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Cost of Remicade: BCBS

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Posted 12/17/2013 1:50 PM (GMT 0)
Every once in a while somebody asks what does Remicade (infliximab) cost. Below is my Explanation of Benefits from my last Remicade infusion at my GI's office. In the end, it costs me $100, after my insurance (Anthem Blue Cross Blue Shield) and RemiStart (patient assistance program) paid the rest.

I weigh in at 64.4 kgs (142 pounds), my dosage of Remicade is 5mg/ml per kg, and Remicade comes in 100ml vials. So, that is 64.4 X 5 = 322mls of Remicade, they must bill you for complete vials, so that makes it a total of 4 vials of Remicade.

CPT........Description.............................Charges........Units.....Total
J1745....Injection, infliximab, 10mg........$150.00........40........$6,000.00
96413....Chemotherapy Admin,..............$350.00..........1..........$350.00
.............IV Infusion up to 1 hour
96413....Chemotherapy Admin,................$80.00..........2..........$160.00
.............IV Addtl hour 1 to 8
J7050.....Infusion, saline solution, 250cc.....$5.00...........2..........$10.00
......................................................................................................
.............Disallowed adjustment BCBS...................................$-3,328.00

............Total Billed............................................................. $3,191.00

............BCBS Paid............................................................... $-480.00

............RemiStart paid....................................................... $-2611.00

............Patient Responsibility.................................................. $100.00

Man, do I wish I could just pencil away half of a bill like BCBS does with it's "Disallowed" line lol.
Posted 12/17/2013 2:31 PM (GMT 0)
Mine is covered 100% thru my BCN so I have no out of pocket expense and for that I am extremely grateful. But every once in a while BCN will send me a bill with verification of membership. I basically just sign it and send it back. But mine comes out to about the same...I don't have the breakdown in front of me but I get IV Soulmedrol and oral Benedryl. The Benedryl is like $25 or something lol
Posted 12/17/2013 2:40 PM (GMT 0)
Insurance is a messy thing. Pretty much BCBS hits me with a $3,000 deductible, once a year (which Remistart neatly pays for). After that the infusions are free, other than the office visit copay.
Posted 12/17/2013 3:07 PM (GMT 0)
Mine looks about like that, too. The write-off is almost half the charges. I'm lucky to have Medicare and a good co-insurance, so mine costs me nothing. Before Medicare kicked in I was paying about $2400 a year (including deductible). It's worth a billion dollars to me, but if I had to pay for it myself I couldn't do it. I'd be either dead or very, very sick.
Posted 12/17/2013 7:21 PM (GMT 0)
My GI office charges my insurance $7,600+ for my infusion. I get 10mg/kg and my last appointment I used 6 vials. I am lucky and only have to pay the $20 copay for an office visit for the infusion.
Posted 12/18/2013 2:38 AM (GMT 0)
I have been billed between $4800-$13,000.depending on where the Remi infusion was delivered.Some variable on dose, but it is shocking when the bill comes.Deductible 10k, out of pocket max near16k. Grandfathered plan for the ACA. 5 years in a row we have hit the out of pocket max, even doing infusions at the infusion center( at the low end). Plan costs about another 6k,for 3 of us.
Wonder what the Vedolizumab will cost, or what hoops we will jump thru to even get it covered next year?
That said, we would have Long
ago lost our home without insurance....D has billed insurance over 100k each year since diagnosis. Insult to injury, or some such.
Posted 12/18/2013 3:58 AM (GMT 0)
Katmom, you lost your home because you had no medical insurance?? If so, I am so very sorry!
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