Wednesday, September 24, 2008

Win Or Lose...Is It REALLY How You Play The Game?...


Especially if you feel like you really didn't WIN anything?

I suppose an apology "should" be worth something these days, but frankly it means SQUAT to me...I'm talking about the Club Med Head's of State meeting today that lasted for one hour as I finally got some concrete answers regarding my Tysabri billing questions.

In short, the Club Med head of Finance and the head of Pharmacy took time out of their busy (and probably overpaid) schedules to appease me today and attempt to answer the ongoing questions I have been posing for the past month about how they are billing Tysabri patients. They actually APOLOGIZED for the organization's mishandling of my concerns. They listened to my questions and had reams of paper they fingered through to respond to my questions. They assured me the CEO of the Club Med campus where I receive my infusions was aware of my concerns. They showed me the reimbursement they would be making to my Gold Card Insurance Company for my 8/29/08 infusion. They told me many heads of many departments had been involved and made aware of the Tysabri issue. I was told there would be a "re-education" process conducted at the campus where I receive my infusions. I was assured ALL of the Tysabri patients within Dr. She Who Will Not Be Named office would be receiving a letter of INFORMED CONSENT regarding future billing issues. They rung their hands, quoted various policies and pharmacy formularies, spat out numbers and equations for how they set the prices for their billing, and told me there was an "exception" made for the drug, Tysabri, within their system...they would be lowering the COST of the drug for MS patients.

But, when all was said and done, and as I calculated long hand on a small piece of paper EVERY FIGURE they spat out, Tysabri infusions will STILL cost well over $10,000 an infusion!!! I pointed this out to the Club Med Heads Of State. I questioned how they could STILL even consider marking up the cost of this medication nearly quadruple Tysabri's whole sale price and STILL sleep at night? I pondered how they could possibly think marking off roughly $2,000 of an already HIGHLY INFLATED drug cost would be seen as a "consession", given the yearly cost of the drug would STILL be well over $130,000???

They stared at me as though I were an ungrateful beggar. Imagine little ol' me...an MS patient with barely a pot to piss in OR a strong leg to stand on...questioning THEIR hard work and calculations that should be viewed as a "gift"? Who the hell WAS I anyway? And although nothing of the nature was actually audible or said, I imagined their lips moving and saying, "We're Club Med. Go eff yourself. We do what we want. Who ARE you to question our Divine ways?"

What WAS audible and DID come out of my mouth is this:

"I am an MS Advocate and I speak for ALL of Club Med's Tysabri patients. This is not acceptable."

The game ain't over team...

5 comments:

Sara said...

good on ya - keep up the fight!

Tricia said...

Keep after them, this really is insane. We get billed 1/3 of that for the same exact treatment in NY which really is not a lower rent district or anything.

LISA EMRICH said...

ok. I think it's time to go through the information which some Ty patients have sent to me regarding their known billed/allowed/paid costs for infusions.

Unfortunately, the medicare folks don't even SEE a bill or EOB statement or nothin' so we can't calculate that in. But I wouldn't be surprised if it's inflated.

Did Club Med EVER acquiesce and provide you with the line item bill, you know, how much was charged for starting the IV, how much for the tubing, how much for delivery of the med from the pharmacy to your comfy seat, that stuff. ?

Good for you for being an Advocate for your fellow MS comrades.

have myelin said...

I love BrainCheese.

Blindbeard said...

Show them that we are not going to take their b.s. and slink away even if we have no money or "power" as they see it. I refuse to back down and only reaffirm my mission of showing them they are messing with the wrong crackpot! Rock on with your bad self!