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Member
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Join Date: Jan 2008
Location: Southern California
Posts: 308
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Member
Join Date: Jan 2008
Location: Southern California
Posts: 308
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Vic - I thought you figured out the incorrect billing going on and that you might/would return to Ty.
In looking at my bills for the two Ty treatments I had...the med itself was around $2500 and the rest of the charges were less than $500. The center billed Blue Shield (of CA) for $2,956.00, and BS "approved" $2,624.66 - meaning that was the allowable amount. And from that, I have a 20% copay - leaving me with around $500 to pay.
What I have never understand from your experience is HOW and WHY the infusion center was charging you exorbitant amounts.....and why you weren't able to check other infusion locations. It is definitely concerning to me.
I also have wondered....and I hope I'm not being TOO nosey....is does your insurance policy have an Out of Pocket Maximum for the year? My policy has a $4,000 out of pocket max. Once I hit that - then all of my copays are covered and I pay nothing. This is different than a deductible (of which mine is currently also $4000). I have a PPO plan.
The biggest "bummer" about my plan is that injectibles - like all the CRABs are covered under PRESCRIPTION benefits - which do not fall into the out of pocket maximum limit. So all of my meds, I have to pay, though the negotiated rate. But now that I'm back on Copaxone - my copay is close to $600 for that alone  ....but I'm VERY fortunate to be receiving assistance from the Chronic Disease Fund.
However, between now and December 31st, I plan on getting as much medical care as possible.......since it won't cost me anything (as long as I'm in network - which with Blue Shield PPO, it pretty much covers anything).
Through the years when I watched my mother chronically and terminally ill....I learned alot about insurance....and I own my own business, so I got to choose our plans.
I guess I should be thankful - BS has been VERY good to me. They approved the HiCy treatment within 5 minutes of receiving the request. When I had gastric bypass surgery 4.5 yrs ago, they approved that within an hour. My MRIs have always been covered. When I needed provigil or other off-label meds, they've approved.
And most interesting is that a nurse case manager has been calling me to follow up on my recent hospital stay/chemotherapy treatment (the HiCy)! Can you believe that?! Totally shocked me.
Oh, and any claims I file when I use an out of network provider....I get my reimbursement check within 10 days or so!
Vic - if you need any help with this stuff - let me know... Plus, I'm a New Yorker....and I've been known to go "NY on people" 
Be well,
~Keri
ps/I still think you should look into HiCy!
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