Kmeb:

This is what the guy from Blue Cross Blue Shield told me. By the way, Alan is on the same plan as me. It's a medicare hmo. With the mediblue medicare advantage plan from Blue Cross And Blue Shield (our plan), you don't pay any co-pays to doctors, there is no co-pay for hospitals and no deductible. When Alan went into the hospital for the ivig, I knew beforehand there would be no co-pay FOR ANYTHING. They have assured me on this.

Now let's get to the home infusion part of the ivig. I called up the medical management department and got this straight from the horses mouth. When medical management approves a home infusion, and it's billed under MEDICAL and not under prescription, ALAN PAYS NOTHING FOR ANYTHING. The key is to bill it under medical and NOT UNDER PRESCRIPTION.

I made absolutely sure about this. I told them we had no money for copays and I asked the person if this had anything to do with catastrophic coverage and the donut. She knew exactly what I was talking about and she said "If you make sure it's billed under MEDICAL, Alan is completely covered for the whole kit and kaboodle and you guys pay NOTHING. That's the important thing. How it is billed and what it is billed under. It has to be billed under medical.

Now believe me, when the home infusion company calls, this is the first thing I will hit on the head with them. If they give me any grief, saying "we are not sure, of this or that', Alan will say "Forget the whole thing". I know him. We simply do not have the funds for this. And because we were told AHEAD OF TIME, that we are completely covered, well if Blue Cross goes back on their word, well the Home infusion company can sue us all they want. We have no assets. But I know that I made this completely clear to Blue Cross and they assured me.

So as far as we are concerned, this whole thing is covered. Now if Blue Cross changes their mind mid-way and gives us any grief, I shall have to shoot them..

Simple as that...........

lol mel

That sounds like a good deal! They dont offer any Medicare HMO's like that in my area that give me the flexibility to go to good docs - so had to go with traditional Medicare Part A, B, and D...etc...... (and the Medi-Gap)

Sounds like there will be no problem!

My dear Kmeb: From your mouth to God's ears (as the saying goes).

It's been my experience that Insurance Companies say one thing and often do another. Case in point. Alan's cardiac rehab. Many months of going to Beekman downtown cardiac unit. Three times a week. We got it approved, pre-certified, the whole ball of wax. It was covered.

What happenened almost 10 months after he was finished and he was already going to the regular gym??? We got billed for $7,800 from Beekman.

Of course we straightened it out and the bill was paid. But honestly, the phone calls are such a mess. We had to call this person and that person and finally Alan's insurance paid the whole thing.

And I will never forget what happened in January of 2006 when Alan changed from Health Net to Blue Cross Blue Shield. He had been having everything paid, no problem, etc. etc. when Bam, he tried to fill a prescription and was told "you have no coverage whatsoever". We then called Blue Cross Blue Shield and, sure enough, they had disenrolled him. We found out that there is a department in Medicare that is supposed to dis-enroll you from your previous health insurance and re-enroll you in the new one as of January 1st. Well, they didn't, and because you can't have two HMO's, he had NONE!!!! Talk about a nightmare. So, naturally, there was Melody, making her phone calls to the Health Net department of dis-enrollment, to the Disenrollment department of Medicare, and yet again, to the Eligibility Department of Blue Cross Blue Shield. Took me two weeks of phone calls. It was OF COURSE straightened out and Blue Cross re-enrolled him back to January 1st and put the blame on the people at Medicare. The people at Medicare blamed Health Net.

I told everybody: "I don't care who did what to whom, my husband is completely covered, so fix the problem". Blue Cross agreed completely, apologized and all was set. Except for my headaches after that.

While I know we need to be covered and thankfully we are, THEY CAN BE A PAIN IN THE BEHIND!!!

jeez.

Anyway, thanks for all the good info. Hope you are okay!!!!
Mel

Hi Melody,

Since I had such good service from my agency - wanted to see it you ever heard from Alans home infusion people? Are you guys all set to go yet?

Hope all is moving along smoothly - let us know!

Hi Kmeb:

Nope, not a word. They got the paperwork a few days ago and I guess it takes time to contact the insurance people. Today is Saturday so forget about the weekend, right? I guess we'll hear something next week.

And Alan said today "wow, you know I think this IVIG is doing it's thing, my neuropathy is not to severe, I mean, I do have pain, but it's much less since I got the 5 rounds". So we're keeping fingers and toes and every other body part crossed.

lol
Melody