Treatment or home: how to avoid this medical decision
Let me introduce you to Carl; teacher, loving wife and mother of two young children who were recently diagnosed with Crohn’s disease and prescribed infusions. Carl assumed her insurance policy covered these treatments until she received a bill for nearly $20,000, and that was for ONE treatment. She would have to continue these treatments every five weeks!!!!! After not having much success, Carl approached me in a panic and we managed to get her bill down to $411 with some of the following tips:
1. get into your zen: The last thing Carl needed was an ulcer. With a few deep breaths and a plan of action in place, she was ready to take on this “billing monster.”
two. Get a copy of the itemized bill and medical records: We were able to uncover some billing errors, but we got a “clearer picture” of what was being done and if there were any options. Instead of Cari, it seemed that his insurance rejected part of the bill because the infusion center was not covered by her insurance.
3. Talk to the right person: Some facilities have patient advocates or social workers who can help find other payment options. Cari was able to verify what we discovered through an advocate on the premises. Also, the advocate pointed out some additional insurance options Cari was qualified for but didn’t take advantage of, so we immediately filled out all the paperwork with the help of the center and got her on the right plan within 2 months.
Four. Talk to your prescribing doctor: Maybe there is an alternative drug or cheaper treatment? In Cari’s case, she had a bad reaction to alternative treatments, so that was not an option. In some cases, the prescribing physician may have free samples (usually about 2 months’ worth) that they can provide you with until a financial solution is discovered. Cari’s case was a bit more difficult as she needed a biologic which tends to be a bit more complicated therapy as there are many factors involved including an infusion site.
5. Find out what financial assistance programs exist: There are many “patient assistance programs” and/or “financial need programs” that are available for all situations. Familiarize yourself with these programs and qualify as soon as possible. Some websites that may be helpful include: NeedyMeds, in conjunction with Rx Access or a State Pharmaceutical Assistance Program.
6. Go directly to the manufacturer: Many larger manufacturers have an “Access Service Manager” or someone equivalent who can help guide you through the qualification process for some of these access and affordability programs. Cari found Kim, an access services manager for the Remicade she needed, by visiting the Janssen Pharmaceuticals, Inc. website and calling the 888 number provided. For those who aren’t as savvy, your prescribing doctor can help provide you with the correct number by contacting the representative they deal with from that pharmaceutical company.
7. Be nice and be prepared: Before you start any call, take a deep breath and make sure you write down the following information so that you can provide it consistently when requested by the representative, which will make the call pleasant and quick:
- Your name and contact information
- The pharmaceutical prescription
- The desired location if necessary
- Insurance information (if you have insurance)
- Your income level (a copy of your W-2 can provide this information)
Some programs may require additional information and you may not get the right person on the phone the first time. Be patient and be persistent. If your blood starts to boil, hang up and call back when you’re calm, or have a loved one call with you.
8. Take note: Get the person’s name and contact information if possible. Document the date and time of the call and summarize what was said, including any additional instructions you were given, as well as when the person can call you back. In Cari’s case, we were asked to call back to get an update on what Kim was able to find out about her situation. Ultimately, Kim was able to locate a site that accepted her insurance and determined that this site was accepting new patients. Kim also signed Carl up for an additional free service to remind her of her infusion dates.
9. Breathe and start: Now that everything is verified, Cari can receive her infusions and NOT incur medical debt. In addition, she knows to ask for an itemized bill and a copy of her medical records after each infusion, so she can keep track of her bills and make sure there are no errors. If there is a discrepancy, she has her access services manager, Kim, to help resolve it and avoid an ulcer.
Today, Cari is a empowered patient no medical debt and with an infusion center convenient to your home that is covered by your insurance.
