Reply To: Rituximab
Karen, My oncologist/hemotologist was denied reimbursement for Rituxan initially due to it’s cost and being a “prior authorization required” drug. “Medical necessity” had to be explained to them (Blue Cross Medicare) before they would approve its use. The key for me was to have Rituxan billed directly to my primary insurance carrier (Medicare if you have a supplement) under Part B.
Perhaps, depending on your insurance carrier and your policy, you would have better support from an Oncology specialist who treated you with Rituxan in their outpatient facility/clinic. They would have experience in dealing with insurance company requirements for Rituxan and can argue for approval of the treatment better than a nuerologist.
Perhaps you should checkout: http://www.ohsu.edu/xd/health/services/providers/index.cfm?personID=2855 I do not have any experience with this doctor, but he seems to have expertise in an area where Rituxan is often used as a primary treatment. Maybe he can write a justification for your insurance? Maybe if Rick3224 is still reading this post he can suggest a doctor who got him through this.
I wish you the best of luck in getting treatment.