Hospital vs. Prescription?

SoozyCue

I am on Medicare Parts A and B with a secondary insurance and also with a Part D Prescription Plan.

I am having a BMX August 1 and chemo/Herceptin/Tamoxifen after.

Can anyone tell me what parts will fall under "hospital" or "office visit" and what will fall under "prescription"?

Is everything during the BMX inpatient stay automatically "hospital" or will part be "prescription"? And then reverse question for chemo... is any "office visit" or all "prescription"?

I'm on disability from two other serious medical issues that already put us under, one salary and huge medical bills. We moved to use $55K in house equity to pay off medical bills and here we are already $20K in debt again with no more safety nets. I'm terrified of facing more huge bills if a lot falls under "prescription".

NotVeryBrave

I have a standard PPO type of insurance plan. My surgery was billed as outpatient even though I did spend the night. The only thing I paid for it was the outpatient surgery copay.

Chemo was given in the infusion center next door to my MO's office. It was billed as a specialist copay - same as what I paid for an office visit. The medications were not billed separately.

I was astounded by what amounts were actually billed to my insurance. Even with contracted rates, it was crazy. I think the TCHP rounds were something like $28,000 each!

There is enough fear and uncertainty with this diagnosis. You should be able to discuss your financial concerns with a social worker and/or financial advocate where you are seeking care. I had to reach out to the financial person twice - once when I started getting huge bills (something wasn't properly approved) and again when I couldn't get coverage (to switch from Neulasta to Neupogen).

SoozyCue

Thank you. It will be a huge relief if my insurance is spelled the same way, The secondary insurance pays any co-pays for hospital and office visits. Prescriptions are the only place that I have a co-pay, and my co-pay would be about a third of the herceptin, which I read is $5,000 a month.

SpecialK

All of my infusions, 6 TCH and an additional 11 Herceptin only (I was treated before Perjeta was approved), were covered under medical because these drugs were infused in an oncology center. The only drugs covered by prescription coverage were the ones sent to the regular pharmacy to take at home, such as pre-chemo steroids and anti-nausea meds, relative inexpensive standard meds. Your center or hospital should have a financial services person who should be able to lay this out for you in advance of your treatment so that you are fully informed and don’t have to stress about this while trying g to focus on treatment. Good luck