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08-23-2012, 09:19 AM   #1
Sandy A
 
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Remistart program

Just wanted to offer some information incase anyone might be dealing with the same situation. I had several infusions of Remicade thinking they were covered by insurance as I had been told, come to find out, they were not. Someone suggested Remistart to me (on this forum, love you guys, thanks) and I contacted them. I was excited once approved thinking they would cover the out of pocket costs I had just accrued...come to find out, you have to be approved with remistart first before they will start covering anything at all. Later on down the road, next yr, this should then help, just out of luck for now. Hope this info benefits someone else out there.
08-24-2012, 02:54 PM   #2
heyjude94
 
Join Date: Oct 2011
Location: Rockford, Illinois
I'm having a similar problem with the "remi-start" program. I had an infusion on 7/7 and 7/21 (two of my loading doses) and just got my EOB today which is what I was waiting for before I enrolled. Little did I know that they will only go back 30 days once you are enrolled. I would have needed to enroll and be approved by 8/6 for those two July infusions to be included for a rebate. I do have my company insurance that is covering it, but my out of pocket is $800+. I am really bummed. My advice is to get all your ducks in a row before proceeding with remicade infusions as they are terribly expensive, even with insurance. My two infusions totaled $30,000. I was previously told at my dr's. office they would probably run around $6k to $8k per visit. Does anyone have a clue why it would be such a difference? I mean, I'm a little overweight.....but not that much to where it would make that big of a difference in how much of the drug I was administered.
08-24-2012, 03:47 PM   #3
Clash
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Are you having them done at a hospital infusion center? It seems the hospital center prices were higher than the prices of the infusion at the GI infusion lab. Can't remember exactly but it seems charges for administering were tacked on at hospital infusion lab.
__________________
Clash
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara


Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
08-24-2012, 04:35 PM   #4
xmdmom
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If you need to pay a lot out of pocket, I would definitely try to negotiate. Hospitals, labs and doctors negotiate with insurance companies all the time. Take a look at this http://www.nytimes.com/2009/03/14/health/14patient.html
Here's some excerpts that may be useful to you or others.

".....
And keep in mind that doctors, hospitals and medical labs are accustomed to negotiating. After all, they do it all the time with insurers. A hospital may have a dozen or more rates for one procedure, depending on whether Medicare, Medicaid or a private insurer is paying the bill, said Ruth Levin, ... Your request for a special arrangement will hardly confound their accounting department.

And it is usually in everyone’s interest to avoid dealing with a bill collector.

If you recently lost your insurance or have a plan with minimal benefits, here is what you need to know if you want to seek a price break from the doctor, hospital or lab.

Dealing With Doctors

DON’T BE SHY “Patients are often intimidated by their doctors ... “But if you need help, speak up. Most are likely to help out.”

Talk directly to your doctor about your financial situation. If that makes you uncomfortable, then go to the billing manager. The office may be able to offer you a discount of 10 to 30 percent depending on the practice (specialists may offer a bigger break), or propose a plan in which you pay your balance in a few installments or on a monthly basis — typically at no interest.

OFFER TO PAY CASH UPFRONT Doctors can lose thousands of dollars every year on unpaid bills and spend countless hours haggling with insurers over reimbursements. If you can make their life simpler by offering to pay right away, you’re likely to get a small discount — even if you don’t have financial hardship.

BE RESPECTFUL...

Talking to Hospitals

STRIKE A DEAL, THEN CHECK IN If you need shoulder surgery, for instance, but don’t have insurance — or are facing a high hospital co-payment — call the hospital’s billing department and explain that you would like to discuss getting a discount and why. Dr. Moritz suggests saying, “I’d like to pay the lowest rate you give an insurance company.”

MAKE A COUNTEROFFER Like doctors, hospitals would rather be paid something than nothing. They lost $34 billion in 2007 on uncompensated care, up 55 percent from 2002.

“Hospitals would rather set up a payment plan than turn it over to a collections agency and then expect to write it off,” Dr. Liu said.

If you end up with a bill you can’t pay — or at least can’t pay right away — don’t panic. Find out what Medicare would pay for your condition or surgery, since that program tends to pay less than private insurers. You can learn that at the federal Department of Health and Human Services database, www.hospitalcompare.hhs.gov, by clicking on the gray button “find and compare hospitals.”

I learned on the Web site, for example, that if I were admitted to my local hospital for chest pain, the average Medicare payment would be $5,732. Use the Medicare numbers as the starting point for your negotiation.

The truth is, said Ms. Levin of Continuum Health Partners, “only a very small portion of consumers or insurers pay 100 percent of our hospital charges.”

...
Bargaining With Labs

Charges for lab work can be exorbitant. But, as with hospital bills, the numbers you see on your statement may not reflect what most insurers actually pay, ....

Negotiate just as you would with your doctor or hospital. Quest Diagnostics, the largest clinical laboratory in the country, for instance, offers a six-month interest-free payment plan, as well as financial assistance for those with real hardship.
....."
08-25-2012, 05:21 AM   #5
Sandy A
 
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Hey Jude....30 thousand sounds ridiculous!!! I thought 6 thousand was ridiculous!! Maybe somebody hit the wrong button in the billing office!
08-25-2012, 12:10 PM   #6
heyjude94
 
Join Date: Oct 2011
Location: Rockford, Illinois
Yes, mine take place in the hospital as an outpatient service. On my EOB, it is all itemized and the "drug" charges for both infusions is listed as $14,572 EACH and the rest of the charges are things like any of the supllies used. I will be calling the billing office first thing Monday morning to find out why so much. I'm wondering if this is due to being the first loading doses....maybe more of the drug is administered? I also have a blood draw scheduled for Tuesday at my Gastro office and I will inquire with them if they think these charges are normal but I'm not confident they will know anything since they aren't involved with the infusion process. Maybe I can get them to look up the Dr's. order to see how much was prescribed for these two infusions and go from there.
08-26-2012, 01:11 PM   #7
Sandy A
 
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I had mine in the hospital also and mine were loading doses...but I'm not sure of the amt delivered.
08-27-2012, 05:47 PM   #8
heyjude94
 
Join Date: Oct 2011
Location: Rockford, Illinois
Well, I called the billing office today at the hospital and there is no mistake on the cost of my 2 infusions. She was able to pull the detail and I was administered 4 - 100mg vials of remicade. She pulled a few other patient's records (anonomously of course!) that are getting remicade billing and mine seems like it's right in the same ball park. One person gets 5 - 100mg vials and their billing is around $18,000 so it seems to average out to around $3,500 per 100mgs....or per vial. She did admit to me that hospital infusion centers are most certainly more expensive because of how it's staffed and the facility itself. Next move for me will be to see if I can go somewhere else in town besides the hospital.
08-28-2012, 03:36 PM   #9
Sandy A
 
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Hey Jude, can't believe how crazy expensive this drug is. I don't know my infused amount, will definitely have to ask next time, but mine is a little over 6000 before the ppo discount. So maybe you get more vials.....still, what is it, gold????
08-28-2012, 06:37 PM   #10
heyjude94
 
Join Date: Oct 2011
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Sandy, I was thinking the very same thing....GOLD perhaps. My ppo discounted it 60%, isn't that crazy? I have a company sponsered plan with BCBS. After the individual $400 deductible the 90/10 kicks in until I reach a $1200 out of pocket. I hit the out of pocket with these charges so now I'm at 100% until the end of the year which I figure I'll have two more infusions.....the third loading dose in September and then one in November and I won't have to pay anything.

So, my plan is to enroll in the remi-start program and I would assume next January when I have to start over, the rebate card should help me with my 2013 deductible and out of pocket costs up to their limiit on those future 2013 infusions. I'm assuming by the enrollment form that you need to filll one out for 2013 since the form right now says it's for 2012. Does anyone know the answer to that?
08-28-2012, 10:52 PM   #11
heyjude94
 
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Hey Sandy.....hope you are okay down there during the hurricane......
09-03-2012, 05:59 PM   #12
Sandy A
 
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Hey Jude...thanks for the concern.....doing okay here, had planned a vacation to New Orleans on the same day the hurricane decided to go, had to cancel...feel bad for those people.....hard to believe it was 7 years to the day. I have basically the same thing with the ppo, I also have BCBS...I've also met my deductible. Having already signed up with remistart, I will be able to use it next year also, but beings I got approved last month, I think that will stunt my year, I don't know, will have to review that part again. Its a drag that they wouldn't pay the part I already incurred, seems a bit weird....but its their game I guess. Good luck with your infusions, I had to hold on my last one because I was sick....not sure about how that all works...but I guess I'll find out.
04-07-2014, 09:11 PM   #13
hurricman
 
Join Date: Apr 2014
Hello. My mother has Crohn's disease and has been receiving Remicade infusions for six years now. She only recently found out about the Remistart program online, and was shocked to find out that the infusion center knew about it all along never told her about it. Needless to say, we are quite angry to have paid so much for the Remicade infusions when so much of the cost of the medication could have been covered by the program - particularly as our family has fallen on some hard times of late. My mother has asked about possible recourse for past eligibility on Remistart, but has not been able to get anywhere due to the 30-day policy. Does anyone know of any ways of recourse or have any suggestions?

Thank you in advance for any help you can provide.
04-07-2014, 09:55 PM   #14
heyjude94
 
Join Date: Oct 2011
Location: Rockford, Illinois
Hey there. I tried to get remistart to reimbuse me for past treatments and they would not because it had been over the 30 day thing. But I know now to do it the first thing in the year. I want that first EOB of the year to come back with my first remicade treatment. And they reimbuse me amount that is my $400 deductible and my $1200 out of pocket..I got a check for $1500. They take some out for their deductible and some is taken out beause it's not all the remicade....other charges. Hope this helps..
04-22-2014, 07:02 AM   #15
Fosterfamily2303
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Remistart has been a blessing for me as well. I have to meet two ded. From my ins. $1500 for them to even pay 80% and i pay 20% and then ANOTHER $4500 for them to pay 100%. my one infusion in am ingusion center NOT a hospital cost $10,000. Needless to say my responabilty is $2600.00 so with the first one i meet my first ded. And Remistart helped pay most..i had to pay $151.00 and then 2 more infusions with the help of Remistart i will then meet the other ded. Andy ins will have to pay 100& for there on.

I am guessing next year the ins will raise the ded. AGAIN. i HATE ins.
05-29-2014, 02:52 PM   #16
texasagg02
 
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I just looked at my insurance coverage online and it appears that they will not cover Remicade. =( I am going to look into the Remistart program for sure!!!! This is crazy to me, if a dr says this is the best med why insurance will not pay!!!! My insurance also refused to pay for Pentasa…. not loving them right now!!!!!!
05-29-2014, 03:15 PM   #17
Fosterfamily2303
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I just looked at my insurance coverage online and it appears that they will not cover Remicade. =( I am going to look into the Remistart program for sure!!!! This is crazy to me, if a dr says this is the best med why insurance will not pay!!!! My insurance also refused to pay for Pentasa…. not loving them right now!!!!!!

Remistart will only cover if ur ins covers part. But if u Contact the man. (Johnson and Johnson I think) they will pay 100% if ins won't cover or if u uninsured
05-29-2014, 03:34 PM   #18
texasagg02
 
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good to know fosterfamily!!!!! Do they ask your income though? My husband makes a good amount of money but we have 2 mortgage payments so we do not have extra cash laying around for expensive meds. =) I looked into Pentasa's program and they would help but only if income was less then 60K a year for a family...
05-30-2014, 04:40 AM   #19
Fosterfamily2303
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good to know fosterfamily!!!!! Do they ask your income though? My husband makes a good amount of money but we have 2 mortgage payments so we do not have extra cash laying around for expensive meds. =) I looked into Pentasa's program and they would help but only if income was less then 60K a year for a family...
I belive so...but I thought my husband's income was high (that's our only income) and I still qualified with help with remistart. I depended on the income and how many in a family I believe
06-06-2014, 07:54 AM   #20
texasagg02
 
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Got the call, insurance is paying and the nurse I talked to said the Remistart program will cover what I have to pay! So excited! Starting on Tuesday!!!
07-06-2015, 12:28 PM   #21
jbair
 
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My stepson has Crohn's and was just recently diagnosed. He will be starting remade infusions soon. His mother had mentioned the remistart program but she said it can only be processed through one insurance company to qualify for the reistart program. Anyone know anything about this? I'm gonna call about it, but I thought I would see if anyone here knows. Also, anything we should know, keep in mind, good tips, inside info, lifesavers, etc when dealing with infusions??? This would be super helpful! Thanks in advance.
07-06-2015, 01:12 PM   #22
Clash
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I'm not sure about the one insurance provider clause. You might read through all the info at the remistart site as it may tell you.

Also, I'm not sure how old your son is but mine was 15 when starting infusions. His were done on site at the GI office in the GIs IV lab so really geared for kids. They provided snacks and drinks. They have a big flat screen tv and the kids are welcome to bring movies, they also had a Wii and Xbox and they really cater to the kids. My son always brought his laptop and any home work since infusions in the beginning can take upwards of two hours. They provided warm blankets as well since it can get chilly in the lab.

They can also be done in hospital iv labs and depending on the hospital my be geared toward the kids. C had a couple infusions while admitted so his were in room but the children's hospital he was in does have an iv lab geared toward kids.

I always make sure to bring a jacket since the waiting room is chilly, a good book, couple magazines and some snacks and drinks for myself.

The procedure isn't bad just an iv then infusion. Also, an advantage of remicade is that they can do any lab draws they need through the iv before infusion so only one stick, which was initially good for my son as hue was so new to all the needle sticks that come with having CD.

Good luck!
07-06-2015, 01:22 PM   #23
jbair
 
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Thank you. I called and she said that there is NO RULE against having 2 insurance providers or 15 for that matter. Its just that if there are 2 providers and they end up jointly paying 100%, then, of course, they wouldn't pay anything since there is nothing left to pay. But, if insurance didn't pick up everything, even after 2 insurances, then they would pay the rest minus the $5 co-pay.
07-06-2015, 09:52 PM   #24
jbair
 
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...And, my stepson is 13 and only 68 lbs. Poor guy! He is also on Norditropin growth hormone injections.
07-08-2015, 02:03 PM   #25
pdx
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My 12-year-old was 69 pounds six months ago, just as she was starting Remicade. Remicade has really helped her, although we didn't see results for several months, since it took a while to get the right dosing for her. She also takes methotrexate. The thing that really helped her gain weight, though, was EEN--exclusive enteral nutrition--basically a liquid diet using special formula, which some kids drink and other kids get through an NG tube. It's helpful for gaining weight, but also helps to reduce inflammation in the intestines. You can find a lot of info about this over on the "Parents of kids with IBD" group on this forum. My daughter gained 15 pounds during 8 weeks of EEN. She's continued with some supplemental EN after those 8 weeks, and she's up to 90 pounds now.

I hope that Remicade works well for your stepson!
__________________
Daughter E (15) dx with Crohn's 12/18/14 at age 12

Current treatment:

Remicade started 12/24/14 (currently on 9 mg/kg every 6 weeks)
Oral methotrexate restarted 12/2/16 (15 mg weekly)
vitamin D, folic acid, multivitamin, Prozac

Past Treatment
90% EN via NG tube 2/9/15 - 4/2/15
50% EN via NG tube 4/3/15 - 4/18/15
Supplemental EN via NG tube 5/7/15-6/19/15
Budesonide 3/3/15-6/30/15
Oral methotrexate 3/13/15 - 5/14/16 (15 mg weekly)
Topical clobetasol for Remicade-induced psoriasis
03-29-2016, 05:06 PM   #26
Madhu
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Hi everyone,

Hope someone sees this. My husband recently enrolled in the Remistart program and we just got info that he is approved. We opted not to receive the Mastercard rebate card and that the payment be directly sent to the infusion provider. I was wondering how this happens.

1. Will the infusion provider send them the EOB, or should we do it on our own?

2. Since we do not have the rebate card, will we get any intimation from Remistart that payment has been sent to the infusion provider?

I will also check with the infusion center on this. Would love to hear your inputs!
__________________
Hubby dx with Crohn's in Feb 2015, in remission from Feb 2016 to Feb 2017.
2 anal fistulas (setons placed in June 2015 and removed in Feb 2016)

Mild flare in Mar 2017. Remicade schedule adjusted

Current Meds - Remicade 10mg/kg
03-29-2016, 05:27 PM   #27
Clash
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When my son started remicade and the remistart program, the GI office (IV lab in office) took care of sending the EOB.

I don't remember that we got separate receipt of remistart paying infusion center. I believe it would just come in one statement(ie ins paid this amount, CO payment assistance paid this amount and then amount due by you).

It's been awhile though so things could've changed.
05-03-2016, 09:39 AM   #28
atruelove
 
Join Date: May 2016
Location: Indiana
I am new to this forum. I was diagnosed with Crohn's disease 23 years ago. Had the bowel resection, numerous fistulas and abscess surgeries also. Been on Remicade for the past 4 years and have found great success with the treatment. But I was wondering if anyone has had problems getting their reimbursement form Remistart.
Typically it takes about 45 days to receive a check for reimbursement until this time. I had an infusion on Jan 13, 2016 and have been told by the company is was approved and should receive a check within 5 - 7 days. That was an April 1, now they say they are having printing issues with the checks. Then it was resolved last week. Still no check and the printing issues have started again (or so they say). Kind of need that reimbursement of $1700.00. Any advice. Anyone else having this same issue??
05-03-2016, 10:11 AM   #29
Clash
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atruelove, ours wasn't set up that way. We never paid anything out of pocket. The GI office/Infusion lab would bill the insurance for the infusion and contact remistart for theirs part. I think the second or 3rd year we started having to fax the EOB to remistart then they would release the money to the GI lab/infusion center.

Hopefully, someone else will be by who has done the process similar to you will be by to post.

Good luck.
05-03-2016, 10:25 PM   #30
Madhu
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atruelove, my husband's recent infusion in April was our first experience with remistart. We did not pay anything out of pocket. The infusion centre would send them the eob and we selected the option for them to receive the money directly. So we did not get a rebate card either. The claim is still under processing though, I have no idea how far it is done. Will know more details in June I guess

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