I Can\'t Post in MS Support Group - Upset About Avonex Denial
I am trying to post but for some reason Daily Strength keeps asking me to join a group that I already belong. And when I try to join, I get a blank page. My Medicare Health Plan turn me down for my Avonex injections. They tell me that it can only be covered under Part D. It is also covered on Part B if you get the injections at the doctors office, which I have been doing for two years now. I also had health plan that covered the co-pay of the 20% in the past two years. This health plan also covers the 20% under Part B.. there is no-copay. I didn't get my injection this week and probably won't next week as I am filing a grievence against this policy as it doesn't follow Medicare rules. I have also called Medicare and they are filing a claim against this health plan. Many of those with MS are still working and have coverage. For those that are not working and disabled fall under Medicare or their Advantage Plans or Medicare and Drug plan... whatever.. I paid for the best policy to have this burden off of me. Many of those with MS doing their self-inject their meds or have someone to help them. I don't have the resourses to pay for Part D or anyone to help me with injections. (I have tremors now). There is no reason for me to be forced to do Part D and self-inject when it clearly states: Medicare Part B for Certain Intramuscular InjectionsMedicare will cover intramuscular injections provided in a physician’s office for medications such as the MS drug Avonex. Coverage is generally available only for intramuscular, not intravenous injections, and only when Medicare presumes that people in general, not the particular patient, cannot self-inject the drug. This presumption has been made for Avonex. To be covered, the drug and administration must be provided in the physician’s office and the services are subject to the Part B annual deductible and 20% co-payment. A few Medigap insurance policies will cover the co-payment. My health plan said the Avonex is consider a drug that can be self-inject and therefore not covered under part B. However that is not what it states above. My Health plan also told me that I couldn't get into another plan. Medicare says otherwise. My doctor's office should have file forms of authorization when I changed insurance the first of the year. I had to because my other plan drop the state of SC from their policy. Unfortunately, the first day I went for my injection in January, I was having seizure like activity and pretty much out of it. I had to have an EEG and then waiting on the doctor. When aware enough I gave them my new card and told them health insurance plan changed. What a mess. I have a whole month of shots and wondering how they are going to be paid. For those reading this, do your best to be pro-active in fighting for what you know is right, checking behind doctor's office to make sure they file for authorization, doing what ever it takes. I leave on this note, that I know I place this situation in Daddy's God hands and He has taken care of it. God bless you.
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