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,

Where do you do the IVIG? At home or at the hospital?

Would a hospital allow you to bring the meds to be administered?

Great job on not giving up and finding a way to make it happen!!

le

12 Selective antibody def., IVIG every 3 weeks last 5 years, 7 surgeries

before being diagnosed.

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Guest guest

's IVIG is done at home with a pediatric home health nurse. It's

my understanding that the medication will be delivered directly to me

several days before infusion. I think as long as you can obtain the

medication before his therapy, you can have it either delivered to the

hospital or bring it yourself as long as you have the script. I'm far from

an expert but I would definitely go for the cheapest route and make a few

phone calls to be sure.

God Bless,

Re: insurance

> ,

> Where do you do the IVIG? At home or at the hospital?

> Would a hospital allow you to bring the meds to be administered?

> Great job on not giving up and finding a way to make it happen!!

> le

> 12 Selective antibody def., IVIG every 3 weeks last 5 years, 7

surgeries

> before being diagnosed.

>

>

> This forum is open to parents and caregivers of children diagnosed with a

Primary Immune Deficiency. Opinions or medical advice stated here are the

sole responsibility of the poster and should not be taken as professional

advice.

>

>

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  • 3 months later...

Thanks Martha! Believe me, we were jumping up and down and screaming

when we heard the news....too bad we were driving....LOL It is

especially a blessing now that it is strongly suspected that my 15 year

old daughter and myself have some type of immune deficiency as well.

Arika would get the children's special health care insurance same as

Kody, but all my bills would come out of my pocket. I guess from what

the nurses said at the hospital yesterday that BCBS barely pays what

medicare pays. That was the problem.

Diane, Mom to Kody

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  • 2 months later...

,

Is there any way you can get your insurance company to authorize coverage of

the upcoming infusion since it is just a couple of days away? Here is what I

just went through...

My employer informed me on a Friday afternoon that our insurance would change

the following Tuesday. Of course, my son's home healthcare agency isn't a

provider of the new insurance company. I requested the new company to

authorize a " continuation of care " since there was no way a new nurse could

be found with an in-network provider in the 2 days we had until his next

scheduled infusion. I also asked for a case manager so I could explain that

we are dealing with a chronically ill child who is difficult to access for

infusions and has had the same nurse for 5 years... except when there has

been a substitute, and those infusions were nightmares. I faxed the

information to them in the a.m., and by the afternoon the case manager told

me they would authorize a continuation with our current home healthcare

agency for 4 months which would give us an adequate amount of time to get

things figured out.

Good luck. I'm sorry you have to go through this. :(

Kathy, mom to Isaac, 11, CVID

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I did ask for an exception but was told no. I also have asked numerous

times for a case manager and again was told no. I feel like a fish swimming

up stream. Talk about frustration.

Re: insurance

> >

>>

>

> ---------------------------------------------------------------------~->

>

> This forum is open to parents and caregivers of children diagnosed with a

Primary Immune Deficiency. Opinions or medical advice stated here are the

sole responsibility of the poster and should not be taken as professional

advice.

>

> To unsubscribe -unsubscribegroups (DOT)

> To search group archives go to:

/messages

>

>

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  • 3 weeks later...

which brings me to my next question--- do most of y'alls (excuse my southern

accent y'all :>) insurances cover IVIG as a prescription or what? i.e. do you

pay a drug co-pay or do you pay 20%

I need to find this out.

Also-- how do they figure out which brand to use? Is there much of a

difference? I've looked at a few sites and they say they haven't noted a

difference... just wondering.

I know that they have been thinking of IVIG for for a long time, but you

all know how it is when a child has so many health issues...you research the one

you are dealing with at the time...

Sorry about all the questions! Hope no one minds.....if you get tired, just

click delete when you see my name in the from section!

:-)

Pattie

Well, we got the news about the new insurance policies at my dh's job.

Insurance itself goes up $50/month. Copays for doctor visits are the same,

but copays for drugs are up a LOT. The drugs Rebekah is on will go up

between $5 and $30 each! Plus, with Hannah's allergies, it looks like we

might be spending as much as $150-$175 per month on drug copays. I'm still

waiting on news about whether gammaguard and IV antibiotics are covered

fully. OUCH! I know that word doesn't cover the financial pinch, but I'll

say it agan: OUCH!!!

Pam

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Pattie,

Since Kody's only had his IVIG in the hospital, I don't know about home

infusions, but it is covered under our insurance as a hospital admittance.

With our insurance hospital admittances are 100% covered after our

deductable is met (we usually meet the family deductible in the first two

months of hte year). Which means that the IVIG perscription is also covered

under the hospital admittance. Now, whatever the insurance doesn't pay, Kody

s second insurance does pay because it is Children's Special Health Care

Services insurance. My experience with home health care for other

antibiotics are that they are covered 100% too. You should call your

insurance company and ask. Here is a tip: with our insurance company because

Kody needs so much medically he is assigned a caseworker, who is also an RN.

She has visited us in the hospital before. Anyway, when you call, ask if

your case has a particular case worker and ask to speak with them. Not only

do they have all the information you need, but they usually will work with

you better than the person that just answers the phone!

Please feel free to visit my website for parents of children with multiple

special needs :

www.geocities.com/schmidtzoo/SNAK.index.html

-- Re: insurance

which brings me to my next question--- do most of y'alls (excuse my southern

accent y'all :>) insurances cover IVIG as a prescription or what? i.e. do

you pay a drug co-pay or do you pay 20%

I need to find this out.

Also-- how do they figure out which brand to use? Is there much of a

difference? I've looked at a few sites and they say they haven't noted a

difference... just wondering.

I know that they have been thinking of IVIG for for a long time, but

you all know how it is when a child has so many health issues...you research

the one you are dealing with at the time...

Sorry about all the questions! Hope no one minds.....if you get tired, just

click delete when you see my name in the from section!

:-)

Pattie

Well, we got the news about the new insurance policies at my dh's job.

Insurance itself goes up $50/month. Copays for doctor visits are the same,

but copays for drugs are up a LOT. The drugs Rebekah is on will go up

between $5 and $30 each! Plus, with Hannah's allergies, it looks like we

might be spending as much as $150-$175 per month on drug copays. I'm still

waiting on news about whether gammaguard and IV antibiotics are covered

fully. OUCH! I know that word doesn't cover the financial pinch, but I'll

say it agan: OUCH!!!

Pam

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Well, it looks like we will be paying 20% on each treatment with a cap on

payments for IVIG at $1000 starting next year. It was completely covered

this year. Ouch. Oh, yeah. One more thing: the $1000 cap does NOT

include dr office copays or drug copays. There is no limit to those

expenses. Double ouch!

Pam

wife to (15 years)

mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

Re: insurance

We do it as a Drs office visit and we only pay for a copay. BARBIE

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Actually our insurance pays for all of Jonathons IVIG. They treat it as an

outpatient treatment. That is private insurance though and I am not sure

how it will work for you

Viriginia

:)

>From: " Pattie Curran " <paxchristi@...>

>Reply-

>< >

>Subject: Re: insurance

>Date: Thu, 12 Dec 2002 23:58:51 -0500

>

>which brings me to my next question--- do most of y'alls (excuse my

>southern accent y'all :>) insurances cover IVIG as a prescription or

>what? i.e. do you pay a drug co-pay or do you pay 20%

>

>I need to find this out.

>

>Also-- how do they figure out which brand to use? Is there much of a

>difference? I've looked at a few sites and they say they haven't noted a

>difference... just wondering.

>

>I know that they have been thinking of IVIG for for a long time, but

>you all know how it is when a child has so many health issues...you

>research the one you are dealing with at the time...

>

>Sorry about all the questions! Hope no one minds.....if you get tired,

>just click delete when you see my name in the from section!

>

>:-)

>Pattie

>

>Well, we got the news about the new insurance policies at my dh's job.

>Insurance itself goes up $50/month. Copays for doctor visits are the same,

>but copays for drugs are up a LOT. The drugs Rebekah is on will go up

>between $5 and $30 each! Plus, with Hannah's allergies, it looks like we

>might be spending as much as $150-$175 per month on drug copays. I'm still

>waiting on news about whether gammaguard and IV antibiotics are covered

>fully. OUCH! I know that word doesn't cover the financial pinch, but I'll

>say it agan: OUCH!!!

>

>Pam

>

>

>

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We pay 10%. She gets 15 gms every 4 weeks. At $190 per gram it comes to $2850.

This comes to a $285 copay each month.

The brand is chosen by the doctor. Different brands contain different amounts

of IgA and can cause or prevent

reactions. Some are more known for causing reactions than others. IVIG covers

b-cell function but does nothing for the

t-cell counts. Actually it provides passive antibodies and not necessarily IgG

directly. It infuses the antibodies

into the system already made per say. It can replace antibody deficiency but

will not always supplement low IgG counts.

This is why many immunologists will hold off on infusing low IgG unless there is

no response to the pneumococcal

vaccination also.

Ursula Holleman

Macey's mom (7 yr. old with CVID, asthma, sinus disease, GERD, Diabetes

Insipidus, colonic inertia)

http://members.cox.net/maceyh

Immune Deficiency Foundation - Peer Contact for GA

http://www.primaryimmune.org

/

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Thanks, Virginia! I am breathing easier today...you guys are all so nice to

respond. I have done some serious scrubbing-- toilets, tubs, floors...and I

feel less stressed .... hadn't been home in weeks to do it! Well...I was home

between doctor runs...but you all know how it goes.

I am hoping that our docs will set it up as a doc visit/clinic visit...then

we'll only pay the co-pay. We will be at the hospital on Dec 31st ad our HEM is

going to meet us at the ENT appt so we can all talk. They always want to know

when the boys have appts at the hospital and they come down to talk to the docs

with us. HOW cool is that? She takes time even when she isn;t getting paid to

visit us!

Pattie

Actually our insurance pays for all of Jonathons IVIG. They treat it as an

outpatient treatment. That is private insurance though and I am not sure

how it will work for you

Viriginia

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did not respond to the Hep B vaccination---we found out recently b/c during

his bone marrow biopsy the doc poked himself with the needle and they had to run

the tests. We knew about his responses and lack of responses to the PPV.....

My concern is that it won't help either or ph..... although all three

docs involved think it would, but the HEM wants to wait to see what the ENT can

do.

Do any of you know what else they can do besides all of the allergy meds and

nasal sprays? We've tried them all.....

Pattie

Actually it provides passive antibodies and not necessarily IgG directly. It

infuses the antibodies

into the system already made per say. It can replace antibody deficiency but

will not always supplement low IgG counts.

This is why many immunologists will hold off on infusing low IgG unless there is

no response to the pneumococcal

vaccination also.

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Ursala,

How does your family manage that much of a copay each month, plus the doctor

office bills and the drug bills? I've got 3 weeks to redo the family budget

for at least $150 more per month, and likely more, of medical expenses.

I just keep chanting: but my God will supply all my needs..... Hurry up,

God! I'm getting scared again!

Pam

wife to (15 years)

mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

Re: insurance

We pay 10%. She gets 15 gms every 4 weeks. At $190 per gram it comes to

$2850. This comes to a $285 copay each month.

The brand is chosen by the doctor. Different brands contain different

amounts of IgA and can cause or prevent

reactions. Some are more known for causing reactions than others. IVIG

covers b-cell function but does nothing for the

t-cell counts. Actually it provides passive antibodies and not necessarily

IgG directly. It infuses the antibodies

into the system already made per say. It can replace antibody deficiency

but will not always supplement low IgG counts.

This is why many immunologists will hold off on infusing low IgG unless

there is no response to the pneumococcal

vaccination also.

Ursula Holleman

Macey's mom (7 yr. old with CVID, asthma, sinus disease, GERD, Diabetes

Insipidus, colonic inertia)

http://members.cox.net/maceyh

Immune Deficiency Foundation - Peer Contact for GA

http://www.primaryimmune.org

/

This forum is open to parents and caregivers of children diagnosed with a

Primary Immune Deficiency. Opinions or medical advice stated here are the

sole responsibility of the poster and should not be taken as professional

advice.

To unsubscribe -unsubscribegroups (DOT)

To search group archives go to:

/messages

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Oh, guys, please pray about our insurance issues! We may have to pay 20% as

an outpatient or go back to the inpatient infusion clinic with the

hematologists. You remember the hem we deal with who give high doses and

doesn't want to infuse until 6 weeks? We would have to go back to him to

pay less but then we would get poorer care. I've got calls in to our case

manager and the insurance policy writer to negotiate/clarify the situation.

Pam

wife to (15 years)

mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

Re: insurance

Thanks, Virginia! I am breathing easier today...you guys are all so nice to

respond. I have done some serious scrubbing-- toilets, tubs, floors...and I

feel less stressed .... hadn't been home in weeks to do it! Well...I was

home between doctor runs...but you all know how it goes.

I am hoping that our docs will set it up as a doc visit/clinic visit...then

we'll only pay the co-pay. We will be at the hospital on Dec 31st ad our

HEM is going to meet us at the ENT appt so we can all talk. They always want

to know when the boys have appts at the hospital and they come down to talk

to the docs with us. HOW cool is that? She takes time even when she isn;t

getting paid to visit us!

Pattie

Actually our insurance pays for all of Jonathons IVIG. They treat it as an

outpatient treatment. That is private insurance though and I am not sure

how it will work for you

Viriginia

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Pam, remember to talk money to the case manager. Outline the costs of

in-patient care as opposed to home care or ask her to tell you what the

difference is. Don't bring up a bunch of " personal " issues like he's happier

at home or even that you feel he gets better care. Do bring up that he will

be exposed to less germs at home and therefore could save them a lot in

hospital bills and ER down the road. I don't know whether it will work - but

it will come near working than being emotional or whiney -- hey, it's works

with Moms!!!! Once I learned to talk in their language, I began seeing more

consideration.

Whatever you do, keep looking for a solution to keep away from the previous

doctor. That was life-threateningly dangerous.

Hope that helps and I am praying for you to get all that worked out soon.

In His service,

Dale

Pam Mork wrote:

>

> Oh, guys, please pray about our insurance issues! We may have to pay 20% as

> an outpatient or go back to the inpatient infusion clinic with the

> hematologists. You remember the hem we deal with who give high doses and

> doesn't want to infuse until 6 weeks? We would have to go back to him to

> pay less but then we would get poorer care. I've got calls in to our case

> manager and the insurance policy writer to negotiate/clarify the situation.

>

> Pam

> wife to (15 years)

> mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

>

> Re: insurance

>

> Thanks, Virginia! I am breathing easier today...you guys are all so nice to

> respond. I have done some serious scrubbing-- toilets, tubs, floors...and I

> feel less stressed .... hadn't been home in weeks to do it! Well...I was

> home between doctor runs...but you all know how it goes.

>

> I am hoping that our docs will set it up as a doc visit/clinic visit...then

> we'll only pay the co-pay. We will be at the hospital on Dec 31st ad our

> HEM is going to meet us at the ENT appt so we can all talk. They always want

> to know when the boys have appts at the hospital and they come down to talk

> to the docs with us. HOW cool is that? She takes time even when she isn;t

> getting paid to visit us!

>

> Pattie

>

> Actually our insurance pays for all of Jonathons IVIG. They treat it as an

> outpatient treatment. That is private insurance though and I am not sure

> how it will work for you

>

> Viriginia

>

>

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Thanks, that's some good advice. I'm kinda glad that I'm not talking to

them until Monday. I'm still in a rather emotional state (and dh is in

denial about the looming medical bills). That's a really good point about

how cheap home care is and how much safer it is for her. I'm going to make

a list of reasons that should continue home care that are financially

prudent (from their perspective).

And, thanks, for saying that the previous situation was life-threateningly

dangerous. That's what I thought, too, but then I wondered if I was

over-reacting.

Pam

wife to (15 years)

mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

Re: insurance

>

> Thanks, Virginia! I am breathing easier today...you guys are all so nice

to

> respond. I have done some serious scrubbing-- toilets, tubs, floors...and

I

> feel less stressed .... hadn't been home in weeks to do it! Well...I was

> home between doctor runs...but you all know how it goes.

>

> I am hoping that our docs will set it up as a doc visit/clinic

visit...then

> we'll only pay the co-pay. We will be at the hospital on Dec 31st ad our

> HEM is going to meet us at the ENT appt so we can all talk. They always

want

> to know when the boys have appts at the hospital and they come down to

talk

> to the docs with us. HOW cool is that? She takes time even when she

isn;t

> getting paid to visit us!

>

> Pattie

>

> Actually our insurance pays for all of Jonathons IVIG. They treat it as

an

> outpatient treatment. That is private insurance though and I am not sure

> how it will work for you

>

> Viriginia

>

>

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We have that plus $100 for Les's new meds that they have started him on in an

attempt to keep from needing IVIG. Plus

Macey has about $100 in meds (some not PID related). Doctor copays are $15.

These plus the drug costs must be paid up

front but the copays for the infusions or any other hospital bills are on a

payment plan with the hospital. We pay

about $20 per account (6 outstanding right now) and as long as we're making

payments in good faith they can't send us to

collections. I believe this is a state specific law regarding medical bills.

We're what they term " frequent flyers "

and they know that we've been good for all our bills in the past. Hopefully

next year when I go back to work fulltime

after graduating we will be adding a second health insurance policy and that

should help.

Ursula Holleman

Macey's mom (7 yr. old with CVID, asthma, sinus disease, GERD, Diabetes

Insipidus, colonic inertia)

http://members.cox.net/maceyh

Immune Deficiency Foundation - Peer Contact for GA

http://www.primaryimmune.org

/

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OH yeah-- we are frequent fliers, too. What I always get a kick out of are the

people who say, " But don;t you have insurance? " LOL. You know they haven't

had to use their insurance much..... My mom seems to think that 20% isn;t THAT

much.

AYE YI YI

Pattie

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OH yeah-- we are frequent fliers, too. What I always get a kick out of are the

people who say, " But don;t you have insurance? " LOL. You know they haven't

had to use their insurance much..... My mom seems to think that 20% isn;t THAT

much.

AYE YI YI

Pattie

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We pay 10%. She gets 15 gms every 4 weeks. At $190 per gram it comes

to

$2850. This comes to a $285 copay each month.

The brand is chosen by the doctor.

Pam,

We have to pay a 20% co pay, 15 grams every three weeks. We do not qualify for

assistance because we are in the middle class........we have tried........my

husband took a new job last year that was 1/2 his salary........long story but

he is much happier.........we applied for Childrens services and they look at

your tax returns for the previous year ........we were doing ok then..........we

also currently have no insurance for meds at the pharmacy. Office visits are

$35

Anyways, we don't stress over what we owe the hospital we pay every month but we

will owe them for along time. They know we are not going anywhere so they are

pretty good with us.

le

Pam Mork <pmork@...> wrote:Ursala,

How does your family manage that much of a copay each month, plus the doctor

office bills and the drug bills? I've got 3 weeks to redo the family budget

for at least $150 more per month, and likely more, of medical expenses.

I just keep chanting: but my God will supply all my needs..... Hurry up,

God! I'm getting scared again!

Pam

wife to (15 years)

mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

Re: insurance

We pay 10%. She gets 15 gms every 4 weeks. At $190 per gram it comes to

$2850. This comes to a $285 copay each month.

The brand is chosen by the doctor. Different brands contain different

amounts of IgA and can cause or prevent

reactions. Some are more known for causing reactions than others. IVIG

covers b-cell function but does nothing for the

t-cell counts. Actually it provides passive antibodies and not necessarily

IgG directly. It infuses the antibodies

into the system already made per say. It can replace antibody deficiency

but will not always supplement low IgG counts.

This is why many immunologists will hold off on infusing low IgG unless

there is no response to the pneumococcal

vaccination also.

Ursula Holleman

Macey's mom (7 yr. old with CVID, asthma, sinus disease, GERD, Diabetes

Insipidus, colonic inertia)

http://members.cox.net/maceyh

Immune Deficiency Foundation - Peer Contact for GA

http://www.primaryimmune.org

/

This forum is open to parents and caregivers of children diagnosed with a

Primary Immune Deficiency. Opinions or medical advice stated here are the

sole responsibility of the poster and should not be taken as professional

advice.

To unsubscribe -unsubscribegroups (DOT)

To search group archives go to:

/messages

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Share on other sites

How about some good news on the insurance front!?! My employer has a small

category called " home health care " and they forgot to include it when they

changed to an 80/20 split for all other in-patient or out-patient care. So,

we are still 100% covered for IVIG. We still have no answers about thinks

like bloodwork, IM rocephin, etc. but I feel a LOT less stressed today about

money. THANK YOU ALL for your prayers and suggestions. The insurance

company was so glad to keep us at home that the issue of going back to the

infusion clinic was never even a serious consideration!

Pam

wife to (15 years)

mother to , 9, Hannah, 6, Rebekah, 3, and Leah, 1

How does your family manage that much of a copay each month, plus the doctor

office bills and the drug bills? I've got 3 weeks to redo the family budget

for at least $150 more per month, and likely more, of medical expenses.

I just keep chanting: but my God will supply all my needs..... Hurry up,

God! I'm getting scared again!

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  • 1 month later...

In a message dated 01/31/2003 5:14:26 AM Pacific Standard Time, pnqt@...

writes:

> Looking for product liability insurance. Please advise if you have insurer

> you're happy with.

>

Look at website www.rli.com. I am happy with them.

Rose

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