I am lying here in bed staring in utter disbelief...still. No, there's nothing pornographic going on in my sleeping lair! I'm talking about the pieces of paper in front of me...EOB's...Explanation Of Benefits. The pieces of paper that my insurance company provides me (as the insured) explaining what they have paid out regarding my Tysabri infusions.
This is the recent amount Club Med billed my Gold Card insurance for infusing my latest dose of Tysabri on July 29th. Yes, you read that correctly...OVER TWELVE THOUSAND DOLLARS!
That's the final amount my insurance company PAID Club Med for the above bill.
That's the amount my neurologist's office billed for my Tysabri infusion on April 8th.
That's the amount my insurance company PAID my neurologist's office for my April infusion.
Does anybody ELSE see a problem here?!? WTF?!? I walked less than 100 yards from my neuro's office to Club Med and this less-than-a-football-field walk ended up costing OVER FIVE THOUSAND DOLLARS!
OK, news flash...I am NOT after all, going to be billed $4,000-$5,000 dollars for my two Tysabri infusions that have already occurred at Club Med. I can breathe again and NOT have to contemplate gun ownership. This piece of information alone should have me whistling "Party On" out my butt. BUT(T), it doesn't. There's a really big problem here and one that I will not be quiet about! I believe my insurance company is being GOUGED. And I also believe it is this very practice that pushes everyone's cost of health care over that imaginary edge.
I have spent the past two days emailing and making calls about this issue because my a$$ is so chapped about the matter I can barely sit down comfortably. I have been taking names. I have been dropping names. Words like "audit" and "State Insurance Commissioner" and "local newspaper" and "line itemization bill" have been spilling out in emails. Dr. She Who Will Not Be Named has forwarded the situation all the way to the top of the Club Med Food Chain. I have threatened to be arrested for trespass while sitting outside the Administrator's door if I have to. SOMEONE needs to provide me some answers about this exorbitant jump in fees just from changing a LOCATION of where I am being infused.
Dr. SWWNBN has politely asked me to remain "calm" while she works on the issue from her end...I have promised her I will remain chained to my dog house in my yard and await her response. I can do nothing about my rabid nature, however. This situation has my blood boiling and my mouth foaming...just call me Cujo.
It is bad enough Tysabri costs (this is the latest estimation I could find) around $28,000.00 a year JUST for the medication, making it the most expensive DMD available to treat MS. NOT TO CURE MS...just to TREAT it. One practically has to consent to monthly anal probing just to OBTAIN access to the drug due to the hypervigilance of the FDA and the TOUCH controllers. Add on the PRICE-GOUGING INFUSION CENTER charges, and one could be looking at spending anywhere from $80,000.00 a year to $110,000.00 a year. I don't know about YOU, but my employer has capped my life time insurance benefits to 2 million.
I used to think $2,000,000.00 was a lot of dough...apparently, it is NOT. At the rate Club Med is charging me (and mind you, this would be MONTHLY), I will burn through my life time maximum coverage allowed in around 10 years (I've already used several thousand dollars of that amount in the past 8 years I've worked for my employer...MS bites the big wallet) and this isn't even taking into account catastrophic illness or, GOD FORBID, a hospitalization for MS.
Lauren left a comment on the previous post about the high cost the infusion centers are charging. This got me thinking (and believe me, THINKING can be dangerous for me!). I wonder how many others taking Tysabri right now are AWARE of what their infusion sites are billing insurance? Any clues on this? I'd LOVE TO KNOW WHAT OTHER PEOPLE ARE PAYING FOR THEIR MONTHLY INFUSIONS (and not including the cost of the Tysabri...that is a preset amount negotiated by your insurance company). I'd LOVE TO SET UP SOME SORT OF TRACKING HERE ON CHEESE TO GET AN IDEA ACROSS THE UNITED STATES WHAT INFUSION CENTERS ARE CHARGING.
Anybody out there on Tysabri want to play along with this game? If you know what the infusion center where you get your Tysabri is charging (you can find this out from your insurance company), please leave a comment and I will accumulate numbers and geography and see if there is any rhyme or reason to these charges.
In the meantime, I'll just be chained here in my yard foaming at the mouth...