HealingWell
Search Close Search
☰

Another Frustrating Infusion Center Visit

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
1 2 3 4 5
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/12/2019 8:16 PM (GMT 0)
With a plan like I have insurance would bill $3000 for the med in Jan. Co pay assistance for remicade will pay $2995 of that and I pay $5. Then the rest of the year I pay nothing for anything -- not for meds, doc visits, labs etc. since I have met the max OOP for the year through my main insurance. They don't care who is paying that OOP -- me or my secondary insurance. So my total medical expenses are $5 for the year.

With your current insurance you are paying $5 for the med (remistart pays $195 to cover your co pay amount) plus the infusion cost every 2 months. You likely also have doc visits and lab tests throughout the year you have to pay a portion of too.

Usually co insurance plans have lower premiums because they were designed for healthy people who don't take meds or have doc visits etc. If they need to see a doc or get meds they pay more than fixed co pay plans.

Example:
Med cost -- $6000
50% co insurance - $3000 I am responsible for
Co pay assistance picks up $2995
I have to pay $5
Cost of the infusion is now covered in full since I already met my OOP
Rest of year $0 cost to me

VS

Med Cost -$6000
Med Co pay -- $200
Co pay assistance pays $195
You Pay $5
Cost of infusion -- I think you said it's around $40
Rest of year -- you would have these same costs plus any dr vists, labs etc.

Hope that makes sense. For people like us who are on very expensive medications that have co pay assistance programs, the co insurance plans are less costly than fixed co pay amounts.

Run the numbers once you see what plan options you have so you can pick what will work best for you

Congrats are feeling better!!! The last 2 days I have only seen a faint trace of blood since Tuesday and and down to 2-4x/day. So my fingers are crossed!!
Posted 9/12/2019 10:33 PM (GMT 0)
PA -- Originally you said you had to come up with $3,000 in January. You said it would be initially difficult for you to come up with it, so I thought that meant you were paying the $3,000. I understand the rest of it now. So everyone who is getting everything paid for must have coinsurance instead of co-pays for meds. It finally makes sense now, lol. Thank you. And I'm super glad you are feeling better!

Thanks all. smile

Yeah, I will have to take a look at other plans. I always assumed I had the best one but have not looked at them again since I first signed up 9 years ago. Thanks, travesty for that additional info.!

Post Edited (Sara14) : 9/12/2019 4:39:40 PM (GMT-6)

Posted 9/12/2019 11:20 PM (GMT 0)
I meant that I would have to pay $3000 in Jan if I don't have Remistart (or whatever it's called now).

When you look at the plans look at the max out of pocket and determine how fast you would reach it. Once you hit the max OOP you pay nothing for any in-network med, dr, lab, procedures etc. It's the only benefit I have from having this awful disease that requires outrageously expensive medications -- next to nothing in medical costs.
Posted 9/12/2019 11:58 PM (GMT 0)
Ah I gotcha. Sorry I misunderstood. Thank you so much for taking the time to type all of that all. That is actually really awesome that you don't have to pay any medical expenses. I'm extra glad now that I took the time to complain on here and get 5 pages worth of responses. Lol! You guys are all so nice to respond and help explain all of this to me!
Posted 9/13/2019 5:07 PM (GMT 0)
I don't want to go to this new infusion center because everyone I speak with is rude and tells me a different thing. I'm so sick of dealing with this crap at this point, I'm willing to just pay a lot more money to not have to deal with these people.
Posted 9/14/2019 1:22 AM (GMT 0)
Sorry to hear that. No I work in the insurance industry. Are there any major GI groups in your area that do their own infusions? Maybe that’s what you were doing before, but lots of GI chains have at least a couple chairs. Just brainstorming. Also ask about home infusion if doctors offices aren’t an option.
Posted 9/15/2019 11:35 PM (GMT 0)
My insurance won't cover home infusion nurses; I asked. I haven't been able to find any other options other than hospitals. I guess I'll try out this infusion center and see how it goes. The nurse there sounded fine. I feel like it's a little weird it's just her there. Thank you for the input! smile
Posted 9/26/2019 3:40 PM (GMT 0)
I made an appointment at this stand-alone infusion center, so hopefully that will be a better experience for me. I don't like dealing with their corporate people on the phone but the nurse who works at the local center called me personally to set up the appointment and gave me her cell number and she seems nice and knowledgeable. It's not until Oct. 31. Will let you all know how it goes. smile
Posted 9/26/2019 4:26 PM (GMT 0)
If I want to change where I get my infusions, I have to get a new prior authorization. If you haven't already done that, you might want to check with your insurance whether you need to. The last thing you need is for the entire claim to be denied because you didn't have a PA.

Hope it goes better for you at the new place!
Posted 9/26/2019 4:34 PM (GMT 0)
Yep, I did that part already -- thank you! Yes, that would have sucked big time, ha. Thanks! Hope you're doing well.

Also, it will be interesting to see how they bill the medicine there because they don't take meds from outside pharmacies. So I think they might bill it through major medical instead of my prescription drug coverage. It shouldn't make a difference though since I have the Remistart/Janssen deal. I'm so glad they have that assistance program.
✚ New Topic ✚ Reply
12345