rheumatoid arthritis, medicare, and regular insurance

[bobbieinok]

I have RA, and I've been getting remicade every 8 weeks. Remicade is administered intravenously at the doctor's office. The procedure takes about one and a half or so hours.

I'm on medicare and have medigap insurance.

For those of you who may not know, medicare never allows the total amount of the bill. Medicare pays 80% of what it allows and (if you have purchased it--it's extra, above the deduction from social security for Medicare) your medigap insurance pays the remaining 20%. And then at a later point you get the itemized charges (what it cost, what Medicare allows, etc).

Soooooo----remicade costs $4000, and the bill shows other fees and what has been paid.

I've been taking remicade since I was 66, and medicare and medigap have paid. I haven't had to pay anything out of pocket. But what do people do who are on regular insurance?? Do the companies pay???

And, of course, if you don't have insurance.........you suffer.

Some doctors refuse to take medicare patients because it never completely allows the amount the doctor charges.

PLEASE NOTE: what I've said about medicare payments is what I believe is accurate. Please modify if you have other information.

ALSO: remicade is one of several newish treatments for RA. I believe all of them cost about the same amount. I believe the doctor prescribes the treatment s/he decides is best suited to the particular patient's case.

[Skittles]

1. may I ask

when you say $4000, that is for one 90 minute treatment? How often do you receive them?

[cbayer]

2. No insurance company pays what the providers actually charge.

All of them have negotiated rates for doctor visits, hospital charges, medications, etc.

What the provider "charges" is generally 3 times what they actually get from any third party payer. The real problems arise for uninsured who can not negotiate rates. They get billed for the whole amount. There have been successful court cases where uninsured patients have challenged this, claiming that they should not have to pay anymore than the insurance company or Medicare does. I recently challenged a bill after researching what a laboratory would get from Medicare for some tests and they accepted that amount, even though it was 1/3 or what they originally billed me.

The providers keep their bills artificially inflated to make a point, but routinely write off huge amounts of the bills.

I hope that makes sense (and I hope the Remicade is working for you)!

:hi:

[HysteryDiagnosis]

3. You may need to read the thread on ginger for the following reasons

J Nat Prod. 2009 Mar 27;72(3):403-7.
Comparative effects of two gingerol-containing Zingiber officinale extracts on experimental rheumatoid arthritis.
Funk JL, Frye JB, Oyarzo JN, Timmermann BN.
Department of Medicine, University of Arizona, Tucson, Arizona 85724, USA. [e-mail]
Abstract
Ginger (Zingiber officinale) supplements are being promoted for arthritis treatment in western societies on the basis of ginger's traditional use as an anti-inflammatory in Chinese and Ayurvedic medicine. However, scientific evidence of ginger's antiarthritic effects is sparse, and its bioactive joint-protective components have not been identified. Therefore, the ability of a well-characterized crude ginger extract to inhibit joint swelling in an animal model of rheumatoid arthritis, streptococcal cell wall-induced arthritis, was compared to that of a fraction containing only gingerols and their derivatives. Both extracts were efficacious in preventing joint inflammation. However, the crude dichloromethane extract, which also contained essential oils and more polar compounds, was more efficacious (when normalized to gingerol content) in preventing both joint inflammation and destruction. In conclusion, these data document a very significant joint-protective effect of these ginger samples and suggest that nongingerol components are bioactive and can enhance the antiarthritic effects of the more widely studied gingerols.
PMID: 19216559



Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis.
Rosenbaum CC, O'Mathúna DP, Chavez M, Shields K.
Bethesda North Hospital Pharmacy, Cincinnati, Ohio, USA. [e-mail]
Abstract
OBJECTIVE: To review efficacy studies of antioxidant and antiinflammatory dietary supplements used to manage osteoarthritis (OA) and rheumatoid arthritis (RA) and make conclusions about their place in therapy. Glucosamine, chondroitin, and methyl sulfonyl methane were excluded.
DATA SOURCES: A literature search was conducted using MEDLINE (1996 through January 2009), EMBASE, Cochrane Library, Natural Medicines Comprehensive Database, and Natural Standard, with bibliographic review of relevant articles. Cited studies from before our search range were included if they represented the only published human data available. Search words included "antioxidant," "antiinflammatory," "cat's claw," "ginger," "fish oil," "omega-3," "turmeric," "vitamin E," "vitamin C," "Baikal skullcap," "barberry," "Chinese goldthread," "green tea," "Indian holy basil," "hu zhang,""oregano," and"rosemary."
STUDY SELECTION AND DATA EXTRACTION: Efficacy studies published in English were included provided they evaluated the dietary supplements in patients with OA or RA.
DATA SYNTHESIS: Our search strategy yielded 16 clinical studies (11 randomized, placebo-controlled clinical trials, three crossover trials, one case-controlled study, and one open-label study) in addition to one meta-analysis and one review article.
CONCLUSIONS: Three studies support cat's claw alone or in combination for OA, and two studies support omega-3 fatty acids for the treatment of RA. We cannot recommend use of vitamin E alone; vitamins A, C, and E in combination; ginger; turmeric; or Zyflamend (New Chapter, Brattleboro, Vermont) for the treatment of OA or RA or omega-3 fatty acids for OA. Whether any of these supplements can be effectively and safely recommended to reduce nonsteroidal antiinflammatory drug or steroid usage is unclear and requires more high-quality research.
PMID: 20232616

[mdmc]

4. Holla at yo BOY!

:kick:R
for mention of RA in an OP.
Now to read the OP!
(I just got back from a remicaid infusion, by the way)..

[mdmc]

5. wow. an RA thread about Remicade..

Lets see..
I've had RA for about 4 years..
I started with blackout level pain (9.5 on a scale from 1 to 10). I got on methotrexate, steriods, and naproxen.
I did pretty good. My pain got down to about a 2 or 3 (on a 1 - 10 scale).
My arm / elbow has never healed. My shoulder still gives me some good pains.
About a two months ago I got severe pains in my finger tips. It spread up my arm.
Now I am on methotrexate, mobic, and remicade.

I have for profit insurance; so far I have been paying $40.oo per IV treatment. I just looked at my bill today and I am in dept to my Rhumey for about $8000.oo

I bet my insurance company strikes some sort of deal with the pharm company and MD. I guess that is how it will work.

Or I can pay it off $5.oo per week for the rest of my life:shrug:

[grilled onions]

6. 45 Years And Counting

I find that having any chronic condition and being ONLY on Medicare you feel like yesterdays leper. While the disease raged on forcing me to quit work years before my time I lost my working insurance and had to go on Medicare. I thought it was pretty decent in the beginning. But the cuts started and I noticed doctors dropping Medicare patients to the point that if I lose my,near to retire,Rhuematologist I can't even get a GP in the area to take over. My latest pitfall came when I had a herniated disc and an MRI revealed several other discs in trouble. Several surgeons waltzed into my hospital room and said" no way" to any surgery. It could very well be true but I have that nagging doubt that they wouldn't be that sure of themselves if I had regular insurance.
I never had any RX coverage so I had to find one of several sad plans that help with some of the meds but very little on any that are not generic. Also for those of us who are under 65 and live in a majority of the states we cannot buy supplemental coverage.
The newer treatments are often listed as experimental so its a way they can squirm out of paying for it. Some hospitals seem to hasten the exit of patients on Medicare as well.
What we get is not free,we worked for it yet we seem to often get lesser treatments,more paperwork. Years ago one doctor charged $20 for the office call(at a time when most charged$50) Medicare claimed it should only cost $18 in this area so they would only pay $16. It's this kind of fuzzy math that makes many doctors opt out of the Medicare market but what are we supposed to do?

[Atticus]

7. I inject Enbrel twice a week plus take methotrexate, folic acid, fish oil and Vitamin E.

I also have prescription for Vicodin for flare-ups and worse than nomal pain.

I am a state employee, so have better insurance than most. I order Enbrel every 90 days and my only cost is $104. The methotrexate costs me half that.

All in all, I feel fortunate that the "new" medications are available and that I have the insurance I do. I am aware, however, of people with RA who live in constant pain as their joints deteriorate. They are often unable to maintain employment and some seldom leave home.

Universal access to medical care and prescripton meds MUST be a permanent plank in our party platform until it becomes law.