Help getting medicare pay for IVIG
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May 4, 2012 at 10:35 pm
I really need your help. I had a Dr. visit and my neuro suggested we try IVIG again. I had a couple of courses in 2003 but I had private insurance. NOw I have medicare.
I contacted the finance folks at the hospital because I knew IVIG was expensive. I asked them how much my responsibility was. After several back and firth calls, they said 758.60 each day. I had 5 days scheduled, the total would be somewhat north of 3,750, which I don’t have. I postponed the treatment so I could seek additional information. So here I am.
The neuro had me do it outpatient. I thought maybe that inpatient would be cheaper (for me) due to the Medicare limit per hospital stay, which would be much less than outpatient fees. I really have no clue about how to proceed financially here. I know that many of us here are not wealthy, and many are on medicare, and receive the treatments. Can you all help me out ??
Dick S -
May 4, 2012 at 10:37 pm
I need information, not money.
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May 5, 2012 at 12:17 am
Here’s a link to a document from the Clinical Immunology Society on the subject:
http://www.clinimmsoc.org/educational-resources/ivig/medicare-ivig-access-act-summary
Do you not have a supplemental insurance policy? Are you still in the open enrollment period?
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May 5, 2012 at 3:35 am
Hi Dick,
When you were on ivig before, were you enrolled in any of their programs that help in these situations? Gammaguard and gammunex both have them. If you were not registered, perhaps you can ask if you get records to prove that you did use their product would they still allow you to participate (free limited ivig) What about self administered sub q, would they allow that? It would help cut down cost in the administration once you were showed how to do it? Good luck to you. We will say a prayer that you can figure this out
Dawn -
May 5, 2012 at 3:50 am
I have no other insurance, just medicare. Well I do have Part D for Rx coverage. From the time before, I have no idea which brand I received, and I have not sought out any assistance from companies, I just had my appointment Wed, and the infusion scheduled for Monday. I just talked with Finance Fri. PM. I hated being forced to make a financial decision like this on the spot. I postponed my treatment until I could gather more info. I will follow link and read, thank you. Dawn, maybe those suggestions might help down the road, but I am not sure if IVIG will even help me. The last time it was inconclusive so we stopped.
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May 5, 2012 at 3:54 am
GH,
good information, and I read it. It doesn’t lead me to a better way to find reimbursement or a lower way to file. There has got to be a better way to attack this than to have 5 separate outpatient charges. There has got to be a way to combine the fees as a single infusion order so it keeps the co-pay and deductibles to one event rather than 5.
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May 5, 2012 at 4:14 pm
Dick,
If you call gammaguard or gammunex direct, you could ask if they work with medicare direct. If so, maybe this scenario could then apply to you…. Gammaguard and gammunex both will sell the ivig direct to insurance (hopefully medicarein your situation) as well, they set up the nurse to come to your house and access. The ivig is cheaper because it was direct and the nursing was cheaper as well. The only reason we did not do it was because our healthcare co became a preferred provider for BCBS and because of the bulk purchase mationwide the rate was cheaper than me getting it direct. Prior to that preferred provider status, the direct purchase was significantly lower. Maybe they will take medicare too!! Regarding not being in the programs previously, it would be relatively simple to get that info. Each infussion the nurse puts a lot sticker on your chart. Our home healthcare does it as well as when we were in the hospital when this whole thing started. Maybe they would make an acception and backtrack what you used and allow it to be counted in the program. If so, it is a sizeable amount they give free, maybe a year? I can’t remember.Since your doc is not sure the results will be positive and the cost is high, what about PP? There are several on the site on medicare that get PP covered. How about solumedrol or a short time with prednisone? I wish I could think of something concrete to suggest to you. You were helpful to us in the begining of this crap. I wish I could return the help with some idea.
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May 7, 2012 at 9:16 pm
I have used prednisone somewhat successfully before, and we will try taht again. I just hope to keep the duration short and sweet. So many side effects.
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