Posted by: Renee ®
01/16/2008, 07:24:53
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Hi Teresa,
My injections without insurance run about $1,500. $2200 seems a little steep to me, but everything is much more expensive on the West and East coast. With insurance, I pay, about $25. I don't know. See what kind of response you get from this post...Renee ADSD/ Austin, TEXAS
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Posted by: Laurie ®
01/16/2008, 12:59:05
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Hi, Teresa,Some MDs (I know of one in NY and one in Chicago) will charge a flat fee around $500-$800 for those without insurance. Most doctors "charge" a certain amount, yet insurers will pay anywhere from 20-80% of that charge yet they accept that percentage as part of their contract. So, ironically, MDs can sometimes make more $$ of those without insurance. I might look at your EOBs (explanations of benefits) from your prior injections w/ BC to see what they actually paid and then try to negotiate with your MD to pay something similar. It may cost more if you have it done in a hospital setting so you might consider avoiding that (also avoid MDs who need neurologists or other folks to read the EMG -- plenty of ENTs can do it themselves from beginning to end) as it only adds to the charges. A third option is to buy into COBRA with Blue Cross from your prior employer as the montly premiums will surely be lower than that Botox cost, especially if you were with a large group. I think you have at least 60 days to decide to buy into COBRA from your employer and have it be retroactive to the day you lost coverage. If not much time has elapsed, I'd look into that. Also, if you prior employer didn't inform you of this option, you may even have a longer time to apply (i.e., from the day they finally do inform you), but that may vary. The thing with COBRA is it would also avoid SD and any other medical conditions becoming "pre-existing" in the future. If they become pre-existing and you have a lapse of insurance coverage (usually has to be greater than 63 days, in some cases 90), treatment for those conditions may not be covered by your insurance at all for six months, or up to a year (varies by state). The key is usually to avoid a gap in coverage greater than 63 days in coverage (for Rhode Island it might be 90). So it can be worth paying premiums out of pocket for a couple of months before you get a new job/new coverage. If you're actually in MA, it's my understanding that they also have some sort of mechanism by which individuals can buy their own coverage as a move toward everyone in MA having insurance. But if you're in RI, the programs would be different. In any case, if you're not able to tackle the insurance issue, you may be able to negotiate a lower rate for one or two injections, especially if you're working with an MD who has a private practice. or a heart! Good luck. -Laurie
Modified by Laurie at Wed, Jan 16, 2008, 13:33:44
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Posted by: Teresa G ®
01/16/2008, 14:50:52
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Thanks Laurie (and Renee)-Unfortunately, I don't have the Cobra option. I got my health insurance covered by a divorce settlement that ran it's course and expired. I did call my doctor's office today and asked for the itemized charges. My doctor does administer Botox in conjunction with Mass. Eye and Ear and their neurologist. The charges are as follows: Physician's charge ($555.), Hospital charge ($448) and Botox charge($1250.) I think the charge for the Botox is high. Do you get Botox injections yourself? And, if so, does your doctor use a neurologist to assist? I always thought that the attending neurologist was necessary. Teresa
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Posted by: Laurie ®
01/16/2008, 16:35:12
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Hi, Teresa,To answer a few questions... I do get Botox injections from an ENT every 3-4 months. He does the entire procedure himself. No need for a neurologist or anyone else in the room to assist. I just mentioned that as I know most do it alone, but some use a neurologist. The break-down of charges is not entirely clear as that's probably not quite how it'd be submitted to an insurance company - they would need procedure codes/descriptions beyond "physician's charge" "hospital charge," etc. As for the Botox itself, from that I can only guess they are charging you for an entire vial (versus a charge per unit - where they would call all patients in on one day, etc.) so you could ask about that as well. Really, for SD, you're only using 1-20% or so of a vial. You can contact Allergan's patient assistance program but all they do is provide the Botox... they don't cover any of the physician's or hospital charges, etc. I'd still investigate your rights under Cobra or under direct pay continuation of Blue Cross. Federal and State laws may trump a settlement agreement so I wouldn't necessarily rule that out. But no one will advertise these things to you upfront. Of course, I'm not a lawyer and don't know the specifics, but it may be worth investigating through the source/company of your husband's insurance. You would have to pay the premiums yourself, of course, but would at least get it at a group rate. Also might not be any harm in getting an injection or two with a different MD who is willing to negotiate a flat fee and/or doesn't do it along with a hospital, neurologist, etc. as the cost could be lower. Good luck,
Laurie
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Posted by: Teresa G ®
01/17/2008, 15:42:54
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Laurie-I guess I've been pretty naive about the difference in how physician's charge insurance co. vs. an individual patient. And, yes, the charge for the Botox itself seems very high considering the injection is carried out assembly line style. I've already contacted Allergan, have downloaded the app. form and will get that in the works. I'm also going to contact the head of my regional SD support group to get the names of some ENTs to start calling. I think the Cobra coverage is out of the question because it's been 5 months since my insurance was cancelled. I thank you for all your suggestions..........I'll post again when I get things worked out. Maybe my research into other options can help somebody else in my situation. Teresa
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Posted by: hoarse whisperer ®
01/16/2008, 14:35:59
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Allergan, the makers of Botox, have expanded their Patient Assistance Program to provide Botox at no charge to financially eligible patients who are either uninsured or underinsured. More information and applications are available on their website or by calling their hotline. www.BotoxPatientAssistance.com
1-800-44-BOTOX Lori
AB/SD and VCD since 2003
Dallas, Texas
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Posted by: hoarse whisperer ®
01/16/2008, 20:15:20
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Hi Teresa,This price seems outrageous. Also, I've had Botox injections from three different ENT doctors and a neurologist has never been present or needed. These doctors were all "affiliated" with a hospital, but the procedure was done in the doctor's office and I was never charged any "hospital fees". The total cost for my September 2007 Botox injection was $951.00. The "negotiated rate" that was charged to and paid by my insurance company was $477.48. They also received a $30.00 co-payment from me. So... for a $951.00 charge, they accepted $507.48 as total payment. You should be able to find out from your previous Explanation of Benefits (EOB) form exactly how much your insurance company paid as their negotiated rate. If you don't still have this form, you can call Blue Cross for the information. Then, you should ask the doctor's office if they will accept the same amount directly from you as they would have received and accepted as payment in full from your previous insurance carrier. I used to be on the board of directors for a medical facility and we offered the "discounted insurance rate" for uninsured patients if they would pay in full at the time of service. If you really like this doctor and his injections have worked for you in the past, I can understand your wanting to remain his patient. However, if they won't work with you on the price, you really should check around for an experienced ENT who offers better prices, doesn't need a neurologist to assist, and doesn't require a hospital setting or services. Good luck! Lori
AB/SD and VCD since 2003
Dallas, Texas
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Posted by: Teresa G ®
01/17/2008, 15:55:44
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Lori-I'm going to call Blue Cross and ask for a summary of the charges for the last few injections and then present my case to my Doctor. If he doesn't budge, I'll move on to somebody else. It's just a bit scary to try someone new after almost 10 years. I'll ask my local support group for recommendations. By the way, I have family in Dallas and plan on visiting them in a couple of weeks. If you don't mind, could you send me the name of your ENT? My email address is t.giannini@cox.net. Thanks for posting. Teresa
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Posted by: hoarse whisperer ®
01/17/2008, 19:01:50
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Here is the information on both the excellent ENT doctor and the speech therapist that I use. If you have time or are able, they are both worth visiting. I've visited many specialists and I think these two are the best in the DFW area for SD patients.This contact information was taken directly from the NSDA website, which is a great referral source. Barbara Schultz, M.D.
UT Southwestern Medical Center at Dallas
5303 Harry Hines Blvd.
Dallas, Texas 75390
Tel: 214-645-8898
Fax: 214-645-8894
Specialty: Otolaryngologist (ENT)
Forms of Dystonia Treated: Spasmodic Dysphonia
Administers Botulinum Toxin for: Spasmodic Dysphonia
Notes: Dr. Schultz has hospital affiliations with Zale-Lipshy University Hospital, St. Paul’s Medical Center, Parkland Memorial Hospital, the Veteran’s Administration Hospital, and Baylor Medical Center. Susan Shulman, M.S., CCC-SL/A
Speech Pathology Services
12700 Hillcrest Rd. Suite 258
Dallas, Texas 75230
Tel: 972-233-4660
Fax: 972-702-9509
Specialty: Speech-Language Pathologist-Therapist
Forms of Dystonia Treated: Spasmodic Dysphonia
Additional Procedures: Speech Therapy
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