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Could someone explain the Remistart program

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Posted 5/30/2010 11:08 PM (GMT 0)
ok, so im enrolled in the remistart program, and got approved. I just got my EOB for my first infusion, and they want me to send them that and they will send the rebate card? how does the rebate card work? im slightly confused on how your get reimbursed with a rebate card. sorry for the ignorance, but everything has made total sense up until now.
Posted 5/31/2010 12:36 AM (GMT 0)
Ok-so you send them your original EOB and then they send you a card-like a credit card. They will load the card with whatever portion they will cover, which is based on your EOB. You will also get a letter with that card that tells you how much is on the card. Remember that it will cover ONLY the medication, not any other charges for the facility/equipment. (for my first EOB-our portion was about $400 and they loaded the card with about $270) When you get the bill from your infusion center, be that your GI's office or hospital or where ever you get your infusions, you use that card to pay the bill-and of course you will pay any remaining balance.

When you get a new EOB, you send it to them, and they will load the card with more funds. You should get a letter when the funds are loaded onto the card.

Does that make sense? Basically, the card is like a prepaid credit card.
Posted 5/31/2010 12:41 AM (GMT 0)
makes total sense now. thank you so much!
Posted 5/31/2010 12:43 AM (GMT 0)
Sure! I was completely confused by the whole thing too. YAY that you were accepted into the program-it helps a lot, doesn't it?
Posted 6/26/2010 3:07 AM (GMT 0)
Ok I understand how the rebate program is suppose to work...I've received my welcome letter from RemiStart stating that I'm eligible to receive benefits through this program for up to $4,400, 8 infusions or for a 12-month period, whichever comes first. I went through the process of submitting my EOB from my insurance to them for my first infusion on 4/30/2010 which stated my responsibility to pay is $931.24 for that infusion. Here is where I am now confused about this program...today I received a letter from RemiStart saying they regret to inform me that they were unable to process my rebate for my infusion on 4/30/2010 because of the following reason....

*Your out-of-pocket expense for REMICADE indicated on your EOB is less than the minimum out-of-pocket expense to receive a benefit from this program.

What does that mean??? Can someone tell me?? Below is what is stated on my EOB from my insurance company maybe someone can shed some light on this situation.

Date of service 4/30/2010
Total Billed: $12,852.68
Patient savings: $9,964.25 (not my responsibility to pay)
Applied to deductible: $92.44 (my deductible is $500 and the amount has been met as of this statement)
CoInsurance/CoPayment Amount: $838.80 (my responsibility to pay)
Claims Payment $1,957.19 (paid by insurance)

Paid Amt.: $1,957.19 To: Long Beach Memorial Medical
It is your responsibility to pay: $931.24 (which is the sum of $92.44 + $838.80)
It is not your responsibility to pay: $9,964.25

I have not received the bill yet from the infusion center but based on the above EOB statement it looks like I'll be expected to pay $931.24 which is gonna kill me if RemiStart is not gonna actually help me out with these co-pays. I received my 3rd infusion today so now I'm curious if they are gonna help me out or not. This letter really has me stumped cuz based on my welcome letter & my EOB stating I am responsible to pay $931.24 I figured the program would have me covered for at least 5 infusion. I thought this program is to help with the co-payment or is it to help with the deductible payments??
Posted 6/26/2010 3:28 PM (GMT 0)
Well, the Remistart program is for the costs of the medication only. Not towards the infusion fees. So, maybe it's because your bill doesn't break down what portion of your co-pay is for the actual drug?
Posted 6/26/2010 6:12 PM (GMT 0)
I have no idea-maybe Jennifer is right though about the break down? Did your EOB have any additional information than what you have listed here? Mine breaks down everything, from the medication to the IV fluids and the equipment.

What is the patient savings all about? That is a huge amount-is that disallowed by the insurance company or is it paid by someone else? My costs for the medication is around $6Kish, and the disallowed amount is about half of that.

Honestly, I would just call the RemiStart people and ask them to explain. I have called a couple of times and they have been VERY nice and easy to work with. They can tell you what the issue is.

Good luck! I hope you get this all ironed out.
Posted 6/30/2010 8:38 PM (GMT 0)
I agree with Jennifer. Chances are, it is the codes for the infusions themselves (which often fall under chemotherapy which is why they are so pricey) that are not covered by Remistart. Remistart does not say this outright to patients or to doctors. They kind of slip it into all the other fine print and reading materials they give you, and a lot of people don't realize they won't get reimbursed until it is too late.

I'd say that is most likely what happened with your billing issues, buffchick. My advice would be to look into Cimzia. I was on Remicade but because of those exact billing issues (and all the infusion codes the doctors office left out initially), I switched to Cimzia. Between insurance and the Cimplicity program (www.cimzia.com for more info), my medication is 100% free.
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