Re: Any Experience with United Healthcare?

January 7, 2008

>

> I switched from a Aetna HMO plan to a United Healthcare Definity

> (HDHP) plan this January 6th. Under Aetna approval for Xolair was

> pretty routine. There was even a form on their website for the doctor

> to fill and send int for pre-authorization. Initially it was covered

> under the medical coverage portion of my plan and subsequently shifted

> to the prescription drug benefit. However, since Aetna runs their own

> specialty pharmacy and managed the prescription drug benefit the

> process was pretty seamless.

>

> Now, United Healthcare does NOT cover Xolair under my plans

> prescription drug plan. When I called to inquire about coverage under

> the medical portion of the plan the lady could not provide me with any

> information other than the doctor has to contact them.

>

> Anyone else had any experience with getting coverag of Xolair under a

> United Healthcare plan?

If it is like BCBS, It depends on the type of plan you have.

Doug

Group founder

January 8, 2008

Hi Dharm,

I have UnitedHealthCare (Options PPO). The insurance is through my husband's

employer and he purchased the highest level they offered I think it is Options

PPO that is on my card. My is X is covered 100% it had to go through Optioncare

a specialty pharmacy. I spoke to at optioncare 734-929-6300.They are open

8:00 am to 8:00 pm est.

I hope that this helps. My doctor's office handled most of the paperwork I

filled out and then I spoke to the rep at Option. I truly hope someone has made

an error and you are covered fully as well.

Let me know if you there is anything else I can help you with.

Best for a quick approval,

Laurie

Dharm Guruswamy <dguruswamy@...> wrote:

I switched from a Aetna HMO plan to a United Healthcare Definity

(HDHP) plan this January 6th. Under Aetna approval for Xolair was

pretty routine. There was even a form on their website for the doctor

to fill and send int for pre-authorization. Initially it was covered

under the medical coverage portion of my plan and subsequently shifted

to the prescription drug benefit. However, since Aetna runs their own

specialty pharmacy and managed the prescription drug benefit the

process was pretty seamless.

Now, United Healthcare does NOT cover Xolair under my plans

prescription drug plan. When I called to inquire about coverage under

the medical portion of the plan the lady could not provide me with any

information other than the doctor has to contact them.

Anyone else had any experience with getting coverag of Xolair under a

United Healthcare plan?

January 8, 2008

________________________________

>

> From: dguruswamy@...

> Date: Mon, 7 Jan 2008 21:27:18 +0000

> Subject: [ ] Any Experience with United Healthcare?

>

> I switched from a Aetna HMO plan to a United Healthcare Definity

> (HDHP) plan this January 6th. Under Aetna approval for Xolair was

> pretty routine. There was even a form on their website for the doctor

> to fill and send int for pre-authorization. Initially it was covered

> under the medical coverage portion of my plan and subsequently shifted

> to the prescription drug benefit. However, since Aetna runs their own

> specialty pharmacy and managed the prescription drug benefit the

> process was pretty seamless.

>

> Now, United Healthcare does NOT cover Xolair under my plans

> prescription drug plan. When I called to inquire about coverage under

> the medical portion of the plan the lady could not provide me with any

> information other than the doctor has to contact them.

>

> Anyone else had any experience with getting coverag of Xolair under a

> United Healthcare plan?

>

HI all,

I was unable to get my first shot of zolair, because believeit or not my IEG's

weren't bad enough, and my PFT's werent either, so United Healthcare willnot

approve the shots, I am in the process of obtaining my pulmonologist records

from last year at my allergists request,but I dont see what difference those

tests are gonna make, meanwhile I am being wheaned of prednisone, down to 20 mg

tommorow and wednesday, I am still advair 500/50 twiceaday, proventil inhaler 2

puffs every 4 hours, and albuterol nebulizer treatments, saw allergist tonight,

he put me on intal inhaler, anybody had any luck with this, I am at my wits end

and very depressed, just dont know what to do anymore, once again thanks for all

the support and kind wishes Kathy

_________________________________________________________________

Put your friends on the big screen with Windows Vista® + Windows Live™.

http://www.microsoft.com/windows/shop/specialoffers.mspx?ocid=TXT_TAGLM_CPC_Medi\

aCtr_bigscreen_012008

January 8, 2008

Dharm - if my experience with their Plan D Medicare drug coverage is any sort of

a guide, I find they keep pushing more and more drugs into tier three, which

requires something like a $71 copay, while they keep increasing their rates.

Maybe it has something to do with paying for that platinum parachute of over a

billion dollars they gave former CEO Wm. Mcguire. I plan on dumping them at my

next opportunity. Something else I've discovered is that I can buy some of our

drugs from Canada for less than the copay. I wouldn't hold out much hope for

United paying for Xolair

Ohldepharte

----- Original Message -----

From: Dharm Guruswamy

Sent: Monday, January 07, 2008 4:27 PM

Subject: [ ] Any Experience with United Healthcare?

I switched from a Aetna HMO plan to a United Healthcare Definity

(HDHP) plan this January 6th. Under Aetna approval for Xolair was

pretty routine. There was even a form on their website for the doctor

to fill and send int for pre-authorization. Initially it was covered

under the medical coverage portion of my plan and subsequently shifted

to the prescription drug benefit. However, since Aetna runs their own

specialty pharmacy and managed the prescription drug benefit the

process was pretty seamless.

Now, United Healthcare does NOT cover Xolair under my plans

prescription drug plan. When I called to inquire about coverage under

the medical portion of the plan the lady could not provide me with any

information other than the doctor has to contact them.

Anyone else had any experience with getting coverag of Xolair under a

United Healthcare plan?

January 8, 2008

Hello,

I had United Healthcare last year as my primary insurance. When I first

started requested approval, they approved me instantly. My doctor and I are

still stunned as to why. We thought we would have to go through a long

appeal process. My doctor who is originally from Pittsburg, said that in

his experience, United usually denies everyone first. After the first 3

month supply (through a specialty pharmacy), United Healthcare wrote to say

that they were not going to approve me in the future. I really think it

depends on the type of insurance you have. There are many different tiers

or policies in each insurance agency.

Fortunately/Unfortunately… I am working with another insurance company and

am waiting to get my X back. I had my last dose on Dec. 21. I’m starting

to feel the effects of not having it in my system. Keep you chin up, and

keep calling your insurance company. Make sure to document everything that

is said, by everyone you talk to. You will get it to go through!

Kristy

From: [mailto: ] On

Behalf Of Dharm Guruswamy

Sent: Monday, January 07, 2008 3:27 PM

Subject: [ ] Any Experience with United Healthcare?

I switched from a Aetna HMO plan to a United Healthcare Definity

(HDHP) plan this January 6th. Under Aetna approval for Xolair was

pretty routine. There was even a form on their website for the doctor

to fill and send int for pre-authorization. Initially it was covered

under the medical coverage portion of my plan and subsequently shifted

to the prescription drug benefit. However, since Aetna runs their own

specialty pharmacy and managed the prescription drug benefit the

process was pretty seamless.

Now, United Healthcare does NOT cover Xolair under my plans

prescription drug plan. When I called to inquire about coverage under

the medical portion of the plan the lady could not provide me with any

information other than the doctor has to contact them.

Anyone else had any experience with getting coverag of Xolair under a

United Healthcare plan?

January 8, 2008

Thanks for the response. In calling back and being persistent (seems

to be required in many cases), I got a knowledgable representative

from Medco, United Healthcare's pharmacy benefit manager. It appears

that most injectible drugs are not covered under the prescription

drug plan but are covered under the medical portion. So once I

fulfill my family deductible ($4,000 on all expenses since this is a

high deductible plan) it will be covered at 90%. Still, since I

talke two vials a month that's over $1,200 a year. I yearn for the

days when I first started and it was covered at 100% like you. Alas,

even if I stayed with United Healthclare it would have cost me $800

(up from $560) a year.

> I switched from a Aetna HMO plan to a United Healthcare

Definity

> (HDHP) plan this January 6th. Under Aetna approval for Xolair was

> pretty routine. There was even a form on their website for the

doctor

> to fill and send int for pre-authorization. Initially it was

covered

> under the medical coverage portion of my plan and subsequently

shifted

> to the prescription drug benefit. However, since Aetna runs their

own

> specialty pharmacy and managed the prescription drug benefit the

> process was pretty seamless.

>

> Now, United Healthcare does NOT cover Xolair under my plans

> prescription drug plan. When I called to inquire about coverage

under

> the medical portion of the plan the lady could not provide me with

any

> information other than the doctor has to contact them.

>

> Anyone else had any experience with getting coverag of Xolair

under a

> United Healthcare plan?

>

January 8, 2008

Hey, $71 beats my 10% copay (over $100 per month for me) AFTER I

meet my deductible (signficant as I'm in a high deductible health

plan) of $4,000.

--- In , " Terry " <onabeach@...>

wrote:

>

> Dharm - if my experience with their Plan D Medicare drug coverage

is any sort of a guide, I find they keep pushing more and more drugs

into tier three, which requires something like a $71 copay, while

they keep increasing their rates. Maybe it has something to do with

paying for that platinum parachute of over a billion dollars they

gave former CEO Wm. Mcguire. I plan on dumping them at my next

opportunity. Something else I've discovered is that I can buy some

of our drugs from Canada for less than the copay. I wouldn't hold

out much hope for United paying for Xolair

>

> Ohldepharte

> ----- Original Message -----

>

> From: Dharm Guruswamy

>

> Sent: Monday, January 07, 2008 4:27 PM

> Subject: [ ] Any Experience with United Healthcare?

>

> I switched from a Aetna HMO plan to a United Healthcare Definity

> (HDHP) plan this January 6th. Under Aetna approval for Xolair

was

> pretty routine. There was even a form on their website for the

doctor

> to fill and send int for pre-authorization. Initially it was

covered

> under the medical coverage portion of my plan and subsequently

shifted

> to the prescription drug benefit. However, since Aetna runs

their own

> specialty pharmacy and managed the prescription drug benefit the

> process was pretty seamless.

>

> Now, United Healthcare does NOT cover Xolair under my plans

> prescription drug plan. When I called to inquire about coverage

under

> the medical portion of the plan the lady could not provide me

with any

> information other than the doctor has to contact them.

>

> Anyone else had any experience with getting coverag of Xolair

under a

> United Healthcare plan?

>

January 8, 2008

Up till this year, my insurance plan used Medco. They were fantastic!

I switched to another BCBS plan this year and haven't received my

first order from the new drug specialty pharmacy. My xolair nurse

called and got it re-approved it for 2008. It is covered at 100% and

there should be no problems.

Doug

Group founder

On Xolair 4+ years

January 9, 2008

I also have United's Medicare Part D drug insurance; mine is the

AARP " Preferred " version. I'm on a lot of meds in addition to all my

asthma meds and also noticed that some got moved up into Tier 3, but

they turned out to be only meds that are now available as generics so

they are just trying to " encourage " us to use generics when they are

available. I don't actually have a problem with that - I've never

had a problem with a generic drug myself.

Also, I don't know if you've caught this in either the 2007 or 2008

plan, but you can request that a drug be charged for you as though

it's in the next lower tier. I haven't actually tried to do it myself.

One more thing - I noticed that this year AARP's United plan for Part

D now covers Xolair, as a Tier 4 medication which requires a 33%

copay. Since I've been covered under Medicare Part B with only a 20%

copay, I panicked and called Medicare to clarify how mine will be

covered. Believe it or not, each individual gets to choose!!! Hard to

believe but the agent told me I am free to stay with being covered

under Part B even though I now have the Part D coverage. Finally, a

policy that favors the insured!!!