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← Return to Insurance has denied Evenity
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@jduke What is Prolia Rebound? I haven't heard that term before. What is your insurance and what is your age? With the initial denial and the denial on the appeal did your insurance company suggest a substitute for Evenity?
I have Traditional Medicare and Evenity is fully paid for with my plan. Medicare Advantage plans are under a private insurance company such as Aetna or United Health Care and while the cost may be different they do contract with Medicare. For that reason, I believe that if Medicare has approved something then the insurance company where you get your Medicare Advantage Plan has to cover it also. I has a fracture last year which is why my endocrinologist, at Mayo, recommended Evenity.
Replies to "@jduke What is Prolia Rebound? I haven't heard that term before. What is your insurance and..."
Helen,
I, too, am on traditional Medicare and on Evenity which is 100% covered. The cost - $5,000+ for each monthly set of shots!
I am pretty certain that the Advantage plans do not have to follow the traditional Medicare guidelines. As they are private insurance plans, they have their own rules.
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The way it was explained to me by my endo, Prolia Rebound is when you stop taking Prolia and the gain you made with Prolia falls away. Prolia is like gum, when it falls away, it takes not only what it added but my bone also. So, within 18 months- 2 yrs of being off Prolia, I went from osteopenia to -4.2 and -4.7. I am 62 and not on medicare but on blue cross blue shield -gold plan. I did do one treatment of reclast. It made me super sick, but little improvement and some worsening. Every doc I've seen since reclast has said that was wrong protocol. Reclast stops bone loss but I don't really have bone to lose, I need to rebuild faster (Evenity) than I'm losing. Radiologist says I'm at 100% fracture rate. Insurance denied and Amgen plans are not a fit, I'm outside the income limits. I've talked to Amgen multiple times and each thing they have tried has been unavailable to me.