topic Re: Infusion Centers in Wellness

Infusion Centers

SilleeMee — Sat, 02 Sep 2023 18:41:18 GMT

I know I can ask this question to my insurance company but I thought I would ask here first.

I go to an infusion center to get my medication injected (not infused) every month. I don't see a doctor but a nurse gives me the injection. Is it normal procedure to have to pay a copay for this sort of thing? I'm new to this infusion center situation.

Re: Infusion Centers

KingstonMom — Sat, 02 Sep 2023 18:44:53 GMT

@SilleeMee

DH has infusions at an infususion center every 6 weeks and we don't have a co-pay.

We have Medicare and B/C B/S Federal Eployees insurance, if that makes any difference.

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 18:47:16 GMT

@KingstonMom

I have a Medicare Advantage plan.

Re: Infusion Centers

KingstonMom — Sat, 02 Sep 2023 18:49:08 GMT

Then you shouldn't have a co-pay.

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 19:12:55 GMT

@KingstonMom

That's what I thought. Thanks.

Re: Infusion Centers

chrystaltree — Sat, 02 Sep 2023 19:22:43 GMT

That's a question for your insurance company because coverage and benefits vary.

Re: Infusion Centers

elated — Sat, 02 Sep 2023 19:22:53 GMT

@SilleeMee I would go to the website where you get your insurance and they should list your benefits. This should answer your question.

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 19:34:13 GMT

I'm going to call my insurance company to ask them. Just wanted to know here first. Thanks!

Re: Infusion Centers

Icegoddess — Sat, 02 Sep 2023 19:51:03 GMT

@SilleeMee does your Advantage plan require you to go to an in-network facility? I had a friend rn into a problem when their Medicare insurance decided the nurse who administered her infusion at home was no longer in-network. They wanted HIM to administer her infusion. I don't know what became of that situation as he has since died and I'm not in touch with her very often and I wouldn't bring it up anyways. As far as I know, we don't have infusion centers.

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 19:57:44 GMT

@Icegoddess wrote:
@SilleeMee does your Advantage plan require you to go to an in-network facility? I had a friend rn into a problem when their Medicare insurance decided the nurse who administered her infusion at home was no longer in-network. They wanted HIM to administer her infusion. I don't know what became of that situation as he has since died and I'm not in touch with her very often and I wouldn't bring it up anyways. As far as I know, we don't have infusion centers.

@Icegoddess

Yes, the infusion center is in-network.

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 20:00:32 GMT

@elated wrote:
@SilleeMee I would go to the website where you get your insurance and they should list your benefits. This should answer your question.

@elated

I just looked at my coverage on the website and here's what I found but it doesn't say anything about 'infusion centers'.

$0 COPAY

Your plan includes coverage for drugs covered by Medicare Part B. You typically receive these drugs at your doctor or health care provider's office, and they aren't self-administered. This includes certain vaccines, cancer drugs, insulin and injectable drugs.

Re: Infusion Centers

millieshops — Sat, 02 Sep 2023 20:02:59 GMT

@KingstonMom I have a Medicare Advantage plan, but mine does have co-pays.

Re: Infusion Centers

Kachina624 — Sat, 02 Sep 2023 20:04:53 GMT

@SilleeMee. Even Medicare Advantage Plans can vary greatly. I bet mine differs from yours. Don't use what someone else pays as the sole indicator.

Re: Infusion Centers

Carmie — Sat, 02 Sep 2023 22:51:00 GMT

Advantage plans are not all the same.

It is possible to have a copay. It depends on your unique benefits.

Do you have a benefit booklet? You should be able to look it up in there, or just call customer service.

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 22:58:02 GMT

@Carmie wrote:
Advantage plans are not all the same.

It is possible to have a copay. It depends on your unique benefits.

Do you have a benefit booklet? You should be able to look it up in there, or just call customer service.

@Carmie

I looked it up on my plan's website. This is what is says and it appears that I don't have a copay but I'm not entirely sure b/c it doesn't mention 'infusion center' and it only say's 'provider's office'. Same thing? IDK.

"$0 COPAY

Re: Infusion Centers

kindred cats — Sat, 02 Sep 2023 22:58:05 GMT

Seems to me the actual Infusion Center has already checked your particular insurance and would only ask for a co-pay if it was required by you.

Good luck w/your injections @SilleeMee ..

Re: Infusion Centers

SilleeMee — Sat, 02 Sep 2023 23:20:18 GMT

The upcoming injection will be the second one out of twelve monthly injections. What's confusing me is that I did not get charged a copay for the first injection so why now? It's the pre-registration online which has a place to pre-pay the copay. That wasn't there on the first pre-registration for the first injection.

I'm not going to pre-pay that copay. I will wait and see what my ins co says on the phone. Something doesn't sound right.

Re: Infusion Centers

Toppers3 — Sat, 02 Sep 2023 23:37:52 GMT

@Icegoddess wrote:
@SilleeMee does your Advantage plan require you to go to an in-network facility? I had a friend rn into a problem when their Medicare insurance decided the nurse who administered her infusion at home was no longer in-network. They wanted HIM to administer her infusion. I don't know what became of that situation as he has since died and I'm not in touch with her very often and I wouldn't bring it up anyways. As far as I know, we don't have infusion centers.

Hi @Icegoddess ,

Most of us probably wouldn't even be aware of an infusion center unless either we needed one or one of our family members needed to use one.

From my own personal experience, they tend to primarily be located in hospitals, in either a separate department or as part of another dept.

I went there to receive out-patient IV antibiotics but patients can go there for various reasons.

Re: Infusion Centers

Icegoddess — Sun, 03 Sep 2023 00:54:51 GMT

@Toppers3 wrote:
@Icegoddess wrote:
@SilleeMee does your Advantage plan require you to go to an in-network facility? I had a friend rn into a problem when their Medicare insurance decided the nurse who administered her infusion at home was no longer in-network. They wanted HIM to administer her infusion. I don't know what became of that situation as he has since died and I'm not in touch with her very often and I wouldn't bring it up anyways. As far as I know, we don't have infusion centers.
Hi @Icegoddess ,

Most of us probably wouldn't even be aware of an infusion center unless either we needed one or one of our family members needed to use one.

From my own personal experience, they tend to primarily be located in hospitals, in either a separate department or as part of another dept.

I went there to receive out-patient IV antibiotics but patients can go there for various reasons.

@Toppers3 , we may have them then. I have another friend who gets infusions and I think she goes to the hospital for hers. I just didn't know there was a separate department for it. I was envisioning stand-alone places like the Urgent Care places.

Re: Infusion Centers

Carmie — Sun, 03 Sep 2023 01:43:57 GMT

@SilleeMee

Infusion centers could be

pharmacy based
hospital based
office based
stand alone

The benefits could be different depending on the type of infusion center.

I would not pay anything until I was sure I owed it.

Check with your insurance company. If you do owe a copay, ask if you received the services from another type of provider if it would be paid 100%.

They should be able to provide you a list of participating providers if you ask and tell you if any of them can provider services at 100%.

It is possible that you will have a copay anyway no matter where you go.