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Stopping Evenity
I have had 7 treatments but now have decided to stop due to the fact my doctor’s office now insists all Medicare HMO advantage patients use the pharmacy portion of insurance. What this means is that I buy drug and pay out of pocket and have it sent to doctor’s office. Before, they provided drug and billed insurance under medical portion and I paid remainder. Doing it the new way will double my cost because I will no longer be able to apply payments to out of pocket expense when using drug portion of insurance.
My question is, what can I use now instead of Evenity. Reclast?
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Although I don't have an answer to your last question, I wonder why he can't have the evenity sent to an infusion center instead of his office.
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1 ReactionHis office is an infusion center. But they are saying billing is too difficult with Medicare HMO advantage plans (especially Humana) with them having to resend billing due to multiple denials for reimbursement. Have no idea of the billing particulars.
Have you contacted your insurance provider? I wonder if there is another infusion center or doctors office who has a more successful track record with your insurer. Is your doc part of a large medical group? What does the billing department say about your insurance provider and the difficulties with reimbursement?
Because your treatment plan has not been completed I wonder if your prescribing physician is aware of this change.
I told him.
Has he come up with another treatment plan for you? I noticed that you are asking for comments on drug sequencing after Evenity.
I am … I will see doctor on Friday. I requested a referral to a different rheumatologist but maybe infusion center might work.
Good luck. I feel angered just reading about your struggles to get treatment!
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2 ReactionsThis is one of the "downsides" to Advantage plans - the doctors have incentive to minimize the costs charged under Medicare Part B because that affects their bottom line.
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1 ReactionAll infusions are done in an infusion center, I do not know of any doctors that can or are doing it in their offices. My infusions are sent from the drug company to the infusion center. Always. I would investigate this further. I have even found drug companies offering programs for people who are disabled or limited income etc. I found I had to be my own advocate when it came to a lot of his stuff and do research on my own be an advocate so you can get the care you deserve to have to help you with the issues that you are desperately needing help with, don’t give up.