The cost of Crohn's Disease. The insurance industry and preauthorization.

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Having recently been diagnosed with IBD and Crohn’s disease, I’m in the early stages of infusion therapy with a biologic drug.

The sticker price is $4,000 a dose. I have had three infusions with more to come.

My state teacher retirement insurance under United Healthcare’s Medicare Advantage program will pay for of it.

My concern, and the concern of others, is that starting January 1st we are being moved from the United Healthcare’s Medicare Advantage program to Aetna.

I have been assured over the phone that the preauthorization I received for the infusion therapy will automatically continue under Aetna’s Medicare Advantage.

Can I rest assured?

Nope.

We still haven’t received information to pass on to our medical care providers and the change of insurance providers is just weeks away.

I’ve heard too many horror stories from other Crohn’s patients about battling for pre-authorization not to be a little stressed about it.

Stress, by the way, is a trigger for a Crohn’s flare up.

Preauthorization is the right of insurance companies to overrule the recommendation of medical professionals.

One issue of living with inflammatory bowel disease is paying for the care and treatment that comes with it. The high costs associated with a chronic illness like Crohn's disease or ulcerative colitis can be overwhelming.

People living with IBD may lose wages due to having to miss work, in addition to large out-of-pocket expenses for infusions, injections, prescriptions, and procedures.

I’m fortunate that as a retiree I don’t have the stress of working with and trying to get accommodations for Crohn’s.

The Crohn's & Colitis Foundation's Cost of Inflammatory Bowel Disease Care Initiative performed a cost of care study, analyzing the annual expenses incurred by 52,782 people with IBD over 10 years. The study found that people with IBD experienced more than three times the direct costs per year than people without the disease.

The study also found that people with IBD incurred the highest costs in the first year after diagnosis for medical bills related to specialty drugs, injections, infusions, and procedures to help treat their condition.

One of the terrible features of private insurance based coverage is their right to deny coverage of a medically necessary drug or procedure.

Prior authorization, or pre-authorization, is an approval process that insurance companies require when a doctor prescribes a specialty drug. This type of authorization is common for IBD drug coverage.

I have heard from many Crohn’s patients who have had to battle with companies like United Healthcare after being denied biologic therapies.

It is one more reason why medical care should not be in the hands of private insurance companies and why a system of government healthcare is needed.