Medical bill for hormone treatment

[pigpiggy2633]

I am a prostate cancer patient. I am getting Degarelix and Xgeva injections. The doctor's office sent me a bill amounting $2600 which is the deductible from Anthem blue cross. I am covered at the same time by Medicare. It seems I have to pay only 20 per cent of the $2600. But they insists I am responsible for the amount. Any one can help to explain that?

[Danielgreer]

Hi pig piggy, are you covered under a Medicare Advantage plan? If so, did you receive an Explanation of Benefits (EOB) from your plan? I’ve never seen an EOB for an MA plan but I would imagine the EOB would show a breakdown of what the plan pays, what Medicare pays, and what you owe.

[pigpiggy2633 in reply to Danielgreer]

Thank you for your reply, I have anthem group insurance as primary insurer, while Medicare original as secondary. I think the care provider did not claim to Medicare, otherwise I should be responsible for 20 per cent of the deductible. Do you think so? Thanks!

[Danielgreer in reply to pigpiggy2633]

Since you have Anthem, you can go online to see the EOB. Take a look at it to make sure it’s correct and you should be able to see what Anthem pays, what Medicare pays and what you owe. If you have questions call Anthem so they can walk you through it line by line so you understand what your responsibility is.

[Hidden in reply to pigpiggy2633]

That is Pure bs and shouldn’t be this way .

[Tall_Allen]

Is the Anthem Blue Cross plan a Medicare Advantage Plan (Part C) or is it a Medicare Supplemental Plan (Medigap- Part F)? Either way, it covers whatever is not covered by Part B.

[Magnus1964]

What plan are you on, Part C or. Part F or other?

[Dachshundlove]

Hi Pigpiggy2633:

Not to scare you, but we have been responsible for $2600 copays for hormone drugs. We too have Medicare and a non-advantage plan supplement.

Drug prices are unacceptably high (especially cancer drugs) and as a country we must address this...

[Hidden in reply to Dachshundlove]

👎🏼

[Dachshundlove in reply to Hidden]

Thumbs down and Boo...

We paid that copay in January and now I believe it will be $744 a month, but either way it feels like legalized robbery.

And, I am grateful we can do it, but depressed for the people who don’t have access to needed medication for lack of $$!

[Hidden in reply to Dachshundlove]

If I was pres. All cancer treatments would be free to all .

[Hidden in reply to Dachshundlove]

😩

[tango65]

This may be a possibility. These medicines may be covered by Medicare part D, but the doctor's office does not bill Medicare part D. Drs working in Institutions (Cancer center, University etc), get around this problem by ordering the medication from the local pharmacy, the pharmacy bills medicare part D, and send the medicine to the infusion center or the doctor's office. Then the infusion clinic bills medicare part B for the administration of the drug.

Doctors' offices bill Medicare part B, and many medications administered (vaccines etc) in a medical office are not covered by part B. It is safer (in terms of payments) to get the vaccines given at CVS than in a doctor's office. I had this problem with a shingrix vaccine and I had to pay.

[Hex40]

I have Medicare plan F plus a plan D and was under the impression that any drug administered in a doctors office would come under Plan B. So far any drug I’ve received at a doctors office has been covered.

[tango65 in reply to Hex40]

Medicare part B covers some medicines. These are some of medicines covered by part B.

If you get one of them in the doctor's office you pay 20%, if the drug is not covered by part B even when is covered by Medicare part D, you pay 100%. Doctors do not bill Medicare part D.

medicare.gov/coverage/presc...

[Ramp7 in reply to Hex40]

That has been my experience as well.

[Hex40 in reply to Hex40]

Well I just got my lupron shot at the Urologist’s office at the hospital. The hospital orders the lupron for inventory not a retail supplier. I was assured the Lupron will be billed to Plan A and I should have no problems. In fact they have not heard of past Medicare patients having problems with Lupron. Time will tell.

[GeorgesCalvez]

I have had a look and the price for a single 80mg injection of Degrelix in France is about EUR 120, at the current exchange rate that is about USD 130, the price in the USA is USD 510 which is four times the amount!

That is a huge difference.

[Hidden]

You are have to read your covered plans and then find out if the appropriate entity is billed correctly.

GD

[Crmp55]

I to had bc/bs until a senior center told me about Aarp’s insurance plan part F. No more co- pays and that was 7 years ago. Imagine the bill I would have racked up. Check out AARPs united health insurance. Good luck.

[GaryG1950]

Good luck with any kind of Medicare Advantage plan. You might get lucky and do OK or you could end up with a huge problem of not being able to see the physician you need to see or not getting approval for drugs your physician wants you to have. Medicare Advantage IS NOT the same as Medicare and don't let anyone convince you otherwise. Like I said, you could get lucky and avoid their limitations and problems or you could be unlucky and end up with care that is not the best for your situation. It is a crap shoot and you have to decide how lucky you feel. And that's all it is. The Medicare Advantage plans are commercially managed and those guys are all about profits, period. And they are making a lot off of Medicare....that's why they market them like crazy.

[Kimmilemo in reply to GaryG1950]

I’m a licensed Insurance agent. I live in a big city and because many like the free part they want me to put them in it. I tell them basically what you said . I said Medicare supplement is the Cadillac version. I actually make a tad more in the advantage care but I always do what’s best for the client and the best fit.

[Kimmilemo in reply to Kimmilemo]

Also my home down town the road a 100 miles, I get clients because my family all still live there have to but the supplement because the hospital does not take advantage care.

[GaryG1950]

If you want an objective article about this, the NYT just published one this past weekend:

nytimes.com/2020/02/21/busi...

[Muffin2019]

I have AARP United advantage plan and I only pay around 217 for the lupron shot, excellent company. My mom had them for years that is why I went with them.

[j-o-h-n]

Greeting.... Would you please tell us more about yourself. age, location, treatments, treatment centers, doctor's name(s). Thank you!!! That info is voluntary but it helps us help you and helps us too.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 02/24/2020 10:13 PM EST

[dmt1121]

I wish us all well in affording our medications and other types of treatments in the months and years ahead, as everyone pleads the fifth!

[AlanLawrenson]

I had Lupron some years ago. It cost he US$50 (or even lower at US$10 if you had an Australian Health Concession card). The balance is paid by our universal Medicare insurance. All taxpayers pay 2% of their gross earnings to fund this.

A great system that has been going for more than 30 years.

I feel for all US citizens with health challenges. Also those in most countries of the world who don't have proper health care available at all.

[Hidden]

Typical insurance company. I had bcbs my first two years. They paid over $800

K for me. Then I went on Medicare Medicaid .. My drug and testing are free due to the test drug that I’m on . Once missed our bcbs payment and was due a Lupron shot and it was$7500 . Ouch . We figured it out and they paid. Good luck 👍

[Turt713171]

Since Anthem is primary you are responsible for the deductible. You can file Medicare as a secondary payor. It may pick up some but not the 2600. Lupron covered under Part B. Not part A. Part A us for Hospital charges

As long as you or spouse is working Medicare can only be a secondary payor

You know the deductible for regular Medicare is I think 185 yearly.

A great deal for those of us who need it.