Cost of 6 month lupron

I was not aware that I did not have Medicare B until I received my hospital bill. Total cost for 6 month injection was $39,000. My insurance covered $24,000. I had to pay half. Along with copay from radiation I owe hospital $24,000. I received Medicare B on Dec 1 But they wouldn’t backdate it so homeboy has to pay. Just for the hell of it I put up a go fund me page. I received $1.00. HaHa!

Howard, your information is confusing me. What insurance paid the claim? What do you mean you paid half? If you didn’t have Medicare B and a supplement, then nothing would be paid by Medicare as the Lupron would not be a Part A reimbursement and you would pay the whole amount.

Are you still on an active employer sponsored plan? If so, that should be primary and negate the need for Part B and a supplement. They won’t both pay. And you can not have both at the same time.

I strongly question an insurance company paying $24k for a six month Lupron shot. Read the EOB and it will tell you the actual reimbursement and any adjustments. Never look at the top line charge from the provider. Totally false numbers.

When did you turn 65 and go on Part A? If you didn’t go on B at that time you had to decline Part B and show proof of the employer sponsored plan. If you have retired and lost your employer sponsored plan you would have been notified by them of the change. Something is missing, but I am happy to match the first $ on the Go Fund Me.

JNF

I have Quartz as my secondary. They paid $24,000 of the $39,000 leaving me with $12,000. Added to other charges post radiation my bill is now $22,000. I got an advanced estimate for my next shot. I will pay 189.00 but now I have Medicare B. I will put up another go fund me page.

I agree with GoBucks. Tremendous ripoff. You should fight it. I have never heard anywhere close to that for Lupron. On several websites like drugs.com, goodrx, wellrx, etc. the drug cost for the 45 mg (6 month depot) is at most about $11,000 available to you retail at a CVS or Walmart. Add a couple hundred dollars for the nurse to jab you. So $39k? No way. Do some digging and call your local consumer advocate on your TV station and get an investigation.

Seven years ago I had my last 6 month shot of Lupron and my doc got about $1700 total reimbursement for the med and administration of it. I can’t believe it is $39k now. And that would be $78k for the year! The new oral Relugolix cost about $30k for the year and is regarded to be more expensive than Lupron. Hopefully others on the board will chime in with their experience.

You say Quartz as secondary, I don’t understand that. Who is primary? Are these with your employer? It is obviously not Medicare Advantage since you are in traditional Medicare. When you enrolled in B who are you using for your supplement? Did you buy G or N supplement? Have you signed up for D for Rx? Which insurance plan did you choose? Your expected cost you state is actually the Medicare B deductible. Sounds like you chose to get a G supplement. Correct?

Your explanation still leaves me confused.

i just looked back at my last Lupron shot, given in November 2018, at MSKCC

The hospital billed $5468 for the shot itself, and $501 for administering the shot. It was a 3 month shot.
These were both the amounts billed and the amounts approved by Medicare. So yes, the amount you were billed seems out of line. I wonder if its simply a function of you not having Medicare, so not being billed at Medicare approved rates?
You should 1. ask, and 2. fight it.

Unreal guys what you pay for Lupron in the USA, I am in Ontario Canada. I just picked up a 90 day shot for
$ 1,985.00 paid for by plan injection no cost from doctor.

Howard, I'm going to join in with JNF and encourage you to question this loudly and forcefully. First, there is absolutely no reason for a 6 month Lupron shot to cost that much. None. It's either a mistake, or price gouging at its worst. Contact the patient advocate, and like JNF said, your local TV stations. This has you paying much more for your co-insurance, than the drug should cost in full. Something, is without a doubt, rotten in this scenario.

Donna.

Howard, so why didn’t they tell you the cost before the shot? Why didn’t they offer alternatives like Eligard or Firmagon? Why not a short term shot to get past the shortage? Why didn’t they alert you to the insurance problem? Had they done so, what would your reaction been? So why haven’t we heard this from the others on the board? If your experience is valid, it should have been experienced by many others and we would have heard about it. I ran it by my urologist and he about spit up a lung with his reaction. He said no way and to fight it.

My BS meter tells me you are being taken advantage of. When you have been grossly overcharged there is no “reasonable payment plan” to work out. Forget Go Fund Me. Better odds with PowerBall in your situation. Go Fund Me is for destitute people losing their home this week, not someone that can calmly work out a reasonable payment plan. No drama in that, unfortunately.

The longer you accept this, the less your chances for a correction. Have you reached out to a professional advocate? You are a senior citizen on Medicare with protections thanks to the whole Elder Law industry. Have you consulted an attorney or patient advocate that specializes in this area?

Do you have the name and phone number and email and Twitter for every consumer reporter of your local TV stations and your local newspaper? Have you called/contacted any of them? Have you escalated it to the head of the insurance company? Have you talked to your doctor that ordered the shot without telling you the cost? Have you escalated this to the patient advocate at the hospital? Their boss? Have you called the Wisconsin insurance commissioner? The Secretary of State consumer advocate? The state AMA? Your local state representative? Your congressional representative and Senator? Surprise Billing was a big deal for the prior administration and they made great strides for people.

You have many great resources available. Use them. All of them.

Howard3569 said...
It’s a Wisconsin thing! I worked out a payment plan with hospital. I will put up go fund me page again,

I have no idea what you did with your insurance, but in 2018 it cost me $5500 out of pocket. This covered RALP at Cleveland Clinic, ART, and 2-3 month and 1-6 month Eligard injection locally. Add about $2700 for 2-6 month Eligard injection in 2020 and it has been less than $10,000 for 2 years of treatment.

I have to suspect you are using a boutique out of network provider along with poor insurance coverage.

Post Edited (Duck2) : 2/24/2021 5:26:04 AM (GMT-7)

Just received my explanation of benefits from my December Lupron shot. Dr billed $3630. Insurance allowed and paid $3252.18.

Since my PSA may be going up (gulp), I wanted to see my BCBS cost should I need Lupron depot. Looking up the cost on Express scripts, it says for the 3-month the (list) cost is 14,317.10, I pay $180. Price for the 6-month is $28,633.87, I still pay $180. It also says "Cost per day: $ 2.00 Your plan pays about 99% of the cost for this medicine." However, it says $2.00/day for both strengths, curiously.

Djin

Great information and inspiration Cyclone. Your vast experience with the various meds is of value to all all of us.

Djin, please remember you are quoting “list price” rather than actual reimbursement amount. Essentially no provider gets or expects to get the top line list price. A very few will actually bill the amount they have agreed to under a reimbursement agreement or charge the stated amount that Medicare will reimburse. The vast majority simply set an amount many times as much as any of their reimbursement agreements and then “adjust” the bill accordingly and you see that on the EOB.

Recently my wife experienced symptoms of heart distress. So off we went to the ER. Five hours later she was assured her heart was fine and it was something else. The bill came to us at some $38,000. Of course the bill meant nothing and caused us no excitement or significant reaction. A few weeks ago we got the EOB and it showed the billing adjustments to meet the published Medicare reimbursement amounts, the Medicare reimbursement and our Medicare Supplement reimbursement. In all the hospital received about $2,800.

Howard, please tell us you have an army of expert advocates working for you. Who is your insurance company? Still Quartz for your new Medicare Supplement? Is that whose advisory board you are joking or your primary insurance Medicare?

You have to go to the provider for the information. The commercial insurance company generally does not publish provider specific details. Of course the Medicare reimbursement amounts are public and apply to all providers.

Every provider can tell you exactly what your out of pocket cost of a procedure will be. But you have to ask for it. We all have to sign the financial responsibility form for our provider. How many of you ask what your cost will be?