Re: commercial/insurance/drug costs

[Guest guest]

Has anyone calculated the approximate additional cost (I know

different Insurance benefits are different) if we have to go to the

Dr.'s office and be injected, instead of injecting at home?

Ron

On Sep 13, 2007, at 6:36 AM, pyle456 wrote:

> I figured out that it normally costs my first 7-8 paychecks every year

> to keep me alive. That is the amount of my health care insurance

> premiums, doc visits and drug copays, and deductibles. (I get paid 24

> times per year, thank goodness.) I get my Xolair delivered to my

> office b/c it has to be signed for. The other day I was driving it

> home thinking, " well, I've got $3,000+ worth of medication in my car

> and it's really only costing me $550, so that's a good thing. " $500

> for the monthly health insurance premium and $50 for my monthly copay

> for Xolair. Since I can't get the Xolair without the insurance AND

> since my asthma is the primary reason I need insurance, I lump the two

> together.

>

> Addy

> Group co-owner

>

>

>

[Guest guest]

Right now it's up to the doctor's office what to charge. I pay only

$20 but some folks on this board pay much, much more than that.

Fran

>

> > I figured out that it normally costs my first 7-8 paychecks every

year

> > to keep me alive. That is the amount of my health care insurance

> > premiums, doc visits and drug copays, and deductibles. (I get

paid 24

> > times per year, thank goodness.) I get my Xolair delivered to my

> > office b/c it has to be signed for. The other day I was driving it

> > home thinking, " well, I've got $3,000+ worth of medication in my

car

> > and it's really only costing me $550, so that's a good thing. "

$500

> > for the monthly health insurance premium and $50 for my monthly

copay

> > for Xolair. Since I can't get the Xolair without the insurance AND

> > since my asthma is the primary reason I need insurance, I lump

the two

> > together.

> >

> > Addy

> > Group co-owner

> >

> >

> >

>

>

>

>

[Guest guest]

--- In , " tiredofsteroids " <sitesee@...>

wrote:

>

> Right now it's up to the doctor's office what to charge. I pay only

> $20 but some folks on this board pay much, much more than that.

> Fran

My doctor's office looks at it as a mini office visit.

The nurse weighs me takes my BP, has me blow into the little kazoo,

and listens to my lungs, asks me about my medications, THEN she gives

me my 2 shots, sets the timer for 30 minutes and I go back out to the

waiting room for 30 minutes. (whew talk about a long sentence.

English was NOT my best subject in school)

They charge it to my insurance as a chemotherapy injection at 114.00 a

shot which is contracted down to 83.23, then paid at 90% (used to be

50% when they were not in network with BCBS) and I wind up paying 8.32

per shot or 16.64 per visit.

I go in at 10 am today for this bi weekly ritual LOL!

Doug

Group founder

[Guest guest]

Doug and anyone else in here who has BCBS,

Our " new " insurance just kicked in. Thank GOD....after

my COBRA fiasco,I need some normality!Sadly the mess

is still not setled.

I called BCBS to find out if I needed to do anything

else to get my approval for Xolair. We've had to fill

out tons of paperwork to get this new approval because

of our " lapse " , which really wasn't a lapse. The

woman I spoke to said that Xolair WAS NOT on the

approved drug list for our plan. She then said it

would be $55 per DOSE for me! Before I was paying $20

for one months supply and was able to self inject, so

I had no Dr.'s office co-pay to deal with. I find

that VERY strange, to say the least. We thought

since we had a very good script plan though them plus

we're PPO!

Any thoughts on this !??!

K

--- uca79iii <bme1979@...> wrote:

>

> >

> > Right now it's up to the doctor's office what to

> charge. I pay only

> > $20 but some folks on this board pay much, much

> more than that.

> > Fran

>

>

> My doctor's office looks at it as a mini office

> visit.

>

> The nurse weighs me takes my BP, has me blow into

> the little kazoo,

> and listens to my lungs, asks me about my

> medications, THEN she gives

> me my 2 shots, sets the timer for 30 minutes and I

> go back out to the

> waiting room for 30 minutes. (whew talk about a

> long sentence.

> English was NOT my best subject in school)

>

> They charge it to my insurance as a chemotherapy

> injection at 114.00 a

> shot which is contracted down to 83.23, then paid at

> 90% (used to be

> 50% when they were not in network with BCBS) and I

> wind up paying 8.32

> per shot or 16.64 per visit.

>

> I go in at 10 am today for this bi weekly ritual

> LOL!

>

> Doug

> Group founder

>

>

________________________________________________________________________________\

____

Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's updated for

today's economy) at Games.

http://get.games./proddesc?gamekey=monopolyherenow

[Guest guest]

> > >

> > > Right now it's up to the doctor's office what to

> > charge. I pay only

> > > $20 but some folks on this board pay much, much

> > more than that.

> > > Fran

> >

> >

> > My doctor's office looks at it as a mini office

> > visit.

> >

> > The nurse weighs me takes my BP, has me blow into

> > the little kazoo,

> > and listens to my lungs, asks me about my

> > medications, THEN she gives

> > me my 2 shots, sets the timer for 30 minutes and I

> > go back out to the

> > waiting room for 30 minutes. (whew talk about a

> > long sentence.

> > English was NOT my best subject in school)

> >

> > They charge it to my insurance as a chemotherapy

> > injection at 114.00 a

> > shot which is contracted down to 83.23, then paid at

> > 90% (used to be

> > 50% when they were not in network with BCBS) and I

> > wind up paying 8.32

> > per shot or 16.64 per visit.

> >

> > I go in at 10 am today for this bi weekly ritual

> > LOL!

> >

> > Doug

> > Group founder

> >

> >

>

>

>

>

>

________________________________________________________________________________\

____

> Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's

updated for today's economy) at Games.

> http://get.games./proddesc?gamekey=monopolyherenow

>

My BCBS policy and group are different than yours. Each group has

different levels of coverage. I can choose from 4 different BCBS

plans each year. Of course, I choose the one that covers the most and

obviously, more expensive.

I live in Arkansas but my BCBS is through a company in Penn.

Doug

Group founder

[Guest guest]

I am blessed--Right now I am not paying anything, although the doc's office

could charge. He just has chosen not to since his clinic is also a research

clinic. I have supplemental insurance to my Medicare and what they pay him each

month is a lot--I think right at $800, but I'll check my next statement and see

what the lastest payments are to the clinic.

Adah

tiredofsteroids <sitesee@...> wrote:

Right now it's up to the doctor's office what to charge. I pay only

$20 but some folks on this board pay much, much more than that.

Fran

>

> > I figured out that it normally costs my first 7-8 paychecks every

year

> > to keep me alive. That is the amount of my health care insurance

> > premiums, doc visits and drug copays, and deductibles. (I get

paid 24

> > times per year, thank goodness.) I get my Xolair delivered to my

> > office b/c it has to be signed for. The other day I was driving it

> > home thinking, " well, I've got $3,000+ worth of medication in my

car

> > and it's really only costing me $550, so that's a good thing. "

$500

> > for the monthly health insurance premium and $50 for my monthly

copay

> > for Xolair. Since I can't get the Xolair without the insurance AND

> > since my asthma is the primary reason I need insurance, I lump

the two

> > together.

> >

> > Addy

> > Group co-owner

> >

> >

> >

>

>

>

>

[Guest guest]

Doug: Your " shot " routine is exactly like mine. The nurse weighs me, has me

" blow out the candles three times " takes my BP and pulse, gives me the shot,

sets her timer for 30 minutes, I sit in the lobby and read, and then when the

timer goes off, I make my next appointment and leave. I just wrote an email

that this visit costs me nothing because of Medicare and supplemental. The

clinic does charge an " office visit " fee which is not allowable, but they have

never billed me for it, and the doc said they don't intend--he told me that from

the first.

Adah

uca79iii <bme1979@...> wrote:

--- In , " tiredofsteroids " <sitesee@...>

wrote:

>

> Right now it's up to the doctor's office what to charge. I pay only

> $20 but some folks on this board pay much, much more than that.

> Fran

My doctor's office looks at it as a mini office visit.

The nurse weighs me takes my BP, has me blow into the little kazoo,

and listens to my lungs, asks me about my medications, THEN she gives

me my 2 shots, sets the timer for 30 minutes and I go back out to the

waiting room for 30 minutes. (whew talk about a long sentence.

English was NOT my best subject in school)

They charge it to my insurance as a chemotherapy injection at 114.00 a

shot which is contracted down to 83.23, then paid at 90% (used to be

50% when they were not in network with BCBS) and I wind up paying 8.32

per shot or 16.64 per visit.

I go in at 10 am today for this bi weekly ritual LOL!

Doug

Group founder

---------------------------------

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[Guest guest]

I have BCBS. My insurance just went up. My employer is having the employees

pay more for our insurance. My doctor's visit copay has gone up from $10 to

$20. I don't know if this will effect my xolair shots. This change just

happened September 1 so I'm not sure what to expect. I just got my 3 set of

shots today. So far, so good.

________________________________

From: [mailto: ] On

Behalf Of uca79iii

Sent: Friday, September 14, 2007 1:08 PM

Subject: [ ] Re: commercial/insurance/drug costs

> > >

> > > Right now it's up to the doctor's office what to

> > charge. I pay only

> > > $20 but some folks on this board pay much, much

> > more than that.

> > > Fran

> >

> >

> > My doctor's office looks at it as a mini office

> > visit.

> >

> > The nurse weighs me takes my BP, has me blow into

> > the little kazoo,

> > and listens to my lungs, asks me about my

> > medications, THEN she gives

> > me my 2 shots, sets the timer for 30 minutes and I

> > go back out to the

> > waiting room for 30 minutes. (whew talk about a

> > long sentence.

> > English was NOT my best subject in school)

> >

> > They charge it to my insurance as a chemotherapy

> > injection at 114.00 a

> > shot which is contracted down to 83.23, then paid at

> > 90% (used to be

> > 50% when they were not in network with BCBS) and I

> > wind up paying 8.32

> > per shot or 16.64 per visit.

> >

> > I go in at 10 am today for this bi weekly ritual

> > LOL!

> >

> > Doug

> > Group founder

> >

> >

>

>

>

>

>

__________________________________________________________

> Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's

updated for today's economy) at Games.

> http://get.games./proddesc?gamekey=monopolyherenow

<http://get.games./proddesc?gamekey=monopolyherenow>

>

My BCBS policy and group are different than yours. Each group has

different levels of coverage. I can choose from 4 different BCBS

plans each year. Of course, I choose the one that covers the most and

obviously, more expensive.

I live in Arkansas but my BCBS is through a company in Penn.

Doug

Group founder

[Guest guest]

i have bc/bs (of alabama), but my xolair is not part of my prescription

coverage. it is covered medical treatment and paid 100%, the doc's office

charges the actual process of giving me my shots (2 shots/2x month) as

chemotherapy and it's usually $18 each time which bc/bs pays 100% although

sometimes it gets charged at $18 per shot, and occasionally i see it go in at

$114 per visit for shots. Not sure what the difference is, as it's always the

same procedure. My plan is the 551 (maybe 552) plan if that helps any. I know

all plans are different though.

****************************************************************

Doug and anyone else in here who has BCBS,

Our " new " insurance just kicked in. Thank GOD....after

my COBRA fiasco,I need some normality!Sadly the mess

is still not setled.

I called BCBS to find out if I needed to do anything

else to get my approval for Xolair. We've had to fill

out tons of paperwork to get this new approval because

of our " lapse " , which really wasn't a lapse. The

woman I spoke to said that Xolair WAS NOT on the

approved drug list for our plan. She then said it

would be $55 per DOSE for me! Before I was paying $20

for one months supply and was able to self inject, so

I had no Dr.'s office co-pay to deal with. I find

that VERY strange, to say the least. We thought

since we had a very good script plan though them plus

we're PPO!

Any thoughts on this !??!

K

[Guest guest]

Hi K,

I have BCBS through my hubby's job in local govt - Gulf Coast

area. I self inject at home and the co-pay for the med is $45.00 a

month through CuraScript (what did they ever cure???).

Since I've never been injected in a doc's office for Xolair I

have no idea what they're charging here. My co-pay for a pcp about

60 miles away is $20.00 per visit but specialists are $45.00. I'm

receiving 3 shots every 2 weeks so if it was charged by the injection

it would be pricey! And I would be very gripey.

The POS for this same group is quite a bit more - don't remember

as it really ate our lunch when my hubby was hospitalized and we were

forced into HMO for $ reasons. On the other hand, with a POS there

is a better selection of doctors.

My best advice is to wrestle them to the ground, find a

customer/consumer advocate and make sure they're giving you

the " straight goods. "

Take Care.

> > >

> > > Right now it's up to the doctor's office what to

> > charge. I pay only

> > > $20 but some folks on this board pay much, much

> > more than that.

> > > Fran

> >

> >

> > My doctor's office looks at it as a mini office

> > visit.

> >

> > The nurse weighs me takes my BP, has me blow into

> > the little kazoo,

> > and listens to my lungs, asks me about my

> > medications, THEN she gives

> > me my 2 shots, sets the timer for 30 minutes and I

> > go back out to the

> > waiting room for 30 minutes. (whew talk about a

> > long sentence.

> > English was NOT my best subject in school)

> >

> > They charge it to my insurance as a chemotherapy

> > injection at 114.00 a

> > shot which is contracted down to 83.23, then paid at

> > 90% (used to be

> > 50% when they were not in network with BCBS) and I

> > wind up paying 8.32

> > per shot or 16.64 per visit.

> >

> > I go in at 10 am today for this bi weekly ritual

> > LOL!

> >

> > Doug

> > Group founder

> >

> >

>

>

>

>

>

______________________________________________________________________

______________

> Boardwalk for $500? In 2007? Ha! Play Monopoly Here and Now (it's

updated for today's economy) at Games.

> http://get.games./proddesc?gamekey=monopolyherenow

>

[Guest guest]

We have BCBS of California though we live in Virginia, so we use the

National coverag plan. I thin our only option was POS. I get my Xolair from

the Wellpoint/Precision RX Specialty pharmacy and they mail 3 months worth

to my allergist who gives me the injection. I pay the $70 copay for the 3

months of Xolair and have over the last 11 months paid $20 for the doctor

visit each month where she was tracking my symptoms and reduction in

medication. But in a few weeks I will only need to go to the shot room and

get my shot and stay the 30 minutes. So I am not sure how that will be

charged. They charge $32 for my three allergy shots per visit and I have to

pay $3.20 for that.

B.