I'm due to start IVIg in a couple of days for CIDP that has resulted from chemo for Hodgkin's Lymphoma. I live in a rural area of Northern California and and I heard from the hospital financial person and was told that they are concerned that they will not be repaid by Medicare. So because of this they will not proceed unless I sign a hospital form taking on full financial responsibility in the event Medicare will not pay. My insurance is Medicare and I'm insured for parts A, B and F however that works. My supplemental insurance is UHC. My first infusions will be for 195 grams of Gammagard liquid over 4 days then followed 50 grams at three week intervals for six total. That's what the neurologist prescribed.
I know this is basic in info but the bottom line is if I can hope Medicare will cover. The doctor believe it will but the hospital people have even asked if I would consider taking the infusion at another place. The closest other place is around 100 miles from here.
So my question is if I should go ahead and sign this agreement with the hospital? Will Medicare pay for my IVIg infusions.
Call Medicare and ask to speak to someone regarding this. When you do, keep track of who you talked to at Medicare~date, time, person's name and their reply to your question. Your secondary insurance will NOT pick up anything on the bill unless Medicare first pays a portion of it.
Every hospital makes everyone sign a piece of paper stating that if your insurance doesn't pay or whatever they don't pay, that you will be responsible for...it's in the fine print. I'm pretty sure Medicare will cover it, too, but again call them and if they say "yes", ask them to mail you something in writing stating that they will pay.
Gammagard was approved by the FDA to be the gold standard treatment for CIDP, so I don't know why they wouldn't pay.
Look for a discussion that I started a while back titled "Losing IVIG covered insurance". In the answers that I received, a number of people told me that they were on Medicare and it was covered 100%. You could ask those same respondents for more information.
Since then, I have gotten onto a new BCBS plan thru "early enrollment" thru the government and it will take me thru until I can get on Medicare myself in about 13 months.
Hi, not sure how MEDICARE works. But, have you thought of having your infusions done at home. It is cost effective and perhaps MEDICARE will cover. After traveling to another city to have my infusions, I asked my neurologist to send orders to my home infusion center. It is less stressful and an RN comes to my home. Just a thought.
Thanks all for your replies. Since my last post I've made it thru the insurance thing and thru 3 IVIg sessions of 4 days each at 195 grams. The first was Gammagard, I got real sick and as a result the next 2 sessions were of Prevacid which I seem to tolerate ok even though as yet I've noticed no affect on my CIDP symptoms.
One problem we are having is getting an IV started. It took 7 attempts to start an IV at my last infusion. My GP has ordered a PICC line. I am a bit worried about this now because I had a failed port due to a DVT during chemo.
Should I move this now over to another discussion? I would like to ask for wisdom or experience or what to expect in regard to a PICC catheter.
Medicare is a tricky beast. Your part D coverage (meds) should cover the actual drug 100% unless you have a copay. My copay is $3.48. For hospital infusions its 80% of the hospitals bill, the rest goes to your extra coverage. If your on disability you should see about getting Medicaid on top of your Medicare. Medicaid will pay the leftover 20%, your part B premiums and for home infusions. For me, without the Medicaid, the infusion company wanted $375 to come and do it, with Medicaid it was covered.
Of course this probably depends on where you live. Each state has different rules.
Hi, I have a secondary insurance thru aarp that has helped with the cost. So far I have not been billed BUT I have as of August fallen into the "donut" hole and as a result all my other meds have sky rocked in cost. Historically I've been able to manage this phenomenon thru the end of the year.....not now. So this is my fiirst year of this treatment so I hope to get thru it if at least to learn how this is going to affect me financially. I am no longer working because if this illness.
Medicare is a tricky beast. Your part D coverage (meds) should cover the actual drug 100% unless you have a copay. My copay is $3.48. For hospital infusions its 80% of the hospitals bill, the rest goes to your extra coverage. If your on disability you should see about getting Medicaid on top of your Medicare. Medicaid will pay the leftover 20%, your part B premiums and for home infusions. For me, without the Medicaid, the infusion company wanted $375 to come and do it, with Medicaid it was covered.
Of course this probably depends on where you live. Each state has different rules.
Hi, I have a secondary insurance thru aarp that has helped with the cost. So far I have not been billed BUT I have as of August fallen into the "donut" hole and as a result all my other meds have sky rocked in cost. Historically I've been able to manage this phenomenon thru the end of the year.....not now. So this is my fiirst year of this treatment so I hope to get thru it if at least to learn how this is going to affect me financially. I am no longer working because if this illness.
So, napper4, are you still paying a small copay? I am getting ready to go on Medicare and it seems the best I can do will put my drug on Part D and I will have a 5% co pay after I come out of the donut hole...that would be about 1500/ mo since I get infusions twice per wk. There must be something wrong with this calculation, but I'm lost. Medicare will only read me the actual text in the page of the rules, which is strange and not so helpful since everyone knows Medicare contradicts itself all over the place. Are there experts out there?
jakespa said:
napper4 said:
Medicare is a tricky beast. Your part D coverage (meds) should cover the actual drug 100% unless you have a copay. My copay is $3.48. For hospital infusions its 80% of the hospitals bill, the rest goes to your extra coverage. If your on disability you should see about getting Medicaid on top of your Medicare. Medicaid will pay the leftover 20%, your part B premiums and for home infusions. For me, without the Medicaid, the infusion company wanted $375 to come and do it, with Medicaid it was covered.
Of course this probably depends on where you live. Each state has different rules.
Hi, I have a secondary insurance thru aarp that has helped with the cost. So far I have not been billed BUT I have as of August fallen into the "donut" hole and as a result all my other meds have sky rocked in cost. Historically I've been able to manage this phenomenon thru the end of the year.....not now. So this is my fiirst year of this treatment so I hope to get thru it if at least to learn how this is going to affect me financially. I am no longer working because if this illness.