insurance

A board to discuss the newly-released drug Tysabri, (formerly known as Antegren) as a treatment for Multiple Sclerosis

insurance

Postby Loobie » Sat Apr 25, 2009 9:09 am

I've got a question since I feel I'm being nailed by Anthem in the same way UHC nailed me. After telling me that all I had to pay was the $50 office visit copay, they called me back after two doses on my new insurance and told me that was incorrect and I owed them $486/dose for the last two. Does anyone else pay that much who is insured? I'm curious because this is the second time a major carrier has done this to me. I mean I'm ok if that is what it is, but 2 of them doing the exact same thing in 6 months? I'm starting to think I'm being screwed. And the funny thing is, Biogen calls twice in the same day to get different people on the line so they can make sure a mistake wasn't made. Both times they were told 0 out of pocket. I'm confused and pissed off severely and would love to hear what others are paying. If you don't want to talk about it, PM me because I'm trying to build a case.
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Postby TWG » Sat Apr 25, 2009 1:24 pm

I too, have UHC. I have had just one Tysabri infusion. Didn't pay anything up front. I haven't received a bill yet either. My UHC plan said I would have to pay 10%, or $800. Once I met my max out pocket, in my case $2000/yr, they would pay 100%. They said in my case I had already had $400 out of pocket bill, I think it was for a post Tovaxin MRI. Those were the days! Nice to see you here on this forum.
Diagnosed with MS in Feb. 14 2000! Was a Tovaxin guinea pig.
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Postby catfreak » Sat Apr 25, 2009 4:55 pm

I have a $3000 deductible then mine pays 100%. I met my deductible with the 1st infusion.

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9/3/09 Stanford - Dr Dake - Stent in R-J to unblock Arachnoid Cyst in Sigmoid Sinus. Stent in narrowed L-J. Balloon in narrowing where R & L Jugulars meet.
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Postby Loobie » Sun Apr 26, 2009 7:57 am

Well I think it's just this expensive until I meet my deductible, so it sounds as if it's just expensive shit! It just seemed like a deluge after paying $120 every 3 months for Avonex. And then going on this in November I had to make up a $1,500 deductible and then do it all over again two months later since it resets in January. Well now we changed insurances and I'm having to meet my third deductible in six months. That is probably more of it than anything. It's just that I just paid off a bunch of debt and I was liking watching my savings grow!! Well no one gets off this ride for free I guess.
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Postby Xandarr » Fri Aug 14, 2009 8:40 pm

Well here is a cut and paste of my first treatment costs this is just for 1 visit getting the iv placed and gimping out the door 2.5 hours later. I know its hard to make out what is what so ill simplfy it.

The hospitals charge to me $7,644.44 aetna negotiated it down to $4,968.69 of which I owed $0.00 I am very fortunate to have a very expensive BUT very comprehensive medical plan with AETNA EPO.

Status : Completed
Payment Made to: Provider

Date of Service/Service Provided Charges Submitted Charges at Aetna's Agreed Pricing Paid By Plan Not Paid/Excluded by Plan Applied to Your Deductible Your Copay Applied to Your Coinsurance
08/05/2009
Hospital Incidentals $552.41 $359.07 $359.07 $0.00 $0.00 $0.00 $0.00
08/05/2009
Hospital Incidentals $7,092.03 $4,609.82 $4,609.82 $0.00 $0.00 $0.00 $0.00
Total $7,644.44 $4,968.89 $4,968.89 $0.00 $0.00 $0.00 $0.00
Your Responsibility: $0.00
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Postby catfreak » Fri Aug 14, 2009 9:46 pm

My Aetna pays like that after I meet the $3000 deductible!! The hard part is coming up with the $3000. I pay through the nose for this insurance.

Cat
Holly - Shine On You Crazy Diamond - Pink Floyd

9/3/09 Stanford - Dr Dake - Stent in R-J to unblock Arachnoid Cyst in Sigmoid Sinus. Stent in narrowed L-J. Balloon in narrowing where R & L Jugulars meet.
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Postby tt89 » Sun Oct 25, 2009 11:22 am

I have UHC
They cover it 100 percent. No copay, nothing.
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Postby singerdf » Tue Dec 01, 2009 6:10 pm

Loobie,

Same situation. Insurance started in April (COBRA) and I needed to meet a $4000 deductible. After that and one infusion, all is covered. Mind you that was not even 1 year. Our clock resets in January and COBRA will expire in June. So once again, $4000 in six months and a new policy will start again. I love the therapy, but not the cost. I am fortunate in that my infusion center has allowed me to pay over time.

This is one of the hurdles for Biogen Idec as they have not reached their break even numbers as the cases of PML continue to rise. So the drug remains outrageously expensive and we are beholden as it helps so many of us.

Debbie
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