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    Infusion "Outpatient" Businesses

    I am on Tysabri. I have been going to an infusion "outpatient" franchise approved by my insurance for the past 7 months. The facility is far from where I live. It is nice, but every time I go there seems to be some mistake primarily on the administrative side. These incidents have cost me time and have stressed me out. I am a person who really gets my ducks in a row in advance, but nevertheless always seem to be correcting large billing or other errors by my insurance and now by this facility.

    I am very interested helping to keep medical costs down for my insurance, but not at the cost of my own safety. Since there are so many inpatient infusion facilities nearby, including one at the hospital where my neurologist works, I've started to wonder if there are ways of getting my treatment to be considered an outpatient infusion at one of these places. Has anyone here ever made that work?

    I am also planning to ask my neurologist. I hope this question is clear and thanks for your thoughts.
    All the best, ~G

    #2
    With my old neurologist, I used to get my infusion at a hospital. It was part of their short stay procedure unit. They also did chemo, transfusions, and other procedures in this unit. A few times, they were overbooked and my infusion was in the recovery area for same day surgery, which was the area right next to the short stay. They would actually admit me and then discharge me each time.

    They did bill higher than my current infusion center, which is affiliated with a private practice. I had same copay, but I guess what the insurance company's negotiated billable amount was higher for the hospital.

    Definitely worth reviewing with neuro.
    Kathy
    DX 01/06, currently on Tysabri

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      #3
      I don't get infusions. If I did the Neurology practice I go to has an in office infusion center. It's possible other Neurology practices also have infusion centers in office, something worth checking into.
      Diagnosed 1984
      “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

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        #4
        Originally posted by SNOOPY View Post
        I don't get infusions. If I did the Neurology practice I go to has an in office infusion center. It's possible other Neurology practices also have infusion centers in office, something worth checking into.
        I would rather not switch neurologists, but thanks. I realize through all this I'm lucky to even be asking this question.
        All the best, ~G

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          #5
          Originally posted by pennstater View Post
          With my old neurologist, I used to get my infusion at a hospital. It was part of their short stay procedure unit. They also did chemo, transfusions, and other procedures in this unit. A few times, they were overbooked and my infusion was in the recovery area for same day surgery, which was the area right next to the short stay. They would actually admit me and then discharge me each time.

          They did bill higher than my current infusion center, which is affiliated with a private practice. I had same copay, but I guess what the insurance company's negotiated billable amount was higher for the hospital.
          That's correct. I had the hospital inpatient infusion the first time, which was at a center attached to the hospital where you pop in, have the infusion, and leave. It was great, and it was all connected to my doctor's records etc. That was billed to insurance at $26,000. The franchise bills something like $1300 not including medication. Honestly, I think it's a great model even with the inconvenience in distance, except for the shoddy administration. I did give them careful feedback, so maybe that is just the best route, to participate in helping them to improve.
          All the best, ~G

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            #6
            I really wish in our healthcare debate,they would look at the pricing models. It is ridiculous for the same infusion, there is so much variability in cost. Then add the pharmaceutical pricing variability for the medicine, and it is a nightmare. Of course, with the powerful healthcare, pharmaceutical and insurance lobbies, not much will change.
            Kathy
            DX 01/06, currently on Tysabri

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              #7
              Originally posted by pennstater View Post
              I really wish in our healthcare debate,they would look at the pricing models. It is ridiculous for the same infusion, there is so much variability in cost. Then add the pharmaceutical pricing variability for the medicine, and it is a nightmare. Of course, with the powerful healthcare, pharmaceutical and insurance lobbies, not much will change.
              If chronic conditions become more common as aging populations increase, there could be some leveling-off. The AARP "lobby" just sent out a pretty big petition about this very thing. Fingers crossed.
              All the best, ~G

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                #8
                Originally posted by gargantua View Post
                If chronic conditions become more common as aging populations increase, there could be some leveling-off. The AARP "lobby" just sent out a pretty big petition about this very thing. Fingers crossed.
                I'm sorry, I don't think I said that right. What I meant was that as the older population increases with the baby boomers there will be more demand for better pricing. I really do NOT hope more people come down with chronic conditions. <3
                All the best, ~G

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                  #9
                  Originally posted by gargantua View Post
                  I'm sorry, I don't think I said that right. What I meant was that as the older population increases with the baby boomers there will be more demand for better pricing. I really do NOT hope more people come down with chronic conditions. <3
                  lol - took it the way you meant it
                  Kathy
                  DX 01/06, currently on Tysabri

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                    #10
                    Originally posted by pennstater View Post
                    lol - took it the way you meant it
                    Thanks for the reassurance
                    All the best, ~G

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                      #11
                      Hi !
                      I've actually sat in part of a hospital in Pueblo, CO and Mesa, AZ for my infusion up to 8 years ago. They each had a room dedicated to outpatient infusions. Since then ( May 2011) I go to the Univ of CO outpatient center which is part of the hospital but, separate buildings. I go the the RMmsC which is housed there.
                      Linda

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                        #12
                        Originally posted by lindaincolorado View Post
                        Hi !
                        I've actually sat in part of a hospital in Pueblo, CO and Mesa, AZ for my infusion up to 8 years ago. They each had a room dedicated to outpatient infusions. Since then ( May 2011) I go to the Univ of CO outpatient center which is part of the hospital but, separate buildings. I go the the RMmsC which is housed there.
                        Yes that is standard. Right now I guess it isn't medically necessary for me to go to the hospital affiliated place, according to my insurance. It would be nice.
                        All the best, ~G

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