$19,800 Lupron 3month shot

I have never heard it that high. I did hear of a shot at about $6,000. My six month shots were usually billed at about $3,000 and reimbursed at about $1,500. Now, it will likely get reimbursed at about $1,800. Remember, the amount billed is a phony number and means nothing. Wait for your EOB and it will show what is paid for the shot.

Why did you switch clinics? Sounds like the new one may not be an improvement. Though a three week delay would not make a difference as the drug continues to be effective for several months after the prescription period.

The cost varies greatly and seems to be a profit center for some Doctors. My 6 months shots were $2200 each my copay was 20%. This is when given under Medicare Part B billing. Same shot, same HMO billed under Part D is $19000. I complained to to Medicare about obvious fraud, silence was the response. It was explained to me by my Dr that Part B the dr buys the drugs directly, Part D billing the drugs must be supplied by a pharmacy. He couldn’t answer if doctors could buy low then charge part D pricing. I don’t know how private insurance is done, but from your billing sounds like same scam.

Hello Larry: Your post got me thinking, so I went to check my EOB statements, I have BCBS Illinois. When I was on ADT, I received the shot and uPSA test every 3 months for 25 months. The hospital billed under drugs 7001, and for giving the shot, doctors visit, 412. Total of 7413. The *discounted* amount was 4300. My payment was 3113 every 3 months until I reached my deductible of 6500. Not wishing my life away, but I can't wait to get on medicare...If memory serves me correct, the shot every 3 months was 22mg. Regards, MM

It looks like the hospital billed Medicare $7100 for a 1 month shot and got paid $500. I think.

The whole thing is obscene

The clinic is asking me for $2000 to cover my out of pocket on this bill.
I might call state insurance commissioner, Or call an attorney, maybe call tv station.

If they would have told me the cost I could have turned it down. I did not get that chance.
Larry

If the cost is a concern you can also use Eligard. Basically the same type of drug with the same effects, but usually much less expensive. I used it several times as it was a six month drug before Lupron was. I never saw any difference in side effects or PSA and T measurements.

Yes they should. Technically you are not responsible unless they told you before you signed the financial responsibility agreement.

Larry,

Pharmacy benefits can vary between providers and payers. Lupron is indeed a pharmaceutical yet billed either in the medical benefit side or pharmacy benefit depending on your doctor decision. This is a common problem with injected drugs. The insurance companies code two ways. J coding means medical benefit and NDC codes are pharmacy. Try and learn where your Lupron is billed. In my case J code / medical billing was far cheaper than NDC / pharmacy. My oncologist had no problem using J codes. Sometimes they just don’t know the difference. This is likely related to the new clinic policy. Good luck!

Larry E said...
Yes that is very much like my situation, I have called my insurance company and the phone number on my bill from the clinic. With no help yet. But I will keep trying.

Best of Luck! If you run into problems, there is a link at the end of that article where you can submit your specifics and you might get some help.

...Jerry