Cost of Lupron shot - here's my bill/insurance

Mel,

My cost, uninsured, for the same was $960. I now have insurance but have not had a shot yet.

Don

I get the 6 month eligard shot which comes up on the bill as around $1600....I pay $12 for the office visit.

Just got my bill from Aetna (Loyola Hospital Maywood, IL) for my 3 month Luprin Shot. Cost to give injection $412.00 Clinic Visit $118.00 Cost of the one shot of Luprin $10,213.34 for a total of $11,038.34
With discount from Aetna (-$5,323.41) net cost to me $5,714.93.
Need to buy stock in the drug company.

Having never heard of Lupron before I received a fast education, it is in a group of medications that is covered either under part B or part D for those on Medicare. Before I received my first shot I asked my Social Security Advantage plan for a quote. First thing they asked me was will my doctor provide the drug or will I pick it up or be provided by a pharmacy. The doctor buys on open market and determines the cost of the shot in office. For me it was far cheaper in office under part B. Cost of 6 month shot $2058, total office visit $2257. My cost $258. Lowest cost under part D drug benefit was $10,000.

Post Edited (LifeCointosses) : 5/30/2018 7:52:36 AM (GMT-6)

The differences in the charged amounts 4-years apart is staggering. I'd be interested in hearing what others are being charged (not what they are paying, which is going to depend on many other things) in the U.S. for these same services these days, so if you've recently (2018) had these services, what was the bill you saw? We could "average" the rates seen from across the country for a current value.

...............................2014...........2018...........delta
Office visit..................$92...........$118..........+28%
Urine sample..............$15.............n/r............. n/a
Lupron...................$1,024......$10,213........+997%
Admin of shot.............$75...........$412........+550%

Mel, if you had Medicare Part B and a supplement (say Medigap plans F or G), I'm reasonably sure you'd pay $0 for a shot administered in a doctor's office. Now whether the cost of the Medigap plans (low $200s/mo in So Cal), plus the Part D plan you'd have to buy would be worth it or not, is difficult to say. But I'd bet a good math prof could calculate it.

Hope you're doing well!

Bobby Mac said...
3 month lupron injection U of Miami Sylvester - Medicare B

Payment Summary
Total Amount Charged:
$24029.00
Total Non-Covered Charges:
$0.00
Medicare Approved:
$24029.00

Can anyone who’s worked in the healthcare industry defend sending UM Sylvester $24k in tax dollars for supplying one 3-month Lupron injection? Sounds like a sweet deal. I wanna piece of that.

There is no one answer.

For Medicare it depends on the plan you have. If you have traditional Medicare and Supplement F you would have no out of pocket cost. Supplement G you pay the $183 Plan B deductible. Other supplement plans will have other levels of out of pocket expenses. If you opt out of Medicare and into an Advantage plan you will have deductibles and co-pays based on the specific plan you choose that is offered in your area.

Actually not, Progressing. What the provider bills is just a number they choose. Every provider negotiates with each insurance company and third party payor for the agreed reimbursement amount. Medicare publishes their reimbursement amount publically and it is in no way connected to the billed amount. The billed amount means nothing.

All Medicare Advantage Plans are private insurance contracts and have a clear contractual schedule as to what costs are born by the insured and it has nothing to do with the difference between what is billed and reimbursed. Remember, Medicare Advantage claims are not submitted to Medicare as they have nothing to do with the reimbursements.

Medicare has an exacting schedule as to what it reimburses and is on their website. When they change these schedules it is done clearly in the public for those that want to know. They are in no way influenced by providers posting high bills that they know will not be reimbursed. And the difference between billed and reimbursed is not a "loss". It in no way figures into any accounting for financial reporting or taxes.

I suggest you pay no attention to the billed amount as it is basically meaningless.

I have straight Medicare Part B, but I also kept my employer insurance when I retired. Better than a supplemental plan as it includes prescription drugs and offers lower co-pays than any Part "D" Plan I have seen.

It would make sense, for tax purposes, to charge $,2,000, or any amount, knowing insurance was only going to pay x number of dollars, and then take the balance as a write off.

It took some detective work, and I don't have a clear answer. The last statement I can find for a 4 month Lupron shot was in July 2015, and it says $3024 for the shot. At the same appointment, I got a Prolia shot (once/6 months denosumab), stated as $3180. The statement included several office charges as well. Insurance discounted the $6710 total by $2339 but no details. So, maybe split the reduction across the two larger charges, and let's say the Lupron shot cost about $2000 plus or minus.