Posted Yesterday 11:24 PM (GMT -5)
I havent posted here for a long time. It speaks to the good fortunes I've had being on Entyvio going on 6-7 years now. I have always had workplace insurance which has been fine. I use Entyvio Connect to plug the out of pocket costs I pay so all I really pay is the admin expense for the infusion.
However, I switched jobs in early 2024 and signed up for new insurance without problems. However, unlike my previous jobs, you have to renew your policy every year. This is different than my previous jobs where if you didnt want to make changes, you would just leave it as is. So I had no idea my insurance lapsed at the end of 2024 and I went to my infusion appointment as normal and now they are trying to hit me with a $21K bill, more than doubled what it would have been with my insurance. My insurance "discounted" amount is $10K roughly.
Now I have Entyvio Connect which would pay the $20K, but that would be my limit for the year, Entyvio Connect caps you at $20K. So between the new insurance I've have to find, which would be about $3K/year in premiums and the out of pocket max which would be another $6-7K, I am looking at about $9-10K in unexpected medical costs which is not a backbreaker for me, but it is certainly not going to make this year easy.
I tried to talk to the hospital billing department today and they essentially told me they already did me a favor giving me a discount from the $27K to the $21K. I asked to pay what my insured discounted amount would be, but they told me to kick rocks. I dont qualify for any medical or financial assistance through the hospital.
The hospital does have a financial counselor who has been very nice. She is trying to help and I talked to my GI's doctors office. I am hoping maybe his office can do something, they have always successfully gone to bat for me so I am hoping they have an ace up their sleeve.
Has anyone had the unfortunate pleasure of dealing with billing adjustments/negotiating? I am not asking to get let off the hook, I made a big mistake that I shouldnt have made, but taking a medication that I've used for 7 years at this facility, always paid on time, never been an issue, and jacking the price up to $21K just makes me lose faith in humanity.
This has been eye opening for me. I'm not sure I'll go back to this place, even with a good outcome. Has anyone heard of the Entyvio pens? I didnt hear anything about them until I fell into this mess.
Hope everyone is doing well here.