IVIG & United Healthcare

[GraceUnderPressure]

I understand that United Healthcare covers IVIG & we have a doctor willing to do it. But the amount our ds18 will get costs $15K. If our plan is the normal 80/20 kind, is this something that we will have to pay 20% of? That's still a lot of money! We can swing it once, but we'll be broke after that & as long as ds has had it, odds are good we will have to do multiples! How do we afford this?

[peglem]

I understand that United Healthcare covers IVIG & we have a doctor willing to do it. But the amount our ds18 will get costs $15K. If our plan is the normal 80/20 kind, is this something that we will have to pay 20% of? That's still a lot of money! We can swing it once, but we'll be broke after that & as long as ds has had it, odds are good we will have to do multiples! How do we afford this?

Do you have an out-of-pocket maximum? Course, its the end of the year, then you'd have to pay again next year. But, if you hold off till January, meet the out of pocket maximum, then the rest should be covered at 100%. At least that's how our policy works.

[momaine]

I understand that United Healthcare covers IVIG & we have a doctor willing to do it. But the amount our ds18 will get costs $15K. If our plan is the normal 80/20 kind, is this something that we will have to pay 20% of? That's still a lot of money! We can swing it once, but we'll be broke after that & as long as ds has had it, odds are good we will have to do multiples! How do we afford this?

the health insurance company settles for a lot less than they are billed for. They billed like 12k for my dd but recieved under 8K. I believe you would only pay the 20% of what the insurnace company accepts from the doctor as the price they settle on.

[monarchcat]

We are facing a similar situation (we have Cigna, though). We are going for our first IVIG in a couple weeks and since our plan is 80/20 we will have to pay the 20% as well as any remaining balance toward meeting the $400 deductible (which I believe we have already met for my son). Then in 2011 we will have to pay 20% of the first treatment, but for the second treatment we will cap out the $3500 individual out-of-pocket maximum and everything will be covered 100% after that. I think we will be doing at least 2 treatments in 2011 (and one in 2010).

 

It's expensive any way you slice it, though. I'm soooo glad insurance has approved, but we're looking at probably at least 6k out of pocket when all is said and done.

[GraceUnderPressure]

I need to dig up our paperwork on our plan to see what our out of pocket max is, but it is probably similar to y'all's. If our enrollment date is in June of each year, is the insurance's fiscal year still likely to begin with Jan?

[peglem]

I need to dig up our paperwork on our plan to see what our out of pocket max is, but it is probably similar to y'all's. If our enrollment date is in June of each year, is the insurance's fiscal year still likely to begin with Jan?

Oh, your yearly deductible will run a year from policy start- so you may have another 6 months or so. When I was teaching we went from September through August.

Edited November 30, 2010 by peglem

[GraceUnderPressure]

Thank goodness! I've been agonizing because we paid just shy of a thousand bucks out of pocket for an EEG to meet his deductible (I picked a great year to go with the higher deductibles ) and it would really hurt to meet it again so soon. Gotta dig up that paperwork... (unfortunately the state of my house reflects the state of my mind plus 5 stay at home kids & an oblivious DH - which is to say TOTAL CHAOS! )

[peglem]

Thank goodness! I've been agonizing because we paid just shy of a thousand bucks out of pocket for an EEG to meet his deductible (I picked a great year to go with the higher deductibles ) and it would really hurt to meet it again so soon. Gotta dig up that paperwork... (unfortunately the state of my house reflects the state of my mind plus 5 stay at home kids & an oblivious DH - which is to say TOTAL CHAOS! )

You could just go to myuhc.com and get the info.

[GraceUnderPressure]

True - I just don't remember my password. (That's ok - I wrote it down on a piece of paper - somewhere )

May just have to call, BUT I'm going to get off my posterior and go see what I can find. Greatly appreciate the info! It is encouraging!

[Priscilla]

I understand that United Healthcare covers IVIG & we have a doctor willing to do it. But the amount our ds18 will get costs $15K. If our plan is the normal 80/20 kind, is this something that we will have to pay 20% of? That's still a lot of money! We can swing it once, but we'll be broke after that & as long as ds has had it, odds are good we will have to do multiples! How do we afford this?

 

 

We have UHC. Our out of pocket max is $2000/yr. Will depend on ivig pharmacy but we paid NOTHING out of pocket. We had 4 ordered at once, so the pharmacy ate the $2000 out of pocket max because they would get 100% for the last 3. Each charge was like $25,000 but they got paid about $10,000. I am VERY GRATEFUL to UHC. I am gonna write them a letter. I think that I also read they are the first insurance co to recognize PANDAS as a diagnosis for IVIG. Hope the others follow suit.

[thereishope]

UHC has many different plans so be sure to look up your individual one. My UHC deductible for an individual in network is $3000. I'm glad UHC is supportive of PANDAS since I don't care for them for anything else:)

[Healingthedude]

UHC has been good about covering IVIG for us. We go to a hospital that is in network for the infusion,

then we only have to pay for the deductible. (we only get 60/40 out of network.)

[saidie10]

Grace! So glad you guys are going to get IVIG! I have been MIA for a while but it was nice to pop in here and see you are moving forward with it. Sorry you are dealing with the financial issues. It is always so hard. We are out 20% to each time and are looking at monthly now possibly...yikes!