I tried to appeal it, but the appeals group couldn't understand the problem--they were paying for the treatment, what did I care how much it cost the insurance company? I live in a town that has one hospital and no separate infusion center so my options are limited. I will eventually try again, to get the infusion done at the neuro's office. I tried this before but the insurance wouldn't approve it even though it would have saved them a boat load of money.

Also, from what I've been told, you have to get the infusion done at a place that's in some way connected to your neuro. Has anyone heard different?

Katty

The center also has to be TOUCH approved. I live in a town of about 60,000 and we have 3 places to get Tysabri, the hospital, an oncology center, and a home IV pharma place. I go to the home IV pharma place. My primary insurance will not pay for me to go to the hospital. They told me that over the phone.

Where I'm going to run into problems, and it isn't a problem for me, but my infusion center. My primary insurance carrier pays a set amount. My secondary insurance has a deal with the center for a reduced amount. But it is reduced for the reasonable and customary charge, not the set amount of my primary. So they end up losing money on me until my max out of pocket is met from my primary.

The center is going to try and bill different. I hope it works. I don't think they are unreasonable, so I hate to see them lose money!

That's incredible, Katty!

I'm glad you have a vested interest in trying to rectify this, and I'll be curious to hear if you ever do.

It almost seems risky to rock the boat though, when you are dealing with corporations where common sense doesn't prevail.

Cherie