Another Frustrating Infusion Center Visit

Can you not use insurance for the remicade and pay the cost on the remistart card? Then that would be 5k out of pocket and you would be free of medical costs for the year. I think mine sort of happened like that... I only had to spend 2500 OOP with 500 deductible at the time. it's much higher now. Since the plans changed, after ACA, the benefits seem to have gone down and the costs up.

I think I'd go for the 4 vials and just reduce it when you get to your goal weight. At the moment, it's closer to 4 than to 3.

I think they should still always weigh you in case you gain or lose weight, but it's great that you feel like you are in remission!!!

I forgot that I don't have normal copays for meds with the insurance we have had the last few years. Everything -- meds, doc visits, labs etc -- are all 50% coinsurance, no deductibles and a $3000 max out of pocket. So the first infusion I have in Jan I would have to pay 50% of the cost which is more than my max OOP. So I pay $5 in January with co-pay assistance, but then everything for the rest of the year is no charge to me. We will soon get our notification for 2020 insurance so that could change next year. This 50% coinsurance works great for me because of the cost of meds but for normal people they have to pay 50% of all their medical bills & meds until they reach $3000 and most people don't hit that. I feel bad for them cost wise (but jealous that they are healthy enough not to max out), but for me I am grateful it is the way it is.

Ahh, that makes sense. Yeah, that would be a horrible plan for most people, but good for people like us, lol. I think my plan is pretty good still. After I switch to this cheaper infusion center, I should only have to pay about $40 per visit, so that isn't too bad. I asked if I should still get the antibody and Remicade levels tests done even though I feel fine now and the nurse said yes but I'm not really sure if she actually asked my doctor or not. I just don't want to waste money on it if it's not necessary right now.

I've only been off prednisone 16 days, so we'll see what happens. But thanks.

Sara, back when I was on Remicade, for a short period of time I used Remistart program, the funds were for the Remicade only, hospital/infusion center charges no.

Just a thought, you should be able to go online at your insurance company to see how they have paid so far on the claims. I had the choice of them being mailed or emailed. I suspect the infusion center is no different than a hospital. They bill for everything, from the IV kit, saline & so forth. I always look at my EOB's because I have found charges for things I did not receive. A call to the billing office can get those charges removed too.

With my health insurance, I always get a higher payout from them in services/meds, then I pay into it through my premium and deductibles and copays. I figure for the remicade alone, they payout more than my annual salary is at work.

I hear ya, hate having to pay for it. I know this isn't a politics forum but I truly hope we get that angry, orange, man-baby out of office soon, and someone who can do some meaningful for healthcare reform. I'm all in for medicare for all, or copy any other first world healthcare system the world over and we'd be better off (Canada, UK, Australia, Norway, etc etc).

Sara14 I notice you said you are a Federal employee with Anthem BCBS. I, too, am a Federal Employee with Anthem BCBS insurance. There are two plans to choose from in my state - Standard and Basic. I carried Standard for years before I started getting sick and it cost more per pay period. I was thinking I would have to pay less out of pocket since I am paying more in premium for the plan. That is not the case I was paying for lab work and large co-pays for procedures but that's because that plan has the 15% for coinsurance. I switched to Basic the next opportunity to do so, and my out of pocket expenses greatly reduced and the premium is cheaper as well. This was also true for my aunt also a Federal Employee. She had a severe arm injury requiring surgery while she was on the Standard plan and she ended up with a copay of almost $4000 (15% coinsurance). We have both switched to Basic with no problems. I had my three Jpouch surgeries and my co-pay was $200 per procedure and that's the same of endoscopies and such. The catch on our particular plan is you have to use Preferred Provider, which has not been an issue. Don't know if this true fro the plans offered in your area but just thought I would throw it out there. It might be worth checking into. I was on Humira injections for awhile and I never paid over $10. It's very difficult to understand what gets applied to the deductible and what does not. The numbers on an EOB don't freak me out anymore. I don't worry about it until I get a bill from the provider.

Mine was billed like yours.
https://1drv.ms/u/s!agkze0tus4sqh-vttpq6os9pqr0mtg

With some of these programs they want it to say the name of the drug. I had a tough time getting this one paid. It was literally like a full-time job calling the hospital and entyvio daily to get it handled - but thankfully, I did. I can't afford to pay 14k. I'd have had surgery sooner if that was going to be the cost!! The expense of being chronically ill always stressed me out a ton.

Now you're just rubbing it in! Lol. So yours actually has the medicine on there but mine doesn't.

I didn’t read every post but since your drug is filled by pharmacy and not doctors office they run the remicade program as a secondary plan instead of the credit card. Like you said. They user the bin and pcn and get the money directly from J&J. Rules have been changing and recently the amount paid by the maker doesn’t go to your out of pocket. But, for those who get billed on the same infusion bill but use the credit card side of remistart, their insurance company sees it as out of pocket and they meet their max quick and have zero bills rest of the year. Lots of people don’t talk to their insurance companies enough, I hope they have helpful workers that give you good explanations and options. I know it’s expensive but I’m glad I don’t have to wait really long times etc. The point about open enrollment coming up is a good thought! Still sounds like you have a good plan!

I get what you are saying about it not seeming fair, but I don't have a co-pay. It's 50% co insurance. So without remistart I would have to pay $3000 for my share of the medication in January. Since my OOP is capped at $3000/year the rest of the year would still be free for me, but I would have to come up with that initial $3000 which would be difficult (not impossible though). I am grateful for the insurance I have.

When you are looking at new plans take a look at lower premium plans that may have a co-insurance for meds instead of co-pays. It may work out better for you. I used to avoid the co-insurance plans. Now it works out better for me.

Anyway, I've been having 1 BM a day and no symptoms, knock on wood. I should have started on Remicade a year ago!

Sara -- when open enrollment starts, they will post all the plan information on https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/. But what you can do is call each company and find out what your costs will be for the infusions after your deductible and then compare each based on premiums + deductible + infusionXtimes-per-year. Also any other prescriptions. I was super annoying and did this.

Each company also typically has a webpage specifically for federal employees with a special number to call with questions. BCBS has https://www.fepblue.org

Good luck with this! I keep telling myself that at least my UC didn't pop up until after I switched jobs and I am very lucky to have decent health insurance bc omg the cost otherwise.