My NJ facility bills my insurance $5200 per infusion. We can check on the computer but they were paid 2300 and $175.

I am interested in seeing how much the Fl facility puts in for. I paid $25 out of pocket.

Good luck to all
laurie f

My insurance pays the infusion center $7500.00 +-
The infusion center bills the insurance co. $10,000.00 +-
$7500.00 of that bill is for the drug and the rest is for the infusion services.
Ins. Co. has their payment broken down at 6500.00 for the drug and $1000.00+- for infusion.

It's still too much for the drug in my book! I spoke with a rep from the ins. co. and asked WHY they are paying that much when they could just order the drug and ship it to the infusion center for a MUCH lower price. She couldn't understand why it bothered me so much when I wasn't paying the bill, they were. I reminded them of my lifetime cap and told her to do the math and then add in MRIs and regular medical visits and tests.

sigh...

Regardless of who is paying the bill, guess who really pays in the long run?....the customer, of course!! Insurance companies are in business to make money and they get this money from the premiums that the customer has to pay.

Harry

I get my infusion in my doctor's office. They have what they call an "infusion clinic" which is basically a room with 4 chairs staffed by one nurse. They bill my insurance company $498 per infusion. This seems remarkably low. I pay a $25 copay when I go in as I guess it is considered a doctor's "visit."

I get my Tysabri through my prescription drug plan -- the specialty pharmacy sends the drug to the doctor's office. So the wholesale cost of the drug is $2,364.01 which is billed to the insurance company. But I pay $37.50 of this amount under my prescription drug plan.

Overall the cost to the insurance company is $2,862 per month which includes infusion plus drug (minus $62.50 out of my pocket). I feel incredibly lucky. My job gives me amazing health insurance. I'm sure the lower total cost billed to the insurance company partly has to do with the fact that I live in a big city with multiple neurology offices/clinics that do procedures etc. in their practices. Maybe this cuts the cost down?? If I had to go to a regular infusion clinic I'm sure they would charge way more for the infusion procedure than my doctor's office AND I would have to pay 20% of the total cost (plus meeting a deductible), rather than a co-pay , since it would be billed as a medical procedure. Anyhow, the cost of this drug (and having it given to you) is outrageous regardless.

Our Rx provider charges the insurance company $2341.17 for 28 day Rx Tysabri.
The insurance carrier pays for the entire amount.

Our Neurologist's infusion center charges $578.00 for the infusion and
the insurance company pays $201.96 which he accepts as payment in full
as a 'participating' doctor. We have zero 'out of pocket' expense.

We don't understand the disparity.
How could a Maine or California Neurologist/Infusion Center charge so much
for the exact same same treatment?

Supply & demand?
Lack of Neuros and infusion centers?
Gouging?
The Governator?

It just doesn't make any sense and it just doesn't seem fair.

I'm in the Los Angeles area...

I had two ty infusions...each time my insurance was billed $2741 for the entire thing. $2550 for the actual drug and the remaining 200 or so on medical/office part of the visit. The insurance company has a negotiated fee of $2268 for the actual med and the office stuff around $180. My insurance paid $1935 and the remainder $512 was for me to pay - as I have a 20% copay.

I still don't understand what was going on with Victor and it makes NO sense to me. Basically he'd have paid less paying completely out of pocket and going to my place...since the flat bill before insurance adjustment was only $2700! I'm still baffled.

~Keri

I truley don't understand the diffrences in the cost of the drug. The infusion centers cost don't seem that great a diffrence except maybe Riverwild. I wonder if TOUCH would provide us with the info concerning actuall drug cost. We will keep checking the computer to see what the Fl infusion site charges in comparison to my NJ site. I will let you all know when it comes up.

Thanks to all who provided the info.

Take care
laurie f

Costs can vary from city to city. Even for a Dr's office.

My old dermotoligist moved to a neighboring town, because the property taxes were 1/2. His rent on a buillding the same size was almost 1/2. The "new" town where he moved also gave all new business tax credits.

Those type of costs can will greatly effect how much it costs to run an office or clinic. Even comparing wages from state to state. Those type of things.

It ends up comparing apples to cauliflower. :wink:

Don't forget the difference in types of insurance, whether it is a self pay or employer sponsored, the state you live in and what their insurance field looks like, etc, etc, etc.

We tried to do a comparative analysis and ran into the problem that you truly CANNOT compare costs unless everyone is going to the same infusion center in the same state at the same time! Even then the variable of insurance plans skewed the data so badly that it couldn't be compared. Everyone has a different type of insurance plan and they all cover costs differently, as they all negotiate different levels of payment. People who do not have insurance and use state medicaid plans all have different levels of coverage and my brain isn't big enough to try to figure it all out!

While indeed there are many different kinds of coverage under a multitude of policies, there is one supposed constant...the wholesale cost of Tysabri.

Regardless of what the policy may be, there is a charge by the infusion center for both the drug and the cost of the infusion. It is here where there are HUGE differences in the final total. I have read the cost can be anywhere from about $ 2800 to $10,000 for one infusion and that is disturbing. Yes, one can account for different center cost structures but not to the extent of that kind of variance. Some centers are making a lot of money out of Tysabri infusions and regardless of their possible difference in cost structure, how can anyone explain that level of difference?

Harry