posted
Here's the deal- my LLMD only takes the PPO version of Anthem/Blue Cross. I have it as an HMO, so I've been paying him cash since I know my HMO won't give me a referral for a specialist for a disease that according to guidelines will be, you know, cured with a few weeks of antibiotics. We're all imagining it, right?
So I CAN change now during open enrollment over to the PPO. However, the Anthem HMO is only $60 out of my paycheck per month for my whole family. The PPO is $670, and then I have a $350 deductible per person or a max of $700 for the whole family. $670 a month versus seeing him once a month is a big difference. But when I have IV antibiotics I don't know how much it will cost and if the PPO would be a better option
I DO like that I won't need referrals for the PPO and that I can go to any doctor in the network without needing an authorization. I was hospitalized in November and it was a serious emergency so I went to the nearest hospital instead of my designated hospital. So Anthem only paid half!! It's disgusting...What, was I supposed to die waiting to get to the right hospital?
So to me, it's worth it in some respects, but the money is a big difference. But at least it's a pre-tax deduction, so I'm thinking it will make about a $300 to $400 difference in my check. My take home pay now is $4,200, so maybe it'll go down to $3800 or $3900. Sounds like a lot compared to many people, but I'm spending a fortune on herbs, medicines, etc. and I have 2 kids in daycare, student loan payments, etc. I barely make it from month to month.
So what do you think? Do I need to just suck it up with less take home pay? Or should I save for the IV antibiotics? Does anyone know what it costs per month?
Posts: 107 | From Hesperia, CA | Registered: Feb 2011
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-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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momlyme
Frequent Contributor (1K+ posts)
Member # 27775
posted
$646.15 per month for 2 grams once a day of generic Rocephin ceftioxone(sp)-- from Infuserve in FL (December 2010).
This price included everything we needed for infusion, plus they loaned a battery operated infusion machine.
-------------------- May health be with you!
Toxic mold was suppressing our immune systems, causing extreme pain, brain fog and magnifying symptoms. Four days after moving out, the healing began. Posts: 2007 | From NY/VT Border | Registered: Aug 2010
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Abxnomore
Frequent Contributor (5K+ posts)
Member # 18936
posted
Consider that you may need many rounds of different IV meds and oral ABX and cyst busters and possibly mepron for babesia (very expensive), etc.
The medication component for treating this illness can be huge. Other IV meds can cost much more than rocephin. They are all priced differently.
Posts: 5191 | From Lyme Zone | Registered: Jan 2009
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posted
I work in home health and I recommend getting cash pay bids from different infusion companies. I have seen cases where the cost difference has been as much as half. The drug will probably be a fixed cost but it's the supplies that get you as well as the RN visits. We were charging $150 for a visit whereas an infusion specialty company was charging $75...their daily supplies were much less as well. Stay away from a traditional home health company and go with an infusion company. You will have to see what the policy is for the company you choose. They still may want an RN out weekly to check the status of the line, check for infection, etc.
Posts: 478 | From Third Coast | Registered: Feb 2011
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kidsgotlyme
Frequent Contributor (1K+ posts)
Member # 23691
posted
I would ALWAYS pick a PPO over an HMO.
I've had both and in my opinion there is no comparison. An HMO is good for people who don't have a serious illness.
-------------------- symptoms since 1993 that I can remember. 9/2018 diagnosed with Borellia, Babesia Duncani, and Bartonella Hensalae thru DNA Connections. Posts: 1470 | From Tennessee | Registered: Dec 2009
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posted
Jennifer, actually I am in the same situation as you as far as insurance goes. We are now starting open enrollment and things are changing! I work for a large healthcare system and healthcare reform is having everyone go to a PCP for almost everything! My current PPO plan will go from 107 to 163 per paycheck, now have a $700 deductible per person, and a $4k out of pocket. They are trying to entice everyone to use what I call the HMO, although they are marketing it under another name, not even saying HMO. If I choose someone out of network, I pay 70%. Oh, and now biometrics are required in the first six months.
Posts: 478 | From Third Coast | Registered: Feb 2011
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I am going to give our experience of paying a lump cash sum for IV treatment and the disallusionment of the expense we ended up paying.
We put up a CASH lump sum of $22,000 for the IV treatment regimen. We were quoted a cost of $19,000 for 6 months of treatment, but we put more money in our account in case we needed more for any other expenses. If not used the extra would be credited to our account or returned to us at the end of treatment. We really expected to get the majority of our extra money back based on the quote given to us.
Treatment included one or two IV antibiotics per month, all IV supplies, and quarterly phone conferences. There are other charges I can't account for....The total monthly cost was approximately $3000 per month for the IV treatment.
An example of the IV antibiocs included, IV Doxycycllin plus IV Merrem, IV Merrum and IV Levaquin, IV Tigecycline, and a couple of others which my brain fog cannot remember.
The regimen of antibiotics were altered monthly.
Aside from IV treatment costs, I also paid for oral medications including: Mepron (very expensive) for 5 months, Septra DS orally for the 7 months, and Flagyl just two days of a two week period for the 7 months.
At least the generic oral antibiotics had a copay, although, some were not generic and were expensive.
I also paid for a variety of supplements taken daily.
The treatment has IMPROVED my symptoms so much and I feel so much better. I am not disappointed I chose to undergo the regimen! My immune system has become very highly funtional. But, I am so disallusioned from the costs charged.
The costs ended up costing us $26,000 over 7 months. The treatment costs so much more than was quoted to us; at least $7000 more. We were tapped out from the total amount spent.
My husband has especially been having a difficult time dealing with the expense, which I cannot blame him. He is a man, the head of our household, so the one whom worries about expenses, and the future, including retirement. Spending so much for only the understanding that treatment MAY provide a POSSIBLE road to a positive response or outcome? In his mind this is difficult to grasp. Also knowing that it is possible I may have to undergo additional rounds of IV treatment in the future.
Listen, he really really cares and prays for me to get better, but as anyone undergoing IV treatment knows what the grave hit the expense has placed on our lives.
Did paying a lump sum result in us being taken advantage of and being charged more than was quoted? I hate to think this would ever occur, but we paid so much more than was quoted.
I wanted to share our experience of paying a lump cash sum and hope others gain some knowledge from our experience.
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