Hello everyone. Just curious if anyone can give me a rough estimate of how much a regular visit to the CF Center is. I'm sure it varies but I'm just looking for a general idea. I have always managed to work and stay just under the income limits for the girls to get medicaid or chip or some type of medical assistance. I've never received the first bill from a CF Center so I have no clue what the cost is. Now I have a great job offer that I really really want to take but I'm scared. It will definately kick us over that limit and I feel like I'll be jumping off a building without a safety net. If I take the job the insurance will pay 80% of the visits after a $500.00 deductible. I'm just curious as to what my 20% will be. I also have to consider the premiums for the insurance and the prescription copays. It's frightening. I want the job but I don't want to put the girls at risk either. I don't ever want to be in a position where I can't take them to the dr or get a prescription because I can't afford it. At my current job I'm working all hours of the night and on weekends and the new job would be 8-5 M-F so I would be home a lot more too. And I'd be making more money but I'm afraid I'll go in the hole because of the extra medical expenses. I'm trying to consider every possibility before I make the leap. Thanks for any info.
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Average cost of CF Center visit
- Thread starter ReneeP
- Start date
Things to look at:
-Out-of-pocket maximum for the family.
-Lifetime maximum/maximum per year
-Rxs
-What is the copay? Are there tiered copays (different amounts of $ based on what medication it is)?
-Can you get maintenance meds cheaper through a 3 month supply mail order?
-Will all of your required meds be covered?
-Medical supplies, such as nebulizers, are they covered?
-Will your CF clinic be a covered location?
-Hospital stays, home health nurses - covered?
I'm sure other people will be able to add more
-Out-of-pocket maximum for the family.
-Lifetime maximum/maximum per year
-Rxs
-What is the copay? Are there tiered copays (different amounts of $ based on what medication it is)?
-Can you get maintenance meds cheaper through a 3 month supply mail order?
-Will all of your required meds be covered?
-Medical supplies, such as nebulizers, are they covered?
-Will your CF clinic be a covered location?
-Hospital stays, home health nurses - covered?
I'm sure other people will be able to add more
Also a good thing to take a look at:
What is your total family income and will your "projected" medical expenses total at least 7.9% of your income (MEDICAL expenses also INCLUDE additional food costs, above and beyond that of the "average" person, same age weight and height-I can give more info if you are interested). If YES, it will be more-keep in mind you can itemize and deduct medical expenses, therefore lowing your tax liablility at the end of the year and possibly a refund. That is always something to keep in mind.
As far as the average cost, I honestly can't answer that but you can call a clinic, (even yours) explain to them why you are asking, and see what they would bill your "new" insurance company for a visit (including everything). Then you can determine what your 20% would be.
Have you looked into see if your medicaid provides a spend down program? Meaning, if you do go with this job and you are over income for medicaid, if you have to spend an $X amount a month, will they assist in paying for any of that $x amount. Like here in CA, we had a $1800 spend-down a month. Meaning we had to pay $1800 a month out of pocket first, then medicaid would cover everything. $1800 wasn't going to do me a darn bit of good, but that's not to say that your limit won't be more like $200, or something like that. Does that make sense?
What is your total family income and will your "projected" medical expenses total at least 7.9% of your income (MEDICAL expenses also INCLUDE additional food costs, above and beyond that of the "average" person, same age weight and height-I can give more info if you are interested). If YES, it will be more-keep in mind you can itemize and deduct medical expenses, therefore lowing your tax liablility at the end of the year and possibly a refund. That is always something to keep in mind.
As far as the average cost, I honestly can't answer that but you can call a clinic, (even yours) explain to them why you are asking, and see what they would bill your "new" insurance company for a visit (including everything). Then you can determine what your 20% would be.
Have you looked into see if your medicaid provides a spend down program? Meaning, if you do go with this job and you are over income for medicaid, if you have to spend an $X amount a month, will they assist in paying for any of that $x amount. Like here in CA, we had a $1800 spend-down a month. Meaning we had to pay $1800 a month out of pocket first, then medicaid would cover everything. $1800 wasn't going to do me a darn bit of good, but that's not to say that your limit won't be more like $200, or something like that. Does that make sense?
As it has already been said there are many things to look at as far as prescriptions and out of pocket are concerned. I also have insurance that pays 80% after my deductible. It has been a couple of years since I've gone to the doctor, but I believe the last time I went it cost me $20.00 out of pocket. The thing that really gets me is the prescriptions. I also have an 80/20 on my prescriptions which means for my enzymes alone I pay $140 a month. One thing that I would greatly recommended is checking to see if they have "Flex Plan". This is an account that you can set up to help you pay for medical expenses. For example at the first of the year I decided how much money I wanted in the account, and it was available to me for immediate use. I then pay $50 a paycheck until I have paid that amount into the account. This way instead of me having to set up a savings and trying to predict how much I will need for expenses that money is already there and payments are automatically deducted from my pay check. I wish you luck in your decision. Insurance is definitely one of those necessary evils that no one can live without. If you have any further questions let me know and I will see what I can do to answer them.
-Ann 25 w/cf
-Ann 25 w/cf
Well, for my 15 yr old ds, a clinic visit that just included (1) pfts, pre-bronchodilator and post-bronchodilator, (2) exam, (3) spacer for his inhaler totaled more than $700. But, he was a new patient so it may have been charged at a slightly higher rate. The pfts were over $300, plus a "room" charge of over $100, the spacer, and a $300 fee for the dr. Does your plan have copays for office visit? If so, you may or may not have to pay anything other than the copay. Check to see how they bill it.
How they bill it is usually the problem. The copay for an ov is $15.00 but usually when you go to clinic they bill as outpatient hospital and that is 80/20. And I have 2 daughters with CF so everything is doubled. I've done some figuring and for now I think it will be okay. The girls are very healthy so we only see the doc 4 x a year. The prescription copays are probably the biggest expense because they are constant but they aren't as bad as I expected. 10.00 for generic, 15.00 for name brand (Creon) and 25.00 for non-formulary (Pulmozyme). I think most of the other drugs are generic. If things change and the girls get really sick or something things will have to change but for now we'll just hope for the best. Kacie just had sinus surgery yesterday so thank goodness we got that over with. She is doing very well. We have to start nasal washes tonight though and that is not going to be fun. She will barely let me get near her with nasal spray right now let alone a huge syringe full of salt water...
Thanks for all your responses and advice. I have called the insurance company 4 times and received a ton of info. I guess worse case scenerio is I'll have to quit sometime in the future... If that's what it takes, I'll do it but for now I'm going to go for it. Thanks again!
Thanks for all your responses and advice. I have called the insurance company 4 times and received a ton of info. I guess worse case scenerio is I'll have to quit sometime in the future... If that's what it takes, I'll do it but for now I'm going to go for it. Thanks again!
Well, I just got my first bill from the CF Center. Actually it was more of an explaination of benefits since we still have CHIP and they paid the bill but I am amazed at the cost... Just incase anyone is interested... The throat culture cost $302.00, the PFT cost $315.00 and the dr visit cost $109.45.... this is for each child so for me it's double that. One trip to the CF Center for both girls is a whopping $1452.90... Amazing! And that's just a normal visit with no blood work or X-rays...Just thought I'd share. My private insurance will kick in on Dec. 1st so from then on I'll be responsible for 20% after the deductible of $500 per child. It's kind of scary. And of course that doesn't even touch the cost of medications. It seriously doesn't pay to work these days if you have a sick child. The cost of medical care outweighs the benefits of having a job (unless you're a doctor).
Me and my husband are employed at Kodak and we have Kodak Bluechoice. Our child's doctor visit are $25 copay per child and for two children, we pay $50 out of our pocket. For a three month supply we pay $180 per child for brand name prescription. Our children's prescription are all brand name so we have to cough up a lot of money just for prescriptions, so believe me I know what you're talking about. Thank God that they are doing great and I hope your daughter feels better soon.
helpusfindacure4cf
New member
<blockquote>Quote<br><hr><i>Originally posted by: <b>Anonymous</b></i><br>mother of 7yr old with cf from uk. i am always shocked that americans have to pay for medical treatment in such a wealthy country! people here moan about having to wait for hosp. appts. but no one has to worry about finances when already under immence worry and pressure!<hr></blockquote>
I agree, we are from the UK, and we here that many people moaning about paying for prescriptions.x mom to Chelsie 5/wCF
I agree, we are from the UK, and we here that many people moaning about paying for prescriptions.x mom to Chelsie 5/wCF
I personally get tired of people from the UK and other places telling us (from the US) how "amazed" or "shocked" they are to hear that we (in the US) have to pay for medical expenses - I mean, HELLO!! We already know that we have to pay our medical expenses, so how much help is it when people remind us of that even more! DUH!
Thankfully, there are a lot of other good things that make our country the most desired place in the world to live...
<img src="i/expressions/face-icon-small-smile.gif" border="0">
Thankfully, there are a lot of other good things that make our country the most desired place in the world to live...
<img src="i/expressions/face-icon-small-smile.gif" border="0">
People from other countries are shocked over things that our "mighty" nation cant take care of for us. We might very well know it, but those that think of the USA as such a strong country must find it very difficult to believe that their country(s) can offer healthcare for all citizens, but many of our sick citizens here is the mighty US of A have to fend for themselves.
6
65rosessamurai
Guest
Depending on the country, their health insurance may not cover everything.
Here in Japan, they don't cover everything, or has a set "deductuble" for it, in which the person STILL has to find additional insurance coverage for what the government's health insurance won't cover. I believe like other insurance companies in the US, if the costs went beyond a certain amount throughout the year, a reimbursement will be paid, but you have to wait til the end of the year (I hope my return is BIG!) for the reimbursement.
I think the reason for the US to have a different system is based on the freedom of business. Having a health system such as in Japan, is somewhat close to a socialist system in which everyone has the same coverage. Fortunately, since employers pay for the service, the employee pays for the deduction costs, if not, the individual (enteupreners, for example) have to pay those service fees as well. Other health insurance companies are available these days, but all premiums are payed by the individual.
The one thing I found out (Thank goodness it was BEFORE I went to the states), is that the government's health insurance won't even cover emergency medical bills if going abroad, therefore a seperate insurance is necessary if you don't want to pay out of the pocket. My visit wasn't to a CF Center, but to a doctor familiar with CF. The bill was very reasonable, but I had to use "connections" in order for it to be so reasonable. I also did all necessary tests here and brought the results with me (Including a CT scan of my chest!)
My only dillema now is getting insurance that would cover healt care in both countries.
As for meds, my wife and I took a gamble and ordered through the net some enzymes that were similar to the contents of Pancrease, and considering my system isn't so extremely bad, the medicine seems to help so far.
Here in Japan, they don't cover everything, or has a set "deductuble" for it, in which the person STILL has to find additional insurance coverage for what the government's health insurance won't cover. I believe like other insurance companies in the US, if the costs went beyond a certain amount throughout the year, a reimbursement will be paid, but you have to wait til the end of the year (I hope my return is BIG!) for the reimbursement.
I think the reason for the US to have a different system is based on the freedom of business. Having a health system such as in Japan, is somewhat close to a socialist system in which everyone has the same coverage. Fortunately, since employers pay for the service, the employee pays for the deduction costs, if not, the individual (enteupreners, for example) have to pay those service fees as well. Other health insurance companies are available these days, but all premiums are payed by the individual.
The one thing I found out (Thank goodness it was BEFORE I went to the states), is that the government's health insurance won't even cover emergency medical bills if going abroad, therefore a seperate insurance is necessary if you don't want to pay out of the pocket. My visit wasn't to a CF Center, but to a doctor familiar with CF. The bill was very reasonable, but I had to use "connections" in order for it to be so reasonable. I also did all necessary tests here and brought the results with me (Including a CT scan of my chest!)
My only dillema now is getting insurance that would cover healt care in both countries.
As for meds, my wife and I took a gamble and ordered through the net some enzymes that were similar to the contents of Pancrease, and considering my system isn't so extremely bad, the medicine seems to help so far.