Monday, September 1, 2008

Calling all Tysabri Patients - Informal Project Underway

Hi All,

I'm approaching all patients who use Tysabri to help me with a little project. 

I'd like to collect some basic information regarding the costs associated with Tysabri infusions and the amounts which are actually paid for those infusions. These are the things I'm interested in learning.

What is the original amount billed to your insurance company (or yourself) for:

a) Infusion location/services

b) Tysabri medication


What is the amount which your insurance company allows to be charged (paid) for:

a) Infusion location/services

b) Tysabri medication


What is your actual co-pay (out-of-pocket costs) required for:

a) Infusion location/services

b) Tysabri medication


Where do you receive your infusions?

Neurologist office, Stand-alone Infusion Center, or Hospital Facility


In which state to you receive your infusions?


To answer the first three questions you will need to locate a recent EOB (Explanation of Benefits) which you should have received from your insurance company. The information should be found on that form.

I thank you so much for helping me with this informal project. Please leave a comment or email me directly.

Thanks so much. I look forward to your responses.

-Lisa


14 comments:

  1. Hi Lisa,

    As I stated on Linda's blog (Braincheese), I am a Medicare recipient that belongs to a Medicare HMO, and as such, I do not pay anything for my Tysabri infusions, nor for the medication itself.

    Lauren

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  2. I am glad you are doing this. Maybe your work will help Braincheese solve her issues with Club Med.

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  3. Hey, Lisa...

    I think you already HAVE my figures/facts on THIS ONE! Here's hoping you get some more info from other Tysabri users to compile some workable data. This is definitely a "hot spot" in my life!

    Linda D. in Seattle

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  4. Hi Lisa,
    I'm in the process of switching insurance due to my new job, but likely Tysabri will continue to be covered under my major medical which means I will need to pay just the deductible each year (somewhere b/w $300-500). The true cost of Tysabri for my insurance company will be roughly $58,000 a year. I believe the insurance company will actually pay around $35,000 annually for my treatments.

    I visit an infusion center for my monthly treatments in Pennsylvania.

    Thanks for taking on this project!

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  5. What is the original amount billed to your insurance company (or yourself) for:

    a) Infusion location/services

    b) Tysabri medication

    These two are billed together for my husband's infusions his current location billed $6287 in July and the insurance paid $4716.50. Then for August they billed $4768.16 and the insurance has not yet paid.

    The past location used the specialty pharmacy and they charged and were paid $2800 and some change. The location charged $350 for infusion services and were paid $152.62



    What is the amount which your insurance company allows to be charged (paid) for:

    a) Infusion location/services

    b) Tysabri medication


    What is your actual co-pay (out-of-pocket costs) required for:

    a) Infusion location/services

    b) Tysabri medication

    we pay $20 for each infusion, no copay for the drug just the services.

    Where do you receive your infusions?

    Neurologist office, Stand-alone Infusion Center, or Hospital Facility

    currently a hospital ambulatory clinic, used to go to an urgent care and prior to that an oncology center

    In which state to you receive your infusions?

    New York

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  6. Hi Lisa!
    I wasn't sure which blog to contact you on, but I am happy to hear that you found my blog! My husband has refused Tysabri b/c of the possible side effects, which ultimately lead us to LDN. I will faithfully post his experiences. He has taken a risk going off the interferons, so we figured, if he is going to do that then we better let others know if this LDN stuff works...check out the links on my page too for more information.
    Take care!
    Bridget

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  7. I'm not sure exactly what the costs are, I know that it comes to about $58,000 a year and my co-pay is about $300 a month. I don't get the bill, it goes to my manure-bag of an ex-husband. I think that the cost for the infusion center is almost exactly the same as for the med, which I thought a little high, but what do I know?!

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  8. I wish I had an answer but as you know I am the midst of trying to get some sort of reasonable answer which seems to include switching to another neurologist and starting from step 1.

    I cannot believe how irritating this all is and I can see how many people would just give up on this idea. I'm even considering HiCy now but don't know if I could get a neuro to okay that, not to mention another insurance nightmare.

    Good luck with this project!
    Weebs

    PS: Happy birthday!!

    ReplyDelete
  9. Hi Lisa,thanks for contacting me thru my blog(Tysabrihelp). I have been on Tysabri for 2 years and will stay on it as I have no other options. Medicare PartB & AARP suplemental is paying. My EOB says the "amount charged" is $9,939.00/month. "Medicare approved" $2407.09/month. "Medicare paid" $1925.67/month. My AARP supplemental gets billed & pays $481.42/month. I have no out-of-pocket (except annual deductible)& receive my infusions at a hospital in AZ.

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  10. What is the original amount billed to your insurance company (or yourself) for:

    a) Infusion location/services

    b) Tysabri medication

    UNKNOWN INFO TO ME. I AM ON SOCIAL SECURITY DISABILITY AND I DON'T GET THE BILLS FOR IT OR ANY EOBS.


    What is the amount which your insurance company allows to be charged (paid) for:

    a) Infusion location/services

    b) Tysabri medication

    AGAIN, I DON'T KNOW.

    What is your actual co-pay (out-of-pocket costs) required for:

    a) Infusion location/services

    b) Tysabri medication

    $0 AND .00 CENTAVOS

    Where do you receive your infusions?

    Neurologist office, Stand-alone Infusion Center, or Hospital Facility

    I WAS GETTING THEM AT AN ONCOLOGY CENTER

    In which state to you receive your infusions?

    TN SO FAR, WE WILL SE NOW THAT I AM IN CA

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  11. Hi, I will look up the rest of the information that you need tomorrow but I can tell you that up until my infusion today I got my first 7 doses at a hospital based infusion lab at Yale in New Haven, CT. Are you ready for this? They bill 11,300 a month for my treatment, when I went to the mat to fight them on charging the insurance company that much, I got caught in a cobweb, Yale said to take it up wiht Biogen and Biogen said they sell it wholesale for the $2400 whatever a dose and that the hospital can charge whatever they want....more tomorrow when I look the info up..if anyone has any questions you can feel free to contact me at wolfradiogirl@aol.com.

    Kelly in CT

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  12. Recently moved from CO to IL. In CO, Tysabri was billed at approx $5250 through Blue Cross. We paid $50 co-pay. In IL, same insurance, we paid no co-pay at infusion site, but did have to pay $100 for the prescription through CVS/Caremark. The insurance was billed at $1080 in IL - they paid approx $380 approved - no additional was paid by us.

    We now have Health Alliance HMO, and it seems we will be paying $488 for the drug and no co-pay for the infusion, but doctor's offices out here are morons, so they have not billed it properly as of yet (last infusion date around 11/05/08). Curious if anyone else has knowledge of Health Alliance HMO billing for Tysabri.

    Open enrollment for my insurance ends on 11/26/08 and I need to know if we must switch back to the PPO before that time...

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  13. Thanks so much for your invite. I will read your blog and answer a little later this evening. I've been on Tysabri since March 2008.
    Later,
    Dennis

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  14. For the Tysabri itself my insurance company gets biled $4500, they allow $2439 and my portion is $786 which I have to pay each month.
    For the doctors portion they bill my insurance company $370 the insurance company allows $161 and that is also the amount I have to pay till I meet my max out of pocket of $5k each year.
    I go to the columbus clinic where a Neuro does the infusions for the tysabri (there are only 2 locations close to where I live that do it & that is one of them). I have BCBS of Alabama thru my husbands employer and we live in Georiga, USA!

    ReplyDelete