I have excellent health insurance coverage. I pay a lot for it. A whole lot. And it’s a good thing I have good health insurance, because I have a chronic disease. The infusion appointments I get every two months cost the equivalent of a decent used car.
But, having insurance does not mean having peace of mind. Those pesky exclusions and limitations can leave you holding a very expensive bag. My insurance will not pay for infusions administered at a hospital. I understand that hospital infusions might cost a lot more money than, say, outpatient infusion centers, so I get the reason for the exclusion. But in practice, it’s asinine.
My G.I. doctor practices at the University of Washington. In March he performed my colonoscopy. I also needed an infusion around that time, and our plan was to do the infusion immediately after the colonoscopy. But, the University of Washington has a medical center – a hospital. Even though I was at a satellite clinic, the University of Washington Medical Center would bill the insurance company for the infusion. My insurance company refused preauthorization. I had to schedule another appointment for a different day at the offices of a home healthcare visiting nurse service in an industrial park in Tukwila.
That’s because, while my insurance will not pay for a hospital infusion, it will pay for a home infusion. This I find the most curious, as a home infusion is very expensive. In theory, at a hospital that also performs home health care services, I could park the rig at the hospital, a nurse could administer the infusion in the parking lot in my home, and my insurance would cover that.
The reason I’m writing about all of this now is the immense difficulty I had scheduling my last infusion. Granted, not all of it was due to insurance exclusions. For example, while I was in Tennessee, where there are plenty of non-hospital based infusion centers and visiting nurses, they would not accept my Seattle doctor’s standing order for Entyvio. Tennessee requires that I first see a Tennessee gastroenterologist, which could take weeks for an appointment, get a new order, then schedule the infusion, which could also take weeks.
Why? Entyvio is a prescription drug. My doctor has prescribed that drug. As I travel the country I can go to any Walgreens or CVS Pharmacy and get my prescriptions filled, as long as there is a doctor somewhere who ordered them. Why should Entyvio be any different?
Getting the infusion in Tennessee was going to be difficult and time-consuming given these hoops. I decided to get the treatment in Mississippi.
And here’s where the insurance exclusion came in to kick my ass. In small, rural communities, the only place to get an infusion, if at all, is in a hospital! In Tupelo, Mississippi, I thought I finally hit the jackpot when I found The Outpatient Infusion and Specialty Pharmacy at North Mississippi Medical Center. But, no. Even though it was outpatient and even though it was a specialty pharmacy, the fact that the bill would come from a hospital meant that my insurance would not pay for it.
Finally, I was able to get treatment in Meridian, Mississippi, at Vital Care Home Infusion Services, and it was a really nice place, too!
I was thankful, as my symptoms have doubled since May. Yup, I’m back up to six or so events every other day or so, and those Canasa suppositories didn’t do jack shit. Now we’re trying corticosteroid suppositories.
The good news is I have two months between every appointment to figure out where I am going to be, and to find an infusion center that will be acceptable to my insurance company. I can also alter my plans to be somewhere else if necessary.
I will. not. let. this. disease. derail. my. life. or. my. dreams!