Sticker shock!!!

[michelleric]

Well I thought Tysabri was expensive, but Boy was I wrong.  Just found out my IVIG treatments are...ready...

$34,887.56. PER MONTH!  My insurance allows them to charge $22,000 per month.  We have a 20% copay on everything.  Ok, this is NOT good.

Just needed to share this with someone...my head is going crazy w this information.  Plus, I have D/C a medicine recently and need to get back on ASAP.  Crying excessively, cant sleep and falling constantly.  Just not a good time to hear about the pricetag.

I am thankful for insurance of course, without it I wouldnt have this infusion at all.  However does give me pause to continue with it.

Now thats alot of MULA!

Michelle

[Maks322]

I should add that they also premeditated me before the treatment, but I not see it listed on the bill.  I believe mine was just benedryl (forallergic reaction)and Advil. (For the headaches that can occur).

[Maks322]

Hi
I just finished a 5 day treatment in February (and got the bills yesterday).
I am amazed at the cost,but mine was cheaper
These are the charges
IV INF THER PROPH DX UP TO 1HR.    432.00
IV INFUSE THER DIAG EA ADD HR.      260.00
RX IVIV LIQUID (GAMUNEX) 500MG.    4392.00

Then it says my insurance of United Healyh Passport. Adj.    -3097.00
And their payment of                                                               -1788.26
So to me this treatment is       $198.00

This was one day of 5., so out of pocket to me was $1000.00
Each days charges were the same, my insurance coverage was slightly different.

I was shocked when I saw this was coming.  I was there just under 3 hours for 5 days.  For me unfortunately, it didn't help alleviate my pain.  So I don't have to incur these charges again.

I would shop around though, for me I found my cheapest MRIs are in a different state (I live on the border) on a 3T machine.  

Maureen

[rendean]

Sorry to hear aout the exorbitant price for your IVIG! I would definitely shop around!!! do you have a cap on out of pocket expenses on your insurance? That would certainly help.

Please restart your other meds to help prevent more falls. Thinking of you and sending M&Ms with the Xanax!

Hugs,
Ren

[kwarendorf]

"Certificate of Creditable Coverage"

I remember this form from when the switch was made. I didn't know what it was all about, but I didn't want to rock any boats :-)

Thanks

[PastorDan]

By the way, Michelle, I will surely pray that there's a way to deal with this, other than winning the Irish Sweepstakes.  I am sorry to hear of this worry being added to your plate.

[PastorDan]

Pre-ex clauses of of that type, Kyle, were supposed to have been outlawed many years ago.

That "Certificate of Creditable Coverage" you get if you ever lose a job through which you get health insurance is supposed to be your ticket in to a new plan, within a specified time.  (My late wife was a claims analyst for many years, when that was all enacted).  In other words, if you've been covered by insurance, you have to be accepted under a new plan, if you join soon enough..

The only thing they're supposed to be able to prohibit is those people who go without insurance until they need it, then sign up to get coverage to pay for something.

Insurance was intended to be a way to share risks, and if nobody pays until they're sick, we might as well all pay our own way as we go.

Some economists think that this has been part of the problem in health care all along, because none of the people who need health services have to handle the total bill; we pass it on to the insurance company, they pass it on to our employers, and they pass it on to their customers as a part of the cost of doing business.  Since "the other guy" always covers most things, we don't shop around for reasonable fees; we take whatever services are offered for whatever fees are charged.  Possible evidence of this phenomenon: prescription drug costs haven't always been in most people's plans, but since they have been widely covered (mid 1980s or so?), their prices have shot up more than ever.

Fast forward to Obamacare: many employers are now required to provide coverage, and many individuals are now required to purchase it.  Therefore, the pool of dollars flowing in should help cover those who otherwise can't be covered.  How the pre-existing stuff works into the new law, I am not sure, but I'd be surprised if it's any more difficult for the patient in need (though I readily admit I could easily be wrong; I was wrong once before!). ;-)

[kwarendorf]

I was afraid the preexisting condition thing was going to get me this January 1. My company switched health insurance providers, from Humana to BCBS of IL. I disclosed all on my forms and waited for the bomb to drop after my first Tysabri infusion ($6,900). Not a peep :-)

Kyle

[Lulu54]

You made me look!!! I had to go find the bills for my Tysabri and infusions and here is what I find was done through BCBS

Tysabri was billed and paid at $4,136.01 (last month the drug cost $3901 - wonder what inflation price will be next month?)

OSU billed for the services of the doctor and the infusion center (I'm there for 2.5 hours - paperwork, 1 hour infusion and one hour observation afterward)  $615.00 and BCBS paid $410.33

I recently had IVSM and it was done at a local neuro's office- they billed and were paid $475 for each one hour session (actually about 50 minutes!).

I'm not sure what kind of gold they are putting into you, Michelle, to charge those types of prices.  A listing on wikipedia (I know about it not being the best source for information!) puts the price at

"IVIG cost is stable but over $75/g. ($15,000 for a 100 kg (220 lbs) person at 2g/kg)"  as of February 2013.

Let us know what you find out about treatment elsewhere. I'm sorry you have this added financial stress to the physical stress.  hugs, L

[Ojibajo]

And people wonder why I don't take my meds. I can't afford those astronomical prices!  And the other FUN part of this disease: Now I have a pre-existing condition. No new disability insurance or new health insurance or life insurance. If anything happens to me, I am basically screwed. If  die, my dependents are screwed. This *****! I better live forever and never get any worse!

[SarahL2491]

I think it depends on where you go!  I will know whenI go back north this summer if the hospital there has raised their rates.  The figure I quoted was from a neurologist office in the South.  I have not gotten the medicare figures for the local clinic where I am going now....I may not want to!

It's terrible and I fear its only going to get worse as we go along.  There may come a day when many of us have to make the decision to keep up medications or not.  I am facing 4 new prescriptions, totalling over $300 copay between them and I don't think there is room in my budget for that much extra medication costs.............thinking of selling pencils on the corner!

[debgen]

I just went to an MS conference last night about research and treatment. The speaker discussed the exorbadent prices of the MS drugs and explained that medications such as Tysabri are so unique that there is really no competition, thus becomining basically a monopoly which drives up their price. Ain't capitalism grand!

So sorry about your situation,
Deb

[michelleric]

Thanks. I am going to ask for an itemized bill.  I know I am getting almost "double" rhe dose as I should be, so said the infusion nurse.  I am pretty sure they use a higher dose for different diseases.

They also " premicate" me before w about 3 different meds, and hang some other infusion med during the ivig infusion.  I al there for about 6 hours.  Maybe they charge me an hourly rate as well?

Think I better get to be a more informed patient.  I am going to shop around as well.  Cleveland Clinic has a "facility fee" as well w most visits. We pay extra to have the priveledge of using the CC services.

Uughhhhhh.   Thx for listening

[doublevision1]

That's really shocking Michelle.  I think it makes a lot of sense to shop around.  It seems that the cost of meds in the US varies wildly from one place to another.  Perhaps you can find one that is more in the range that Kyle speaks of.  Good luck, and enjoy that Xanax.

[kwarendorf]

I meant 5X higher...

[kwarendorf]

That number is more the 10X higher than any number I was able to find for IVIG treatments. The high estimate I saw was $100/g. you need 1g IVIG for every kilogram of body weight. a 154 (70kg) pound person would need 70 grams, or about $7,000 for the IVIG before the cost of administering it.

[michelleric]

Yea, thanks.  Guess this is why IVIG is not the first line of treatment.  Neuro told me it is very expensive...but I would have never beleived the actual cost.  Good lord...

Sarah, my tysabri was $11,000. Per treatment.  Maybe I need to get away from the Cleveland Clinic?  Probably cheaper at a different hospital?  Who knows...

Expensive to be sick!  Rediculous...ok.  I am starting to fume.  Think I need a xanax.  At least that is a cheap med ;)

[SarahL2491]

Lulu was also talking about the price of this expensive medication!  I don't remember the post(s), perhaps she will chime in later with the answer for us.

Yeah, my Tysabri is up to $8800 plus some change now, amazing, they must think all MS patients are rich, perhaps this is why many go without treatment.

[essdipity]

Oh Michelle, I'm so sorry about this. I've never heard of *anything* so expensive. I doubt that many people could even afford your co-pay, so maybe the insurer just doesn't want to help.

Can you find another source for the treatment, one that charges less for the same thing? Can your neuro suggest anything?

Thinking of you,
ess