HealingWell
Search Close Search
☰

Worst day, then best day

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 3/27/2013 1:35 AM (GMT 0)
I get my Remicade infusions in my GI's office, for the cost of my co-pay, $35.
The infusion nurse called last week to tell me that she took a new job. That was sad news to hear, after so many years! She explained I would have to get my infusion this week at the hospital since the new nurse was still training. She said it should all be handled the same by insurance (the hospital owns theirnpractice now)...but I wondered and did some checking.

The hospital charge was going to be more than $16,000! And, long story short, this one infusion at the hospital would be subject to co-insurance instead of just a copay, and cost me my whole out-of-pocket max, $4500!

I was mad! I was scared. Didn't my doctor realize what this was doing to her patients? Were others already doing as they were told, not knowing what they would be charged? I had alread enrolled in Remistart and it would help, but this just didn't make sense.

I was ready to throw in the towel. I wasn't going to do it. Lots of tears.

The woman in the hospital billing office was upset about it. My doc's nurse and office manager were upset, too. It was crazy. And they made a miracle happen.

They got the hospital to agree to do my infusion. My cost would be $35, and they would eat what insurance would not cover.
Is that not amazing?
Posted 3/27/2013 1:42 AM (GMT 0)
Wow, glad you did your homework in advance and could get in front of a huge problem. And then have your doctor's office go to bat for you. Awesome.

You deserve a lot of the credit. I always said the harder I worked the luckier I got.
Posted 3/27/2013 1:54 AM (GMT 0)
That was smart. A similar thing happened to me getting IVIG once for a different autoimmune disease. My doctor's office is actually located in a hospital. They gave me IVIG and found out after the fact that I had to pay like $1500 instead of zero since it was done at a hospital instead of the doctor's office. It wasn't until over a year later that I realized the doctor's office coded the procedure wrong as being in the hospital instead of the doctor's office. By then everyone claimed that nothing could be done.
Posted 3/27/2013 2:18 AM (GMT 0)
That is wonderful and they should considering they own the practice where you were getting your infusions for that cost. It's crazy that they are going to try to suck all that money out of people for doingt he same exact procedure you've been getting this whole time. Insurance is such a scam business. I hate it.
Posted 3/27/2013 5:48 AM (GMT 0)
Hospitals suck! They overpay their administrators, bully doctors, underpay staff who do the dirty work, and overcharge patients. Good thing you fought for yourself, and I believe that it could make you break into tears. We never know when our next battle with The System will come up! Good luck with your infusion in the new location. / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)
Posted 3/27/2013 11:35 AM (GMT 0)
That's stressful and I'm glad it was sorted. It's scary though - you're an attorney who was able to advocate for yourself, what happens to the many who aren't able to? It's criminal. Where I live it's the opposite - everything when inpatient in hospital is free, but we have to pay for remicade and all other meds rxed or received when we're not inpatient.
Posted 3/27/2013 12:27 PM (GMT 0)
this thread scares me quite a bit, i just had my first remicade treatment outpatient hospital. they just said ti was expensive but I have no idea how much they charge. my guess is my insurance company negotiates the price down quite a bit and then I have to pay a portion. i applied for remistart to help, i'm a student on student health insurance so I definitely need the help right now
Posted 3/27/2013 12:43 PM (GMT 0)
Nice! I remember going thru similar issues while I was on Remicade. The thing that angers me the most is living in fear of insurance, co-pays, etc. It's just not right- it's hard enough to deal with a chronic illness, nevermind worrying about money, or losing access to meds that work due to money and/or insurance! Sounds like the hospital would've billed the infusion as an outpatient day procedure- I had a similar scare, but was able to speak with hospital billing re. billing it as an office visit. I'm happy for you!
Posted 3/27/2013 11:08 PM (GMT 0)
I could tell they didn't want get into whatever financial work-around they planned. It might have been possible because my GI is actually now employed by the hospital. But clearly everyone is on board with it...!

BTW, my next step was to find another office-based infusion center. My insurance carrier didn't know, they suggested calling every GI on the list. I would have had to go through lots of hoops to get in to see that doctor and/or get portable doctor's orders, pre-qualify again with the insurance, etc etc. although it was time for me to get a dose NOW. No one knew of any in my area, but I would have traveled to make it work. There was one business in the next state called "Infusion Express," and I was ready to see what that was about...

It is SO important when you have a chronic disease to understand your insurance: copays, coinsurance, deductibles, out-of-pocket max, and finding out what it will cost! Doctors and hospitals are still not very good at that, although they are better than they used to be. Insurance companies might be helpful...or might not. And you have a choice where to go! Doctors will normally have privileges with more than one hospital, and you can also choose which imaging center you want to go to, etc. and can shop around!

That is another great thing about this message board, we can help each other figure it all out!
Posted 3/27/2013 11:12 PM (GMT 0)

garylouisville said...
That was smart. A similar thing happened to me getting IVIG once for a different autoimmune disease. My doctor's office is actually located in a hospital. They gave me IVIG and found out after the fact that I had to pay like $1500 instead of zero since it was done at a hospital instead of the doctor's office. It wasn't until over a year later that I realized the doctor's office coded the procedure wrong as being in the hospital instead of the doctor's office. By then everyone claimed that nothing could be done.

I collected back a $700 coinsurance amount that I had thought was a deductible, more than a year later. I think it is never too late! Worth trying. They make lots of mistakes, I have two or three claims a year corrected. Not appealed, simply resubmitted for correction.
Posted 3/28/2013 1:04 AM (GMT 0)
I look at every health bill that comes in and so I called my insurer when I saw they didn't cover a $42 Pap smear because I know annual exams are covered. Woman there said she'd request a review and we ended up getting about $300 worth of checks from them for other bills that should have been co-pays instead of "us pay".

It is so confusing that I don't think anyone understands the billing in's and outs.
And it should not be this way.
How do people really sick with spouses overworked ever have a chance at this problem.
Posted 3/29/2013 8:00 PM (GMT 0)
I think every medical professional who can order treatment or prescribe medication should be required to take a course or seminar on how insurance works. They have to participate in cost containment. Not managed or rationed care, but just awareness would be huge. Health reform has some components of it, but more is needed.
✚ New Topic ✚ Reply