|
Sorry, I should have been more clear in the first post.
My Onco is part of my insurance HMO. According to my benefits schedule, they should pay 100% except for a $15 co-pay for doc office visit, and $200 deductable for the year.
I met the deductable in Jan. with other doc visits and port surgery.
The first chemo bill came to $5087.82 with $3745.50 of that being Herceptin.
The first bill submission was denied pending "large case management rates".
After they reviewed the bill, they show a "provider discount" which is what they allow to be paid per their contract with the doc for being in the HMO network. The full price is what I would have been charged if the doc was "out of network".
The charge for the Herceptin was $3745.50 full price, and they show a provider discount of $608.30, meaning they allow the doc to charge $2529.18 for the Herceptin.
Since he charged me more, that leaves me owing him $608.02 for one dose of Herceptin.
My insurance is 3 tier, with HMO, PPO and out of network options. I can choose any, but HMO is supposed to be paid 100%, PPO is 90%, and OoN is 70%.
Where it gets sticky is that the chemo drugs are considered as medicine/pharmacuticals, and I guess he doesn't have to charge the "contracted" rate for meds.
I'm tending to thinking they charged that amount to recoup the "discount" on the Herceptin.
Anyway, this is not good news, and I hope the doc doesn't end up charging me the extra cost, because I won't be able to continue at that rate.
I am checking into getting him to write me a script and get it filled at mail order pharmacy that my insurance co. contracts with. If I can do that, then the insurance should pay it all, or I may have a small co-pay.
My insurance co said the onc can order it from thier pharmacy and get it at a reduced rate and I would only be charged what they cover. Meaning I would have no cost.
But the Onc isn't inclined to do that.
edited to add- this isn't an old bill. Up to now we've been able to keep everything paid up.
|