Blue Cross Blue Shield and IVIG question

    • Anonymous
      February 18, 2008 at 3:38 pm

      Hello, Here’s an insurance question for those who have BCBS insurance and get regular monthly IVIG treatment (or anyone who understands insurance really well): Do you still have to pay a fair amount each month for your treatment? I have to pay $929 out of $12,600 for my first IVIG dose. If I have to pay this every month or even half that, that is like adding another car payment to my bills. I honestly don’t have another $500 to spare and if I have to pay this every month for the rest of my life or even long term, this is going to be a serious financial burden on my family. I called BCBS, but they are closed for the holiday today. Is there something I am missing here or am I really looking at paying this each and every month? I do have a yearly maximum out of pocket expense of $4500, but that is still quite a lot of money. Thanks for any insurance advice/info, I am really fretting over this.

    • Anonymous
      February 18, 2008 at 5:12 pm

      Every plan under BCBS is different. It depends on what is in your plan.

      We have BCBS of Michigan under Messa. We have a $5 copay on office visits & rx’s. We’ve been asked to pay nothing else. Emily’s IVIG bill at one point was between $20,000 & $25,000 a week & we luckily didn’t have issues with getting the insurance company to pay.

      If you have a yearly maximum out of pocket expense of $4500, then they may ask you to cover a portion of your infusions until you reach that point. If that is the case then you can call the manufacturer of your brand of IVIG & ask for some financial assistance. If that doesn’t work then you can ask your hospital to waive the extra fees or to offer you a deal. Sometimes a hospital will put you on a payment plan, so you don’t have to come up with $900 a month.

      Hospitals have a patient advocate on staff that is also available to help you figure out how to get your meds covered. You can call & ask to speak with him/her. The one at your hospital was a huge help & I’m actually considering a career in that field because of her.

      If you are getting homecare then you can call your agency & ask to speak with someone. They should be able to offer you some assistance in whom to speak with or what you need to do to get costs reduced through them.

      There are ways to get around the insurance not paying for it. Please don’t get discouraged and just keep trying.

      Good luck,

    • Anonymous
      February 18, 2008 at 7:04 pm

      Hi Kelly, thanks. I guess I did not realize that the different BCBS plans differed so much. I have the federal employee program and I have to pay a lot more out of pocket than you. We have $15 copays and have to pay a portion of all labs/diagnostic tests, etc. after a $300 deductible, usually 10%, but it adds up when you’re always getting something done. I’ve paid quite a bit for the MRIs, x-rays, spinal taps, etc. when you add them all together. In looking at having to pay $4500 each year for the IVIG treatments on top of my premiums, prescriptions, etc, it is still a lot of money. I am just sick over this – I never thought I could be facing having medical bills I can’t pay, when I work for the federal government and have “good insurance.” I will call the insurance company tomorrow and the IVIG company as well to see what they have to say. Thanks.

    • Anonymous
      February 18, 2008 at 9:32 pm

      I am also covered under the federal BCBS program. I switched to the “basic” plan this year and it seems to cover diagnostic services better than standard (but only if all your providers are preferred). Standard seems better for inpatient services. I had outpatient gall bladder surgery last year and I think I could have saved a lot of out-of-pocket expense if I would have carried basic — not to mention the premium difference. My co-workers encouraged me to switch because they said they were really happy with the basic coverage. At least we have the option to change plans each year — so you can “shop” around next November for the best plan for your needs. Good luck! I am interested how this turns out for you.

    • February 18, 2008 at 9:43 pm

      You can also use your bills as a tax deduction (depending on what you make)
      There also is a sort of plan if you can figure out your expenses, you can put that amount aside every year tax free. But it has to all be used and not rolled over, so it takes careful planning. We will be hit hard in the beginning this year as well, to meet our deductables. We pay $15k a year plus $20 copay on visits and prescrip. and 1500 deductable per person. I just try to keep the big picture in view. We get ivig, they don’t deny it and Kevie is doing pretty good. Thank God my husband has a good job and kevin can continue his treatments. Good luck to you and I will pray that it all works out for you.
      Dawn Kevies mom

    • Anonymous
      February 19, 2008 at 9:53 am

      I’m sorry to hear about your issues with Blue Cross, I had them last year and although they covered my IVIG they did not cover Where I recieved my treatment, so what I’m saying Is that they charged me for going to the infusion room. My plan crearly stated that outpatient care was no cost to me, but they allowed the hospital to charge for the room. If I were you I would see if it made a difference if you have IVIG at home. Good luck with them, also see if the place where you received treatment has financial ass.

    • Anonymous
      February 19, 2008 at 12:56 pm

      Thanks everyone for your responses, you guys are great in trying to help us newbies out. I did call BCBS just to make sure I wasn’t missing anything and yes, I will have to pay 10% of the allowable cost of the treatments (which is a lot lower from what the treatments actually cost) until I meet my max out of pocket expense of $4500 for the year. 10% shouldn’t be a big deal, but with the cost of the IVIG being so much, I figure it will run me about $450 every 4 weeks. As a Federal Employee, I already have my insurance premiums taken out before taxes, but I am going to look into having the money for the IVIG put into a Flexible Spending Account so I am not taxed on it, thanks Dawn, that is a great idea. Do you do that?

      Lameka, they are doing the infusions at home, and in looking at the charges for that, that is minimal. It is just the gosh darn IVIG is so expensive.

      IowaGal, I may end up switching plans too, I just have been so happy with BCBS with not having referrals and having nearly all providers take my insurance. Have you had a problem with finding preferred providers under Basic? How about referrals, do you need them with the Basic? Thanks!

    • Anonymous
      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!

    • February 19, 2008 at 5:37 pm

      We do not do it, because we only pay the 1500 out, and it is not worht the trouble, but being that you will spend much more, it is a thought. My nephew does it, and if you are not careful, you have money left over. So at the end of the

    • February 19, 2008 at 5:50 pm

      No clue what happened, but at the end of the year he buys bandaids, tylenol, anything over the counter just so the money does not go to waste.* There are programs available for asistance through the ivig companies, there might not even be any criteria for some companies, call the company you deal with.* Lameka informed me about gamma assist, it is a program that is set up for free ivig in the event you loose your insurance.* They keep trac of what you use and award you certificates for a certain amount should you need it.* There is a five year limit on the cert., and then you start over.* I always am psycho about saving for a rainy day, so I did it just in case.* One more thing worth looking into.* Apparently the MDA assists people with bills that are out of pocket.* I am in Illinois, and for whatever reason, even though cidp is neuromuskular, this particular chapter does not recognize it in the md family.* BUT SOME STATES DO, so call your local chapter and ask. Apparently income level is irrelevant, so check into it. Good luck! One more thing, our infusion company bills $163.00 / 2 hours of infusion. Kevin gets infused for 6 hours and 40 minutes, so that is 3 blocks of 163. times 4 days. If you too have a long infusion, you can request that the nurse start you up, leave, and you disconnect, and they return the following day. You could save some money. We personally do not do that because Kevie has reactions, and I feel better with the nurse present. others on the site and within the company we use do do that however. Just a thought!
      Dawn kevies mom

    • Anonymous
      February 19, 2008 at 8:06 pm

      You should definitely have an FSA. I have money deducted for a flexible spending account each year. In November I check what I have spent out-of-pocket and divide that by 26 pay periods and sign up again. Before I switched to basic, I checked my EOB statements from 2006/2007 and I could not find a single provider I used that was not “preferred” so I decided it was safe to switch. I am saving $600 a year just on premiums (I have single coverage and my husband has his own). There is no deductible with basic. You do not have to have referrals to use specialists under the “basic” plan either. We have a BCBS rep stop at our office each year. You may want to find a rep or call them and tell them your situation and have them tell you which plan is better for you (i.e. how much each plan would pay and what your out-of-pocket would be for your IVIG treatments). Good luck — let us know what you find out.