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1831849 tn?1383228392

How Much$$??

Most of us are at the mercy of docs and insurance companies when it comes to our treatment. We are often asked to undergo treatment or tests without knowing much about the cost to us.

My Tysabri infusions are billed to the insurance company @$6,000 each. I couldn't get an info on MY cost before I started getting them in November. I started them anyway. My out of pocket for the 4 infusions to date is less than $600, my annual out of network deductible. Now, after the fact, I'm comfortable that my out of pocket will be minimal. It could have been different. If my insurance only paid $4,000 of the $6,000 billed, and my doc wanted the difference from me, I would have been in real trouble.

Yesterday I got a call from my doc's office. They have recently installed 2 new MRI machines in the practice. The caller wanted to know if I would like to schedule an MRI. I thought they were looking for test volunteers so I said OK. Then she said she would submit it for insurance approval. I then asked if this was medically necessary, meaning did my doc order the scan. She gave me a somewhat plausible explanation. I said as long as it was 100% covered and medically necessary I would come in.

With all medical care, and MS treatment in particular, the doc is both the buyer and the seller, And they don't pay, we do! It is in our best interest to do a little more proactive fact finding before agreeing to expensive treatment/test.

Just one man's opinion.

Kyle
5 Responses
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2078115 tn?1333926565
No kidding. I have no idea how much a doctors visit or an MRI costs. I was shown a CRAB "price list" (it was stuck in between the pages of the info/CRAB comparison booklet i was given at the MS clinic)

let's just say that but for universal health care, i don't think i would be able to begin the treatment i know i need.
Helpful - 0
382218 tn?1341181487
MS is an expensive disease.  Getting diagnosed with it gave me an appreciation of universal health care.  I used to take it for granted.
Helpful - 0
572651 tn?1530999357
Medical necessity and costs are really in the news this week.  A big study was just released about the use and expense of anesthesia for colonoscopies.  You can read the results of this multi-year test at

http://www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/31739

Jane - the SS program says that no patient will pay more than $35 out of pocket, and you don't have to apply for that assistance.  They know who their users are.  People who are on government insurance still need to talk to SS for help.

The costs of MRIs have dropped dramatically, thanks to the wide spread use of the technology.    Just be sure you have preauthorization.  On tysabri you should have more frequent MRI's to monitor for PML.  

As for the Tysabri cost, apply to Active Source (Biogen Idec) for their assistance program and they will cover the entire cost of the drug and also most of the infusion center costs.  Between my insurance and Biogen, I am paying nothing for my Tysabri, if you don't count the cost of gas to drive 70 miles each way.  

hope this helps,
L
  
Helpful - 0
Avatar universal
So very true! My first round of IV steroids will likely be my last. I was told by both the pharmacy and the in-home nursing company that all was 'covered by my insurance' with the exception of about $200 that would be mine to cover. Afterward I received bills that totalled over $600. Neither company could explain how that happened. Had I known then what I know now I would have contacted my insurance company myself to verfiy what I'd been told by the providers. I will definitely double check in the future!
Helpful - 0
1936411 tn?1333831849
This is very true. I just received my first bill for Copaxone. They are billing my insurance company over $3K monthly, which is much higher than the monthly cost I had heard others discuss on the forum. My copay would normally be $250, but I somehow qualified for a financial assistance program in which Shared Solutions will cover all of my copay except for $35/month. I have no idea what I did to qualify, since there was no application.

It's all quite strange.
Helpful - 0
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