I can understand the ‘sticker shock’….

February 19, 2008 at 4:03 pm

that comes at first.
I truly hate the beginning of each year waiting for the EOB’s and the claims put in to catch up with all my doc appointments and all. That First and Second Infusion Bill can put one off on the FEP plan until you meet that catastrophic deductable. Some Infusion companies like to bill ‘quarterly’ and at the new benefits year, that can create havoc….I just check all those EOB’s and make sure they are put in ASAP! Once it all gets into the insurances’ computer system and you’ve met your Cat.Ded. Well, then everything is totally Free?[Unless YOUR plan is very different?] Some preferred docs will still charge you the co-pay but, IF you return their bill with a copy of the BC/BS EOB showing what you really OWE…Somehow those docs never show that you have PAID…You should get refunds…Same with other meds. Once you meet that Cat.Ded. Whether you use the mail-in or local pharmacy you should get it all at no charge….IF you are charged…once things catch up in the systems…you get refund checks. That pharmacy aspect is one you should watch closely…I always call at the end of Feb..onwards to see what date I’ve met it, and when I should expect to not pay more…Can’t hurt to be cautious.
The good thing is once you meet that deductible things should be covered? [At least it is here in the DC metro area-all of it] but the time lapse between it getting into the computers and back to the world can take two months plus. It seems to be a first claim IN on date received not date debts are occurred kind of thing, in terms of adding up that Cat. Ded. It IS a big hit to the wallet tho for a ‘new years’ present’ tho.
I don’t know about PP’s under the basic plan…I’ve the preferred [standard], as I’ve had many issues and, once that C. D. has been met, all is home free… I have found that some docs will take on new Standard[old-high] patients where they hesitate with basic patients…Don’t know why, maybe it relates to what they can or do charge? I don’t know about you, and I know I am lucky, but co-pay plus some? I don’t mind paying extra IF I feel I have a really good medical professional WORKING FOR ME! I do have specialists who have gone out of plan and have made arrangements for me not to pay extra…again, don’t know why but I do appreciate it for sure!
More interesting, is that in my area? Many PP’s on the plan are not included in the pp’s on other plans and quite a few are even listed in the ‘Top Docs’ ratings for the area. I’d done the hunt and peck version of finding my specialists before they were ‘listed’, and am happy, and very glad with most of them.
I now have infusions done at home, I find overall the costs charged are far less than at the hospital’s infusion clinic/center. Actually a lot less by about $1,000.? I also find getting it at home is a lot easier on ME in the long run. I get the Same Nurse each time, and the same IVIG each time. AT the time I am scheduled to get it. Think on it, for us? It’s better than home delivery Pizza! INsert smilie here!
Keep us up to date, please….

PS for me/us this year, I did notice our Catastrophic deductible went up $500. for this year. Given what they PAY out for both my and other’s care in my family, I’m not arguing? I’m paying lots for the insurance, but getting about 10-15 times back each year in benefits coverage! I KNOW I am far FAR more fortunate than ever so many. I do count blessings, no matter how convulted and how they work. Knock wood quickly!