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Contacted Blue Shield of CA about IPI coverage

Forums General Melanoma Community Contacted Blue Shield of CA about IPI coverage

  • Post
    killmel
    Participant

    Hi All,

    For what it is worth, I contacted my Blue Shield of CA (spoke to Manager over Benefits) regarding coverage to pay for IPI. I was told that the fact FDA approved IPI there was no guarantee the Blue Shield would pay for the drug. Patients would have to get a pre-service authoriztion which entails reviewing patients history  then Blue Shield would make a decision whether or not to pay for the drug. 

    Hi All,

    For what it is worth, I contacted my Blue Shield of CA (spoke to Manager over Benefits) regarding coverage to pay for IPI. I was told that the fact FDA approved IPI there was no guarantee the Blue Shield would pay for the drug. Patients would have to get a pre-service authoriztion which entails reviewing patients history  then Blue Shield would make a decision whether or not to pay for the drug. 

    Well, the review of patient's history is a reasonable process to determine coverage on IPI. But then I was told that IPI is so new, that the decision to pay for IPI was very low because the drug was so NEW & the drug is considered experimental/investigatory at this stage…not enough patients took the drug on the clinical trials

    For those now on the drug under compassionate use,your chances are better to get payment for IPI because you are in the middle of treatment. For those, hoping to start IPI, it will be an up hill battle with Blue Shield.

    I asked if IPI covered under Medicare would that make a difference that Blue Shield would pay for IPI. The manager told me "NO". For those not  covered under Medicare, our chances of getting IPI paid for by insurance could be problematic.

    I read another post on MPIP that said, maybe we were better off having IPI under compassionate use because now it is up to insurance companier whether or not to pay for IPI. I think that is a worse situation than trying to get IPI under compassionate use. Now our fate is up to the insurance companies. Life is not easy.

    Thanks for taking the time toreadmy post

    Douglas

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  • Replies
      EmilyandMike
      Participant

      Thanks Douglas – we have Blue Shield of CA also so this is helpful.  Some good news is that the experts including the MRF (Tim is quoted as saying so in this article) expect insurance companies to pay for the treatment.   But who knows how long that will take. Article says that it should be for sale by early April.

      http://www.insurancequotes.com/health-insurance-melanoma/

      Best,

      Emily

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      EmilyandMike
      Participant

      Thanks Douglas – we have Blue Shield of CA also so this is helpful.  Some good news is that the experts including the MRF (Tim is quoted as saying so in this article) expect insurance companies to pay for the treatment.   But who knows how long that will take. Article says that it should be for sale by early April.

      http://www.insurancequotes.com/health-insurance-melanoma/

      Best,

      Emily

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      lhaley
      Participant

      I have BCBS of Delaware and it's a PPO plan. So far I don't have to get anything preauthorized except for surgeries. PETS and MRI's don't have to be. Which kind of BCBS do you have?

      Thanks,

      Linda

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      lhaley
      Participant

      I have BCBS of Delaware and it's a PPO plan. So far I don't have to get anything preauthorized except for surgeries. PETS and MRI's don't have to be. Which kind of BCBS do you have?

      Thanks,

      Linda

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      CKasper
      Participant

      I have BCBS of New Hampshire.  I don't know if they will cover IPI, they covered all my surgeries, tests and treatment.

      C kasper

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        killmel
        Participant

        Hi,

        I also have Blue Shield of CA PPO and I have to get pre-authorization to have MRI PET & CT scans. Also, need approval for surgeries.

        I was told by  Benefitsthat there is a Boardmof Doctors that review all new drugs approved by FDA. These Doctors will decide if Blue Shield will pay for this drug. If Blue Shield of CA decides to pay for the drug, there will  guideleineswho will qualify for the drug.

        Most importantly, I was told the a pre-service authorization would need to be completed by our doctor, supporting the "medicalm necessity for the drug.

        dee

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        killmel
        Participant

        Hi,

        I also have Blue Shield of CA PPO and I have to get pre-authorization to have MRI PET & CT scans. Also, need approval for surgeries.

        I was told by  Benefitsthat there is a Boardmof Doctors that review all new drugs approved by FDA. These Doctors will decide if Blue Shield will pay for this drug. If Blue Shield of CA decides to pay for the drug, there will  guideleineswho will qualify for the drug.

        Most importantly, I was told the a pre-service authorization would need to be completed by our doctor, supporting the "medicalm necessity for the drug.

        dee

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      CKasper
      Participant

      I have BCBS of New Hampshire.  I don't know if they will cover IPI, they covered all my surgeries, tests and treatment.

      C kasper

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