How is Tysabri billed?

[Tinkerbell65]

So I've been approved for Tysabri as well as the Tysabri assistance program. What I'm still confused about and insurance "isn't able to tell me yet" about the rest of the billing since the co-pay program covers only the drug itself, not the infusion. How are you being billed for the rest? As an office visit? Additional lab work? Ultimately it won't change whether or not I do it, but I am anxious to know. Apparently I have control issues

[lindaincolorado]

Hi Tinkerbelle, on my Medicare form it is listed as chemo iv infusion. All is billed thru part B none thru pharmacy.

[jbell2435]

I just got the bills from my Solumedrol infusions in Dec...although insurance is paying, they billed part of it as "surgical" (I assume the iv line placed in my arm), then part of it was pharmacy (the meds themself I'm guessing), then home health something, I guess for hooking up the infusion itself.

They billed for 3 days, even though I only went in 1x and self administered the other two days, including removing the iv line. I contacted insurance to tell them it was only 1 day.

Remember to review your bills or EOB and report anything not right. It saves us all in insurance premiums and overall healthcare costs!!

[LL60]

My old insurance covered everything with Tysabri. It was under a "major medical" clause and just went in and had it done and that was that. No worries as far as money goes.

When our insurance changed last year I could not get a straight answer to save my life!!! I called every number my inusrance could give me and Biogen. Biogen said they couldn't help until the insurance actually started. My insurance company gave me cost of everything to $170 to $2500 and said, "Don't worry, you cap out at $6,000 and then won't have to pay anything." Like I just had $6,000 laying around to pay them. It was very stressful until I got the first bill. Then it is just confusing.

But.....from what I can tell, I still have the Tysabri infusions under the "major medical" part of my insurance, BUT I now have to pay for the cost of the infusion. And that changes. Because sometimes I get stuck once and sometimes I get stuck 5 times. That is all new tubing and needles. You get two is my understanding, after two you pay for the extra stuff. So....I have been billed from $171 - $186 for the cost of the infusion. Per month. Which is fair. And way way better than the $2500 three different people told me it was going to be.

I pay full price for all blood test and $175 for each office visit with my neuro - which I try very hard to keep down to twice a year. My insurance charges me over $1800 for an MRI so I now go to a private place and pay out of pocket $575 for one. I send the CD and the report to my doctor and she enters it into my records.

It sort of is like barely having insurance, but I guess if something major happened we at least know that it won't cost us any more than $6000. A year. This is pretty much the type of insuarance Obama wants everyone to get. You have to save up and pay your own bills, but if something major happens you are covered.

If you are healthy, it is a very good thing. Doesn't cost you anything and you have years to save up for later in life if something major happens. But we came into this type of insurance just last year and it has been very hard on us. But.....at least it's something. And I can continue the Tysabri. For that I am grateful.

Thanks for letting me vent a little.

[0485c10]

You should get a call from a Tysabri patient representative that will call and make sure you know exactly whayt it will cost you out of pocket. Since you are already on assistance for the cost of the med maybe they have contacted you already?

One problem can be that since ty infusions have to be done at a TOUCH center, sometimes people are forced to go out of network so it can cost more...?

if you don't yet know where you will go for the infusion, the tysabri site jhas a locate the nearest infusion center to you...you can call out right to ask what the cost of a 1 hour infusion in. My first infusion center did not charged me for the hour of observation, you need to wait after the infusion. My 2nd infusion center didn't charge for that hout at first, but now on the bill for that hour.

when that tysabri customer admistrator called he was very detailed in the cost and all the details of my insurance.

http://www.tysabri.com/tysbProject/t...ion-center.xml

[Tinkerbell65]

Thanks for all the help and insights everyone! Whatever happens, it's certainly will cost more than Avonex, but my understanding is that (hopefully!) the results will be worth it. Will keep you posted.

[Scooter24]

Check into other places to have the infusions also, My nuero office was charging 140 for it, but found that my oncologist's office was also approved as a TOUCH center and only charge 110, but the hospital had an infusion center and they charged 75.00

[als5445]

They do actually offer infusion assistance as well, up to $1200/yr. However you have to ask for it.

The copay assistance has been a life saver. It would have normally cost me $160+ per month but i'm only paying $10 with the assistance.

[Scooter24]

They never offered or said anything about it to me.

[als5445]

I didn't know about it either until my infusion coordinator told me about it. Maybe its new, i just qualified for the copay assistance in January since I changed insurance.

Like I said, you have to ask for it. My coordinator said they can be stubborn about wanting to pay assistance out, even though its less than 10% of what the drug costs.

[KyleW]

I've only had 3 infusions, so I'm not sure how all this will cycle through but...

My doc bills the insurance company about $6,000. They pay around $4,000. That leaves around $2,000. My first infusion was on 11/30/11. I have not received a bill from my doc for the difference for that infusion. Neither have I received a bill for the 12/30/2011 infusion nor the 1/29/2012 infusion.

He is out of network so I am "responsible" for the difference. I'm hoping that he accepts the insurance payment as payment in full. It looks that way so far.

If not, my max out of network, out of pocket is $3,300. After that Insurance pays 100%. Worst case scenarios is I'm out $3,300 for the year. Good thing I bumped my FSA to $5,000 this year!

Kyle

[kt0406]

so lucky here but my hubby is military so i have full coverage when it comes to health insurance. i do get a statement though. the fee for the infusion and blah blah blah is over 14000!!!!! every 28days!!! my insurance pays very little of it too. so i reckon my doctors office just has to eat the rest. when i found out how much it was i wondered how do people afford to do this?

[0485c10]

kt0406--
that lose the doc & hospitals take confused me at first also. Its especially visible on the uninsured bill, which i was at the time i investigated it. You know the uninsured are always billed more than the insured--which i found true but not for the reason that is so often cited in reports that they a ripping off the uninsured...

they bill high with the expectation that they will not get paid, so they can claim it as a business loss offset against profits on their taxes...

you have to take that in context though, docs & hospitals are not rolling in dough, they are using what they can to keep their head above water to be able to provide a standard(respectable) level of care to all their patients..

some docs and hospitals are going to, i forget the word, having the patient pay a yearly premium to retain services.

others are using the losses on their taxes to offset the profits gained on some treatments...so it evens out & they are able to keep their head above water financially.