@ghosalb yes my doctors got a prior approval for RTX. I have no idea how they coded it or what they wrote. I had at the time of my RTX treatments Blue Cross, through pers choice. My Stanford team for some reason has the best luck with getting me certain treatments and blood work.
Like for instance, I have to have my B-cells checked every 3 months, my local doctor can't figure out how to code that, several things have been tried but for what ever reason they can't get my insurance to pay for that blood test. They have even used the same code at Stanford- doesn't fly.
So I have go all the way to Stanford for that one blood test. Now this trip is 5 sometimes 6 hours to get there and 7 hours to get home. I am half dead from that trip. But it's worth it to get the B-cells checked.
Now my insurance is switching to Medicare as primary ( hubby retired) I am not sure if Medicare is going to pay for things like RTX and B-cells checks. Kinda nervous about this. I think teaching universities have much better luck in getting these things ordered.
@BurnA, I wonder the same thing, what is it going to take to treat ME/CFS with RTX. They sure don't let the people with RA suffer with joint pain, they throw these types of drugs ( and lots of new ones ) at them all the time.
@jimells, you are spot on, it's all about the codes. As I said above the teaching universities have very good luck with this. It's almost like they get a free pass, (which actually I believe they do)
( I see you're from Maine, I am too~ Orono)
I have no idea if anything about my case will be in journal !