Guest guest Posted September 17, 2001 Report Share Posted September 17, 2001 , It will be important for you to have a diagnosis and preferably a letter of medical of necessity from a medical doctor. This will help your chances of an appeal immensely! Please call back your specialist's office and see what they can do to help you with this! Marci (Mom to ) Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Does anyone have a pharmacy plan which is separate from their medical coverage? For example, my prescriptions are covered through Express- Scripts, and my health insurance is covered through Cigna. If you have a similar set-up, which insurance plan is currently covering your Xolair? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 --- In , " " <justinlouisville@...> wrote: > > Does anyone have a pharmacy plan which is separate from their medical > coverage? For example, my prescriptions are covered through Express- > Scripts, and my health insurance is covered through Cigna. If you have > a similar set-up, which insurance plan is currently covering your > Xolair? > > Thanks! > , Yes, I do. My plan is BCBS and my Rx plan is throught Medcohealth http://www.medcohealth.com (They are Owned by Merck Pharmacutical) They are super and even have their own specialty pharmacy where I get my Xolair. Doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Thanks for your reply, Doug. So your Rx plan (medcohealth) pays for everything related to the Xolair, even the administration of the injections at the doctor's office? Thanks again! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 I have medical coverage through Blue Cross Blue Shield and the pharmaceutical items are covered under Caremart. The two are separate from each other. I made sure the xolair is covered under the BCBS medical coverage because it had a smaller co-payment plus the co-payments are capped at $1000.00 at a 80%/20% split with me paying 20% of the total cost of the injection. . If I went through Caremart then the co-pay is 30% of the total cost of the injection plus there is no cap which means I would continue to pay 30% of the co-payment forever. With all the other co-payment I have I figured the Medical portion of the insurance was the better and less expensive way to go. ~STEVE ZIMMERMAN, CPM, CVOM~ ________________________________ From: [mailto: ] On Behalf Of Sent: Friday, April 28, 2006 10:31 AM Subject: [ ] Insurance question Does anyone have a pharmacy plan which is separate from their medical coverage? For example, my prescriptions are covered through Express- Scripts, and my health insurance is covered through Cigna. If you have a similar set-up, which insurance plan is currently covering your Xolair? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2006 Report Share Posted April 28, 2006 Thanks, Steve. So are you saying that you actually get a CHOICE about which coverage to use? --- In , " Steve Zimmerman " <steve@...> wrote: > > I have medical coverage through Blue Cross Blue Shield and the > pharmaceutical items are covered under Caremart. The two are separate > from each other. I made sure the xolair is covered under the BCBS > medical coverage because it had a smaller co-payment plus the > co-payments are capped at $1000.00 at a 80%/20% split with me paying 20% > of the total cost of the injection. . If I went through Caremart then > the co-pay is 30% of the total cost of the injection plus there is no > cap which means I would continue to pay 30% of the co-payment forever. > With all the other co-payment I have I figured the Medical portion of > the insurance was the better and less expensive way to go. > > ~STEVE ZIMMERMAN, CPM, CVOM~ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2006 Report Share Posted April 29, 2006 hi there: I have BCBS NJ and my pharmacy per the insurance card is caremark. Xolair is being covered through another pharmac - curascript. My doctor's office took care of that. I just had to okay the copay and pay that directly to curascript. - niti --- In , " " <justinlouisville@...> wrote: > > Does anyone have a pharmacy plan which is separate from their medical > coverage? For example, my prescriptions are covered through Express- > Scripts, and my health insurance is covered through Cigna. If you have > a similar set-up, which insurance plan is currently covering your > Xolair? > > Thanks! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 1, 2006 Report Share Posted May 1, 2006 Hi Niti, Thanks for your reply. Does BCBS cover the cost of the administration of the injection at the doctor's office? Thanks, > > hi there: > > I have BCBS NJ and my pharmacy per the insurance card is caremark. > Xolair is being covered through another pharmac - curascript. My > doctor's office took care of that. I just had to okay the copay and > pay that directly to curascript. > > - niti Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2006 Report Share Posted May 2, 2006 Hi : I have gone to my doctor's office twice for administration of xolair. And just got a statement for the first one from BCBS. So it appears they did bill BCBS for that, and BCBS paid part of it +i pay the copay. However, the amount that the doctor billed to my insurance was minimal: a total of $60. After reading other people's experiences with the amount they are charged for administration, my already high respect for my doctor has increased...I don't think they believe in charging much for shot administration. - niti > > > > hi there: > > > > I have BCBS NJ and my pharmacy per the insurance card is caremark. > > Xolair is being covered through another pharmac - curascript. My > > doctor's office took care of that. I just had to okay the copay and > > pay that directly to curascript. > > > > - niti > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2006 Report Share Posted May 2, 2006 Hi : I have BCBS and it covers part of the cost. My doctor bills for a doctor visit and 2 " chemotherapy " treatments. Instead of the usual $20 copay, I have to pay $44 for the Xolair shots, plus a nominal copay for the med. The administration is WAY more expensive than the cost of the drug. Carol Corley wrote: Thanks for your reply. Does BCBS cover the cost of the administration of the injection at the doctor's office? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2006 Report Share Posted May 15, 2006 I have Medicare Part B for major medical and Part D for pharmacy. Xolair is covered under Part B, not under the pharmacy plan. My coverage is excellent - my doctor " buys and bills " Medicare for Xolair and bills me only for the $20 Medicare shorts him for the cost of the Xolair. From some of the other posts about all this, I think my doc must be a saint. Fran --- In , " " <justinlouisville@...> wrote: > > Does anyone have a pharmacy plan which is separate from their medical > coverage? For example, my prescriptions are covered through Express- > Scripts, and my health insurance is covered through Cigna. If you have > a similar set-up, which insurance plan is currently covering your > Xolair? > > Thanks! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 9, 2008 Report Share Posted September 9, 2008 From what other parents have shared with me and my own research as a parent regarding the very same it appears that most children on the spectrum are not diagnosed with behavioral health issues. Most behaviors for children and adults on the spectrum are a means of communication and or reaction to their environment due to sensory issues. Unless your child has a a specific mental health diagnosis you should be able to leave the box blank since autism is recognized as a neurological disability. Hope this helpsSandee WinkelmanParent Quote Link to comment Share on other sites More sharing options...
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