Have any questions about how to use the community? Check out the Help Discussion.

Kisunla Infusions

kmcmorrison
kmcmorrison Member Posts: 2
First Comment
Member
in I Am a Caregiver (General Topics)
Hi everyone. I’m new here. My wife and I are trying to get my mother in law moved from LA out to PHX but it seems impossible to re-establish care in a new state while trying to create as smooth of a transition as possible. Hoping to get her started on Kisunla asap but insurance just denied it and now it feels like we are having to start over. Any suggestions on ways to get it covered? My mother in law is only 62 so she doesn’t qualify for Medicare quite yet.
Tagged:

Comments

  • H1235
    H1235 Member Posts: 1,991
    1,000 Insightfuls Reactions 500 Likes 1000 Comments 250 Care Reactions
    Member

    Welcome. At 62 would she qualify for disability? I thinks I remember others mentioning this. Hopefully someone will come alone that has some experience with this. You might also try searching the site. The treads may be old, but will still have relevant information.

  • kmcmorrison
    kmcmorrison Member Posts: 2
    First Comment
    Member
    https://alzconnected.org/discussion/comment/272830#Comment_272830

    Thank you. Yes she is on social security disability already as well.

  • SDianeL
    SDianeL Member Posts: 3,336
    1,500 Likes 1,000 Insightfuls Reactions 2500 Comments 1,000 Care Reactions
    Member

    why did they decline coverage? I would call her doctor and her insurance company.

  • harshedbuzz
    harshedbuzz Member Posts: 6,612
    Ninth Anniversary 1,500 Insightfuls Reactions 1,500 Likes 5000 Comments
    Member

    Have you reached out to The Lilly Cares Foundation?

    https://www.lillycares.com/assets/pdf/lilly_cares_application.pdf
  • notequipped
    notequipped Member Posts: 48
    10 Comments 5 Care Reactions 5 Insightfuls Reactions 5 Likes
    Member

    I would start with finding out why it was denied. There should be an explanation on the EOB but if it’s still not crystal clear to you, call the insurance company. They may have specific testing requirements that haven’t been met. Sometimes insurance companies have a preferred drug - maybe Leqembi vs Kisunla. If she’s already on disability, could it be that she has moved beyond the stage where the medication is deemed beneficial? I’m not sure that there’s a magic one size fits all answer. It’s more than likely insurance/patient specific and you need to know why it was denied.

  • sandwichgen44
    sandwichgen44 Member Posts: 1
    First Comment
    Member
    You could try to grieve the insurance’s decision to deny it. Call and say you’d like to file a grievance for their decision and a major process is set off where they have to evaluate the decision and reconsider. If they continue to deny you can continue to grieve it until it goes to a hearing with an outside entity making the decision. It’s free.
  • iceview
    iceview Member Posts: 7
    First Comment
    Member

    IWe had Cigna through work. They denied teh covrage as they still view tese drugs (Kisunla akd Leqmbi) as experimental. Many others at our Dr office were also denided regardless of our Dr talking to insurance company.

    Good thing for us was my wife is 70 and she qualified for Medicare which has no issue to cover the expenses

Commonly Used Abbreviations


DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
Read more

Community Guidelines


Click here to review the ALZConnected Community Guidelines

Categories