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Knee Injections Looking Like A Bust

Feb 19, 2016 8:19 PM

So I'm suppose to start injections into my knee joint on Wednesday, one week apart, five in all. I got a very interesting and disturbing phone call today from a specialty pharmaceutical. They wanted me to authorize the order for the Supartz prescription for my knee injections, ordered by my Ortho doc. I asked who they were and where they were located, and proceeded to look online my insurance site, to verify if they were covered... Not.

I then told her before I could authorize the purchase & shipment I needed to know the cost of the drug. She started to say an estimated cost and I stopped her, telling her I need a verified cost of expense to ME. She put me on hold while she called my insurance company. She came back on and said, "Your portion of cost, according to your insurance company, will be $904.00". 😲 I about choked! I asked her if there were alternative meds for the injections, to which she had no answer. I then told her I needed to talk with my insurance company and with my doctor before authorizing anything, that she could put it on hold. I know that unless my insurance would agree to some type of alternative medicine or payment, there is no way I can pay $904.00 for one injection, let alone for five!

I was talking to my hubby about it and he asked what the purpose of the injx are for. I told him what the doc told me, "to provide more cushion and comfort for the arthritic joint and delay joint replacement surgery, until the damage is really bad." Then my hubby asked how many of my family members used the injx before getting TKR's; an uncle, aunt, & cousin. They ended up with their TKR's within 5 years but also were older with worse damage. So maybe I'd have a TKR sooner, but it's hard to swallow $904 x 5! Ugh, I feel faint! Lol πŸ™‚πŸ’•πŸ™πŸŒΌ

Feb 19, 2016 8:30 PM

Wow! That has got to be frustrating. I know how frustrated I get when I have to fight for my stomach med every December.

Feb 19, 2016 8:33 PM

I'm so blessed to still have insurance, when many on here do not. But I don't have a money tree in my backyard! Lol I'm not that blessed!

Feb 19, 2016 8:45 PM

I've always wanted a money tree. I've never been able to find one though. LOL

Feb 19, 2016 11:51 PM

So sorry flappys. I hate the insurance lack of coverage. It lis like they don't care about doing good for the patients. Causing stress to make our lives worst. I'm good you get your treatment so your pain can get better

Feb 20, 2016 1:36 AM

Flappsy, I am sorry that happened to you!! Thank God you had the presence of mind to ask about the cost and coverage of the medication. Check with your Ortho and see if he thinks that synvisk would provide you with the same kind of cushion. It is generally covered by Medicare and then if you have a secondary insurance as a supplement, they will pay the balance of the cost. I had the Synvisk injections and don't remember right now if I had 3 or 5 of them. It felt better for a little while afterwards. I hope this information was helpful to you, Flappsy. I'm sending you gentle {{{Hugs}}} and prayers that you get the assistance you need and that you are able to get your injx.πŸ’•πŸ™πŸ»πŸŒ»πŸ˜Š

Feb 20, 2016 7:37 AM

Newfibrogirl & AlwayZ, insurances don't care that they could alleviate problems. It's all about the dollar in their pocket. We took a much higher costing insurance because when I get disability (hoping sound than later), but this company is the one I must use with disability coverage. I old my hubby I don't want to be caught in the cross fire with no coverage due to mid-year change. The insurance won't cover supartz, synvisc, euflexa, or any of the injections. Ain't that a hoot! I hope you all have a good weekend! πŸ™‚πŸ’•πŸ™πŸŒΌ

Feb 20, 2016 7:49 AM

Flappys that horrible.. However you just thought me something. Disability has requirements on insurance types? How is that possible.. How do they have any say so in what insurance we use.!!

Feb 20, 2016 8:13 AM

It's not a disability requirement. My hubby works for a state government employee. They choose to pay to carry only one insurance that will be the add-on to disability. The other choice they have is about $140/month cheaper, but I'd have to be uncovered from the date disability is instated until open enrollment, unless we went ahead and took the higher premium coverage.

Been caught in the crossfire between the retirement insurance being dropped in July and waiting on Jan 1st the next year. It cost us way more than we could afford and ended up selling stuff just to pay for medical needs. Never again if I can help it!

Feb 20, 2016 9:13 AM

Flappsy, that sucks!! I'm really sorry that they don't cover ANY of them. It's a shame!! I had to take a higher costing plan this year myself because they discontinued the one I was on. What pain in the ass. I went from paying $83.50 a month to $189.10!! And, less coverage!!! Smh!! I hope your weekend is spectacular and that you have less pain my friend. {{{Hugs}}} πŸ’•πŸ™πŸ»πŸŒ»πŸ˜Š

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