Does anyone have any knowlegde about this insurance and its coverage for CF needs? My 8 year old daughter was diagnosed with CF just over a month ago... and my husband is in the middle of a job change! Specifically if you are involved with the Loma Linda CF clinic any extra info would be great because I believe that would be the CF clinic she would attend. We have called Pacificare and check their formulary and many of the CF drugs are not on it, but they told us to call Loma Linda. We talked to the nurse at Loma Linda and she said they were able to get permission from Pacificare for some of the drugs. The two drugs that we are currently concerned with are Pulmozyme and Creon 10. Any info would be greatly appreciated.
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Pacificare Signature Value - California
- Thread starter anonymous
- Start date
Hey there! I have a little bit of knowledge in this area. PacifiCare is known to be a bit picky when it comes to drugs that it covers. HOWEVER, your physician can always submit a "prior authorization" which is basically an override to the formulary at any insurance company. Long story short - it may take some extra work on behalf of your physician, but you will definitely be able to get the meds covered. <img src="i/expressions/face-icon-small-smile.gif" border="0"> CF docs are used to this type of stuff - most insurance companies like to make patients jump through hoops.
Let me give you some background - I have CF but I also do pharmaceutical sales in Los Angeles. One of the drugs that I sell is not covered by PacifiCare, but many of my physicians do a "prior auth" to get the med covered for the patients - even though it's technically not on formulary.
I haven't heard great things about Loma Linda, to be quite honest. I went to Children's Hospital in Los Angeles from 6 months to age 18 - it may be a commute (sounds like you live in the IE), but well worth it. As you know, docs can be a make it or break it with CF.
Hope this helps. Let me know if you have any more quesitons. <img src="i/expressions/face-icon-small-smile.gif" border="0">
-Amy 24/CF
Let me give you some background - I have CF but I also do pharmaceutical sales in Los Angeles. One of the drugs that I sell is not covered by PacifiCare, but many of my physicians do a "prior auth" to get the med covered for the patients - even though it's technically not on formulary.
I haven't heard great things about Loma Linda, to be quite honest. I went to Children's Hospital in Los Angeles from 6 months to age 18 - it may be a commute (sounds like you live in the IE), but well worth it. As you know, docs can be a make it or break it with CF.
Hope this helps. Let me know if you have any more quesitons. <img src="i/expressions/face-icon-small-smile.gif" border="0">
-Amy 24/CF
Thanks Amy,
I'm not sure when it happened but Loma Linda's CF center is now an affiliate of Children's Hosplital of Los Angeles. So they basically work under their guidance and call them if they need advice. I'll see how it works, if I don't feel I am getting the best care then I would definately consider driving the 100+miles (yes we are in the IE!).
It sure is eye opening to see all the hoops you have to jump through to get the care you need. We've only had the diagnosis just over a month so for the first 8 years of her life there were no problems getting her what she needed. (Or at least what we thought she needed) At this point I can work with going through the hoops if she gets what she needs in the end. She is still very healthy, but her her health goes down, and I have to run circles to get what she needs...I just can't imagine some of the things parents & CFer's have to go through!
Thanks Again!
I'm not sure when it happened but Loma Linda's CF center is now an affiliate of Children's Hosplital of Los Angeles. So they basically work under their guidance and call them if they need advice. I'll see how it works, if I don't feel I am getting the best care then I would definately consider driving the 100+miles (yes we are in the IE!).
It sure is eye opening to see all the hoops you have to jump through to get the care you need. We've only had the diagnosis just over a month so for the first 8 years of her life there were no problems getting her what she needed. (Or at least what we thought she needed) At this point I can work with going through the hoops if she gets what she needs in the end. She is still very healthy, but her her health goes down, and I have to run circles to get what she needs...I just can't imagine some of the things parents & CFer's have to go through!
Thanks Again!