Remistart... ???

[Mehita]

We got the Remistart credit card in the mail today. Call me stupid, but I don't understand what we're supposed to do with it? And, it's in DS's name... WTHck?

 

[crohnsinct]

Wow! Did you apply for it or did the doc do that for you? After the infusions, you send your Explanation of Benefits to Remistart (the fax number should be in the letter that came with the card). They will reimburse you for everything over $50 that you are charged for the medicine only. So the nurses time, supplies, blood draw etc are not covered by this program. Piece of advice...when you are billed by the doc, only pay what Remisart won't cover. After they get your E.O.B. they will load the credit card and then you can call the doc and pay with that card. Payments will only go through to the provider of record so if for some reason you change centers etc, you have to notify them officially. They do this to keep you from paying other bills with Remistart money. But I would imagine you have met your out of pocket max at this point and aren't paying anything but it will come in handy come 1/1. There is a cap to benefits on this program but we max out on our insurance early on and they pay 100% so we never max out on Remistart benefits.

If you need any more help just PM me.

 

[Mehita]

Thanks, CIC. I filled out the form and then the nurse did everything else. Never saw it again. Is it okay that it's in DS's name?

We met out of pocket this year on January 3rd. Sad, but true. *sigh*

 

[crohnsinct]

Yeah. They have to put it in his name as he is the patient. We have never had a problem with our hospital. They infuse Remicade often so are very familiar with the program. So your one year starts now...I would have held the paperwork until 1/1/2014 but like you said we all sadly max out pretty quickly so probably not much to worry about there. Just don't submit any infusion paperwork until 1/1/14 so they start counting infusions then.

 

[Mehita]

We haven't gotten an EOB yet.

His infusion dates were 11/1/13 tho this one was inpatient and 11/15/13, and will be 12/13/13 and 2/7/14... so I should wait for a 2014 EOB?

Sorry for so many questions.

 

[crohnsinct]

I would as they cap coverage at 8 infusions (at least I think 8...like I said we max out after 3 or 4 so I never get that far with Remistart) in a year. If you start submitting the others (2013) then those "may" count as part of your 8. If you just start submitting in January then you could probably get the full 8 coverage. Our first year with Remi, the office staff advised us to wait to apply until 1/1 for this reason...we maxed out on our insurance with her hospital stay as of February so since all her infusions were covered at 100% no need to start the Remistart program as they would "count" all those infusions we weren't paying anything for. Soooo we started our Remistart almost a full year into her treatment.

No need to submit the 2013 infusions anyway as there was no out of pocket expense.

You could also call Remistart and ask them if they would count the 2013 infusions and ask if maybe they would just change the start date in the program to 1/1/2014. They are super nice and the spirit of the program is to help defray the cost (to keep you on their drug) so I am sure they will do whatever it takes.

We are just coming to the end of the first year so U need to start researching what comes after...I think there is something called extended access....anyone?

 

[Mehita]

Finally got an EOB, but I'm going to sit on it and wait until the February 2014 infusion. Unless I'm missing something, it looks like it's (only) $2700 per infusion and we pay 20%. I was expecting WAY bigger numbers.

 

[crohnsinct]

O's total infusion cost is more like $4,000. The drug itself is $3,300 so yeah it sounds like the cost for the drug for you guys is $2,700. Remistart will cover just the drug portion of the infusion less $50.

So if you are having to pay any of that $2,700 I would go ahead and get him emrolled and then submit it but I think you said you maxed out and everything is covered now at 100%.

Hey cool news. O has completed her first year and Remistart sent us an application for the extended access program to extend it another year. That was nice of them! I though I would have to go looking for it. Cool! Here's hoping we get another year out of the Remicade!

 

[Mehita]

Woohoo! So good to hear she a doing well on it too. It gives us hope!