Stopping Evenity

Here is the difference. Yes, the drug company sends drug to infusion center. But, in the new scenario, drug company charges me directly so the drug cost is applied to my drug coverage not my medical coverage even though shots are given through infusion center . The former way, Doctor received drug, administered and sent billing to insurance company which was applied through my medical coverage, not drug coverage. I then paid my insurance portion and amount paid went to out of pocket cost. If I pay directly for drugs, it is automatically applied to drug coverage and the out of pocket expenses do not apply for drug costs..

My evenity an one shot of Prolia were given in my endocrinologist's office but he is part of a county wide medical group

I would reconsider my choice of insurer! Original Medicare as your primary insurer plus a senior suppliment insurance is like GOLD! Isn’t your ability to receive best medical care worth a little more money allocated to your health insurance?

@dbamos1945 I have Traditional Medicare plus a supplement to cover the “gaps” in coverage of Medicare Part B. I’ve been told that it’s not easy to go from Medicare Advantage to applying for and receiving a supplement to go along with Original Medicare. The reason? After your initial period when you become eligible for Medicare no supplemental insurance company is allowed to exclude you for preexisting conditions. So let’s say at age 65 you selected Traditional Medicare Parts A and B and applied to United Health Care for Supplement Plan G. You will be approved by United Health for that Supplement. But if you went with a Medicare Advantage plan at age 65 and then at age 70 decided to switch to Traditional Medicare and apply for a Supplemental plan with United Health Care they are allowed to turn you down for a pre existing condition. It’s worth it to ask these questions before switching insurers.

@susanew This is disturbing and disappointing for you. I wouldn’t want to get my prescription for Evenity through my prescription plan and pay huge prices when I know Evenity is covered at an infusion center through my medical plan. Can you ask your doctor for a referral to another infusion center where you can get Evenity under your Medicare Advantage medical benefits?

People seem to have missed these statements by @susannew:

" 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."
And
"doctor’s office now insists all Medicare HMO advantage patients use the pharmacy portion of insurance. "

It seems that the problem is with the HMO's that are not paying bills in a timely manner. Therefore, doctors are fighting back.

@naturegirl15: Thank you for this response. I had never heard that senior suppliment insurance had pre-exist decline ability. All the more reason to evaluate every health insurance decision and not be convinced a low or 0 monthly premium is your best decision for continued best health care.
I guess I am lucky to have Original Medicare with UHC sr. suppliment -if Medicare pays a claim then UHC also pays on the claim! Medical insurance coverage needs to be verified before a procedure/ $$rx/ etc. just to cover the unknown. We all need to be aware that It can be a tricky and confusing decision.

Does the new Medicare cap on drugs at $2000 per year not include you?

Here is the problem …Evenity with the Insurance discount is $823 per treatment on the drug portion. I need 5 more treatments …so we are talking over $4,100 plus the price goes up after $2,000 cap reached covering only two treatments if on drug plan. There is no help from Angen if getting Medicare and no charitable organizations are donating to Evenity treatment this year. I will ask my doctor to try a local hospital infusion center to see what costs would be.

Do you have original Medicare and a supplemental?

No ..I have an HMO Advantage Plan with Humana. I have no pre-existing conditions except Osteoporosis and only take 1 med for thyroid.