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  • FBCoachC
    started a topic Bleo Treatment Price

    Bleo Treatment Price

    Got a call from the doctor's office this afternoon (Saturday) in inform me that they needed to cancel my bleo treatment on Monday because they have yet to receive approval from my new insurance company (company changed on the 1st). Anyone have any experience with this? What would it cost me to pay out of pocket? This is the next to last treatment of cycle 3 of 3 and I'm ready to get this over with. I hate the idea pushing everything back a week.

  • Mike
    replied
    Yeah, a lot of times they have to admit patients on the holiday when the infusion centers seem to think it is OK to close. At this point I suppose it is water under the bridge.

    Mike

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  • FBCoachC
    replied
    Waiting to hear back from the Oncologist's office this morning. I believe the anti-nausea drug Akynzeo is the hold up. I do remember when I started Cycle 1 my oncologist had to call my previous insurance company, anthem, to get approval as it was originally denied. A Google search says it's $594 per dose. Being that I've had no issues with nausea thus far, I'd hate to stray from what's working.

    I believe they handled the holiday situation as best they could. For cycle 2, I was treated MTWMT to avoid Thanksgiving and for cycle 3 we did MTThFM to avoid Christmas. A pain in the ass for sure, but I couldn't find any alternatives and all facilities in my area (Northern Virginia) we closed on the same schedule as the office I'm being treated at.

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  • biwi
    replied
    Also. If you insurance tried to deny it raise hell. The local news media would be very interested to get a story crucifying the insurance company for not approving a known lifesaving treatment.

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  • biwi
    replied
    Originally posted by FBCoachC View Post
    Got a call from the doctor's office this afternoon (Saturday) in inform me that they needed to cancel my bleo treatment on Monday because they have yet to receive approval from my new insurance company (company changed on the 1st). Anyone have any experience with this? What would it cost me to pay out of pocket? This is the next to last treatment of cycle 3 of 3 and I'm ready to get this over with. I hate the idea pushing everything back a week.
    I would tell the provider to go forward anyway, and then sort out the billing afterwards. Most assuredly it will be covered and your insurance will pay the bill or reimburse you. Delaying treatment is not great for results.

    Leave a comment:


  • Mike
    replied
    From what I can find, the Medicare allowable cost for code J9040 is around $27 per 15 units do you are looking at Medicare only paying less than $60 for a 30 unit dose. There is likely an administration fee too just it can't be that high. Perhaps you could have them give the med and bill later with you paying the Medicare cost for it if that fails.

    So they delayed your chemo for a week both weeks of the holidays? If so, that is pretty crappy.

    Mike

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  • FBCoachC
    replied
    Thanks for the input guys, seems like the best course of action is to just be patient. The typical 9 week course will now end up being 12 weeks due to my last 2 long weeks falling on holiday weeks. Fortunately, I'm 6 days removed from my last EP and feeling fairly well. Planning on returning to work, I'm a teacher, on Tuesday. Also, my HCG has gone from 865 post-OP to >1. Everything seems to be working, just need a couple more weeks of patience.

    There doesn't seem to be any concern that they'll deny it, apparently Cigna typically takes 3-5 business days to process the approval and this time of year is their busiest, therefore typically it's on the long end.
    Last edited by FBCoachC; 01-05-20, 05:08 PM.

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  • billandtuna
    replied
    What a pain! Why do they make things so difficult at a time like this?
    Yes, definitely call the insurance company and push hard, it would be outrageous for them to deny coverage for your bleo.

    On a quick google search, I saw such a wide range of prices for bleo, I have no idea what to make of it. Could be hundreds to thousands or even more, but then there's also the charges for administering it, and whatever else is going on.- like antinausea drugs, blood tests, etc.
    It is possible that the clinic might be able to quote you a price, but often they don't even know what they charge - because it is often a separately negotiated price for every insurer.

    Good luck & we'll be standing with you!

    Leave a comment:


  • Davepet
    replied
    Not sure what your deductible is, but likely a few grand for treatments, just guessing. Waiting a week at this point probably won't affect the outcome of tretment and some insureance companies will waive the deductible to finish treatment already in progress, so look into that as well.

    Leave a comment:


  • FBCoachC
    replied
    Yes, 2 belo only days left. My thought process is that if 1 treatment is somewhere around my deductible, I can just handle it that way. The assumption is that everything will be good to go by the following Monday. I'm going to reach out to the insurance company Monday AM as well.

    Leave a comment:


  • Davepet
    replied
    So you have two bleo only treatments left? I have no idea what that would cos out of pocket but probably pretty pricy, maybe contact the new insurance directly & see if they can speed things up?

    Leave a comment:

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