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I think insurance approved it but now what?

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    I think insurance approved it but now what?

    I was able to use all my testing from june to start Gilenya. YAY .. And switch my health insurances as of the first of the year. I've been checking the Insurance website looking for the claim to go through and it did!!! It has a claim number, "plan paid amount", "member responsiblity" amount, even an rx number. I'm taking that as it being approved.

    I saw that info for the first time on 1/7 but I haven't heard anything from anyone else.

    I haven't heard from the doctors office about my first dose, or the pharmacy to scheduled delivery. I also haven't heard from Gilenya.

    I know when I started Avonex they called me to talk to me about the meds and about their financial assistance program does gilenya do that?

    Do you think I should call someone? My husband asked if I should but I don't know who? IDK if I should call the dr office, the pharmacy, the insurance company, or Gilenya...
    Sos219
    4/24/2014
    Avonex

    Gilenya 1/29/2015- present

    #2
    I've been going through this same process and I got a call from the dr's office to set up a day for the first dose. I haven't even received anything in the mail from the insurance company yet saying they approved it. The way I understood it is the dr's office will get the first two weeks worth, give you the first dose and you take home the rest. After that, the pharmacy will call you to set up shipments as usual.
    Diagnosed 1/4/13
    Avonex 1/25/13-11/14, Gilenya 1/22/15

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      #3
      that's what I thought too. It seems weird that it's taking so long for them to set it up....
      Sos219
      4/24/2014
      Avonex

      Gilenya 1/29/2015- present

      Comment


        #4
        I got a call from my Gilenya Go nurse letting me know that my insurance had approved before getting the call to set up the appointment with my neuro for the first dose. I go February 6th. I'm a little nervous. I tend to have a low resting heart rate and on my EKG, it was 61 (not abnormally low but pretty close). I was on Tecfidera for 6 months and had an allergic reaction and haven't taken anything since late October so I'm anxious to get started with Gilenya!

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          #5
          I applied for Gilenya june 2014 but my insurance at the time denied it. I just looked througha all of my facbook posts and found out. Once I finished all the testing I got a call from my dr office setting up the FDO then I got a call from Gilenya advisor guy explaining it all, then about a week before I was supposed to go in I got denial letter in the mail from my insurance.

          I have new insurance now which is why we waited until the 1st of the year to send in the paperwork.

          It's annoying that the doctors make a big deal about being on meds that work saying stuff like "we NEED to get your on a new med ASAP" but everything takes so long. Like there is no sense of urgency at all.
          Sos219
          4/24/2014
          Avonex

          Gilenya 1/29/2015- present

          Comment


            #6
            All the worry and stress was for nothing. I got the call today, my first does is scheduled for next Thursday :-D
            Sos219
            4/24/2014
            Avonex

            Gilenya 1/29/2015- present

            Comment


              #7
              Mine too! Looks like we're both in for a long, boring day.
              Diagnosed 1/4/13
              Avonex 1/25/13-11/14, Gilenya 1/22/15

              Comment


                #8
                seriously though I can not wait for it! I'm so excited! LOL
                Sos219
                4/24/2014
                Avonex

                Gilenya 1/29/2015- present

                Comment


                  #9
                  Me too. I was on Avonex for almost two years and I just couldn't take it anymore. I was only able to convince my neuro to try something else when I took it upon myself to quit the injections. I've been wanting to try Gilenya for a while now, especially when I really think the Avonex never did anything for me (my neuro didn't think so though). And why take something to reduce relapses by 30% when you can reduce them 50%?

                  I never thought I stood a chance at my insurance approving Gilenya, so I was totally excited when I got the call to set up a date for the first dose. I certainly won't miss jabbing myself in the leg once a week!
                  Diagnosed 1/4/13
                  Avonex 1/25/13-11/14, Gilenya 1/22/15

                  Comment


                    #10
                    I got a phone call from the neurology office yesterday letting me know not to take my avonex next wed. AND that they are waiting for prior auth forms and if they don't get those by next weds we will have to postpone my start date....so it still might not happen.... such a buzz kill
                    Sos219
                    4/24/2014
                    Avonex

                    Gilenya 1/29/2015- present

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