Blue Cross Blue Shield Informative - Insurance companies and cost of Remicade
NORTH CAROLINA -- After 2 years of an undiagnosed illness, I was referred to a University Hospital. First visit was basic - previous history, getting new bloodwork done, etc. Second visit, doctor starts me on an infusion of drug Infliximab or "remicade". I had never heard of it, but went ahead with the process. Tiny bag - 400mg, no big deal, it was just a slow drip that was all. Went back again next month for another dose, same amount. Doctor said bloodwork looked good. I was feeling much better. Doctor says I have an immune disorder. Go again 3rd month. Feeling like a human being again. Doctor is glad I've improved. New bloodwork looks really good. BIG problem. Blue Cross sends me statement for "pharmacy" charges it will not cover for $38,000 for (2) Remicade infusions. And they still have one more bill for about $20,000 yet to send me!!. Found out the hospital failed to get a pre approval from insurance company before using this medicine on me. Several hospital officials told me, since it was the hospitals fault, I would not have to pay. The drug would just be replaced by the drug representative. Not so. My statements are now in collection agency hands
and I have to find a lawyer. I am at my wits end. Insurance company paid for everything but the medicine. Oh, I checked with a local pharmacy to see if I could by "remicade" if I had a prescription. Yes, I can, but it would be in a 100mg vial at a cost of approximately $825.00 to me. Multiply that times four and you still don't get $20,000 like the hospital was charging my insurance company for 400mg.