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Thursday, March 19, 2009 Marlene Adams, Community Member, asks

Q: what percentage of Reclast is covered by medicare and secure horizons?

I may be a candidate for Reclast injections.I need to know what my out-of-pocket

expenses will be.

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Answers (4)
Pam Flores, Health Guide
3/20/09 8:19pm

Hi Marlene:  I wish I could help you with this, but unfortunately I'm not familiar with Secure Horizons.  Don't quote me on this, but *usually* Medicare pays 80% of the bill and your secondary insurance pays a portion, or all of the remainder.  Since all these Medicare supplements work sligthly differently, it's impossible to say what the total out of pocket cost would be.

 

However, your Dr., the one ordering the reclast infusion is supposed to know exactly what the cost should be for you, surely he or she has other patients on this type of coverage and would know the answer.  If for some reason he or she doesn't have this info, which seems unlikely to me, then all you have to do is contact Secure Horizons and ask what the cost will be for you, after MC pays their portion of the bill.

 

Since you spend good money on this coverage, don't ever hesitate to contact the insurance co. because it *is* their job to give you this info, that's what you pay for.

 

Good luck finding out what this will cost, and hopefully it will be very little or completely covered, depending on how your secondary insurance handles the 20% that MC doesn't pay.  Just out of curiosity, is SH a HMO or a PPO?  Some HMO's charge a co-pay, but some don't so you need to find this out from them and verify it *all* with MC, when they provide the answer.  Another option is to contact an infusion center near you and ask what MC/SC (Secure Horizons) pays for the total bill, certainly they must have other patients with the same insurance as yours.

 

You can look up infusion centers at this link for more info on this, in your area.

Reply
Pam Flores, Health Guide
3/20/09 8:21pm

Hi Marlene:  I wish I could help you with this, but unfortunately I'm not familiar with Secure Horizons.  Don't quote me on this, but *usually* Medicare pays 80% of the bill and your secondary insurance pays a portion, or all of the remainder.  Since all these Medicare supplements work sligthly differently, it's impossible to say what the total out of pocket cost would be.


However, your Dr., the one ordering the reclast infusion is supposed to know exactly what the cost should be for you, surely he or she has other patients on this type of coverage and would know the answer.  If for some reason he or she doesn't have this info, which seems unlikely to me, then all you have to do is contact Secure Horizons and ask what the cost will be for you, after MC pays their portion of the bill.


Since you spend good money on this coverage, don't ever hesitate to contact the insurance co. because it *is* their job to give you this info, that's what you pay for.


Good luck finding out what this will cost, and hopefully it will be very little or completely covered, depending on how your secondary insurance handles the 20% that MC doesn't pay.  Just out of curiosity, is SH a HMO or a PPO?  Some HMO's charge a co-pay, but some don't so you need to find this out from them and verify it *all* with MC, when they provide the answer.  Another option is to contact an infusion center near you and ask what MC/SC (Secure Horizons) pays for the total bill, certainly they must have other patients with the same insurance as yours.


You can look up infusion centers at this link for more info on this, in your area.

Reply
Pam Flores, Health Guide
3/20/09 8:29pm

Hi Marlene:  Sorry for the repost of the same answer.  This site has been running pretty slow, and I can't imagine why it posted twice since I didn't hit the "answer this" icon twice.  Hopefully these slow downs will go away soon, as the company is working on many different things to improve all of our experiences with OsteoporosisConnection.com.  Just bear with us until all the new IT work is completed.

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Judy, Community Member
4/ 2/10 5:25pm

What percent does Medicare pay for Reclast Injections>

How Much are the injections?

Reply
Pam Flores, Health Guide
4/ 2/10 6:33pm

Hi Judy, welcome to the community.  Reclast is covered under Part B of Medicare, so if you are considering this infusion, the infusion center should know how much MC pays.  Traditionally MC pays 80% of the assigned (approved) amount, but this figure varies from service to service.  Then if you aren't on a advantage plan, then you'd have to pay the remaining 20%.  If you have original MC, this is how it works, but if you have an advatage plan (PPO, or HMO) then the policy should cover the entire amount, but you'd still have to verify this with your insurance provider whoever that is, to see if they charge a copay amount.

 

I would call 1800 Medicare and ask them, or ask the infusion center or Dr. that's ordering this treatment.  It entirely depends on what type of MC you have.  Since many have different stand-alone plans you'd have to talk to the insurer, or MC if you have original MC.  This probably sounds very confusing, but contacting the Dr, infusion center, or MC should get your answer for you.  There no one set answer to this, unfortunately.

 

Good luck with this and let us know what you find out, if you want to.

Reply
Pam Flores, Health Guide
4/ 2/10 6:56pm

Hi again, I forgot to mention that the retail cost, the last time I checked it, was around $1,100.00, plus there may be infusion and administrative costs as well.  It's possible that this price has gone up, and I've also heard others say they paid a lot more than this, but I don't know why since I don't have the particulars in their situation.

 

Good luck...

Reply
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By Marlene Adams, Community Member— Last Modified: 11/18/13, First Published: 03/19/09