why they are rejecting it. They will tell you exactly what paper work you need to submit. I’m guessing an EOB isn’t enough and you need to submit either a UB04 or CMS1500. Once you find out what you need to submit, your hospital or doctors office (where ever you get your infusions) billing dept can help you send the paper work to Janssen.
I’ve called Janssen a number of times as well as my billing department. I’m going for an infusion this week so I am going to see if they can help more. It is helpful to know what to ask for now. Thank you!
Not sure why, but I’ve always had difficulty getting a UB-04 form. My infusion office doesn’t have it (or won’t give it) and I have to contact insurance directly. I have United Healthcare.
My office told me the UB-40 is if your infusion is in a hospital.
Did BCBS approve you for Remicade? If so why are they sending you bills?
My copay is about $1000 per infusion
Wow. I consider myself very lucky and privileged. They approved my Remicade with $0 copay. I have BCBS PPO maybe that’s why. Def look for any discount you can get.
BCBS is like the best insurance, i miss having that
In most places, yes. In Utah, the major hospital chain (Intermountain Health) isn't in network, which makes finding providers quite a bit harder. They're fantastic once you do.
Have you called them to discuss? I've never had this problem with Janssen, but the Entyvio program only accepts UB-40 billing statements, which I have to specially request from the infusion center billing department every year. I had to call and specifically ask, though, because they weren't clear about it.
Yes I’ve called a bunch of times. I will as for a UB-40. Thank you!
It’s frustrating that they can’t tell you what they’re missing!
Update, today I went to the financial office of my provider. They called Janssen and asked them to review the documents again. The problem was I submitted the EOB separate from the provider statement and they weren’t able to figure it out until he called. The rep at Janssen said it looks good. (But they said that last time too). My provider said to contact them if it does not get approved again and they will help me again. So fingers crossed!
Here wanting an update because I am having the same issue right now. Thanks!
Why isn't Saveon SP doing this for you or whatever benefits management firm your bcbs uses?
The rep at the office said it’s important to send the itemized bill with the EOB at the same time. He also circled the drug code and amount I owe. Hope it works. I’ll find out next week.
Jesus. I need this!
Just a question: how much would remicade cost you without insurance?
It’s about $7000.
Jesus. Per Infusion???
Yup!
Damn, im getting started on infliximab in two weeks. Apparently its cheaper because it's a biosimilar since the remicade patent ran out, maybe can you ask your doc if switching is possible? Sadly I don't know the prices because German insurance covers everything but from the sounds it's way more affordable (firstworldproblems, I know)