cost of Zometa!

Yikes, just got a statement from my insurance which does not cover Zometa and I was charged over $6,000.00 dollars!!!! I am in shock. Last year, while still in Santa Fe I had a nice set up where the insurance company paid to send me the medication at the hospital and I was covered. But now that I moved they will not cover it anymore. I am thankful that my mother agreed to pay for my out of pocket medicals but she might freak at this too!

Report post

14 replies. Join the discussion

Wow, that's crazy. I've never heard of an insurance company that stops paying because you have moved. That amount also seems very high. My clinic charges $3994. for the whole procedure, zometa, saline solutuion, etc. which is then discounted because the clinic is a preferred provider by the insurance company. The insurance picks up the balance since I've already met the deductible for the year.
I think you need to contact that insurance company and challenge their decision. Also, some hospitals, clinics, etc. will negotiate a lower fee and some also offer financial aid.
How in the world can anyone maintain their treatment protocol at $6K a pop?! I have to take zometa once a month along with aromisin - which is also expensive, around $400. retail for a month's supply.

I'm convinced there will never be a "cure" for cancer as long as all of these meds are so profitable for the providers. And who thinks we don't need health care reform?

Report post

Hello, hello! The cost of my zometa is exactly the same as yours. By any chance are you being treated at MDA in Houston or Orlando? Yep, the Zometa is $6,000 every month and my Xeloda is $2,400 for a two week supply. Yikes!!!!!!!!!!!!!!!! I really feel for those who have no insurance at all, as for your situation, was your insurance funded by the state you use to live in? Otherwise, I would check to find out why the move effected your insurance. Good grief, it is always something, isn't it? We who have parents who can cover for us if needed are very blessed. Take care and I hope that you can get your insurance thing worked out. Julieanne

Report post

Oh I would challenge this decision too! The insurers hope that we dont challenge them, walk away, and pay -up! They count on a certain percentage of us to take 'No' for an answer. Remember all it is, is a person just like us making decisions regarding our coverage. They are a part of the system, and the cut backs being put upon them....to save money! If their is a loop hole, they will try to get away with your coverage costs, no doubt! Sometimes it is just a matter of how your doctors office billed it, which in turn got it rejected. It may just be a matter of the doctors office changing the billing code for it, re-bill it, and usually gets paid then. Anytime I have challenged, and questioned a rejection, it has always been reversed, and PAID! Please don't take this lying down! Fighting for proper coverage you deserve, with nothing to lose by doing so!

Report post

Before you have your mom pay that very large sum of money I would:
- Contact the pharmaceutical company about their patient assistance programs for those drugs.
-Contact pparx.org
- Contact your oncologist
- Contact VT's Department of Social Service - NYS has a program called Family Health Plus for folks that make too much for Medicaid

Report post

I would ask the oncologist to contact them, and to explain to them why you need it.

Report post

Wow!!!! First of all I am not sure why you are paying so much for a monthly treatment of Zometa. I have been taking Zometa for 2-1/2 years and charges to my insurance are either $1,000 (when in Michigan) and $2,000 (when in Florida). When I had to change insurance companies last year I was told I would have to pay about $2,000 out of pocket each month but when I questioned why because I had not done that before. They asked if I was getting this procedure done at a hospital or doctor's office and when I said doctor's office they said oh, then it would be covered in full. I know all of us have different types of insurance BUT I would definitely check with yours to see what the heck is going on. I have Medicare and AARP. Good luck to you.

Report post

Your poor thing! This sort of financial stress must be like a form of torture!

I hope in the near future there will be serious health reform for you all - in Australia the full cost to our government from Novartis (the drug company), to provide Zometa to anyone is $535.00.

Under Medicare, we make of co-payment of about $33 if you work and earn an average wage; and if you're a low wage earner/pensioner you pay $5.40.

I spend a small fortune each month of my own self-styled regime of complementary supplements, but no private health insurer (or the govt's Medicare) would cover me for that, despite the fact they are a fraction of the cost of some prescribed cancer medicines, which are of questionable benefit.

Shame on those in high places profiteering from the suffering of others........they best hide from 'karma'!

xxxGGC

Report post

Do you mind if I ask what insurance you have? I thought Zometa was standard of care and can't imagine any insurance not covering it.

Report post

WOW!!!!!!!!!!!!!!!!!!!!!
6K it does sound outrages!!!!!!!!!!!!!!!!!!!!!!!!!
There are few websites you may find useful in your case:

1. The Patient Advocate Foundation, see a link below: http://www.patientadvocate.org/index.php?p=480#36

2. CancerCare’s Web site is an informative fact sheet with lots of resources for financial assistance, see a link below:
http://www.cancercare.org/pdf/fact_sheets/fs_financial_en.pdf


Good luck,

Zhanna

Report post

Sickening isn't it!. I have a policy through the Self Employed that my first ex husband set up. It is called MEGA Life and I have been on the phone to them twice so far, they raised my premium because I moved. The them it's all about zip codes NOT people and certainly NOT health care. So yep, the Zometa plus the cost of the infusion is over $7000.00 Scary and criminal in my mind. I called the drug company to see if I could get assistance and so I am now in the approval waiting loop....

sigh

cancer sucks

Report post

I thought that price was high. I just checked and my Zometa costs, per month, are retail $1500, BCBS pays $884. I weigh 112# so may have a smaller dose than some. Of course, there are more costs for the infusion costs. My Avastin was at the other end of the spectrum.. retail $10,300 and ins cost was around $3500.
robin

Report post

Depends where you live and if the insurance has a contract with that vendor. In Minn. my Zometa cost is $224 and $1872 for administering it. If I have it done in Ill. locally the cost is $3995 including the cost of the Zometa (they don't break it down). Both facilities have a contract with my insurance. I contacted the insurance company as the local vendor raised their price $995 from the previous month. The insurance company told me they don't check contract price accuracy and if it's close they just pay it. So why such a difference? Whose looking? It's not the Zometa that costs, it is the service part that costs. There should not be that much of a difference in costs from one area to another.

Report post

Good advice from all....contacting the pharmaceutical company and other agencies all good. Might want to first talk to the folks at the facility that's providing the treatment.
There's been some mighty large institutions (no big brother, incase you're reading, I am not naming names) that have recently been in hot water because they did not inform patients that financial help was available. There was always a "hardship" fund, but they kept it hush-hush..someone found out and sued...and well...let's just say, a pamphlet is given to each and every patient, each and every time they step foot in the hospital. That phamplet gives them phone numbers to call for financial help.

I'm just sayin....

Here's the deal...they accept a certain amt when they contract with insurance companies..so find out what the average is that they accept and bring that to the table. You will be way below that $6000.00. I see that mine gets billed these large amts. but then I go to the column for "agreed upon amt." and it is considerably lower. Sometimes ridiculously lower. Probably 1500.00 on a 5000.00 bill. I have to pay the first 2500.00 and then they take it from there. Also, they like the doctor's office instead of the hospital. Never got an explanation on that one.
Good luck to you. All great suggestions and links. Might be a little bit of a hassle, but worth it!

Report post

My Zometa with infusion/chair fees etc. was about $3500 per treatment back in TX in 2003-2006. I couldn't afford that (had no ins coverage for Zometa during 1 year pre-exist wait period) and got into their patient assistance program. They paid 100% of the drug costs, and my cancer center dropped their fees etc for me by almost 50% and put me on a payment plan.
My experience with the Zometa patient assist program was really good. They approved me quickly and for 1 year, so no hassles of re-applying every couple of months.
At this point, you are paying full retail for the drug - a cost much higher than anyone with insurance would be billed. Stupid, but those without insurance get billed a much higher rate than those with insurance as the big companies negotiate contracts for lower costs... it's so wrong that those of us who have no money get charged the most!!
Best advice is to stay on top of them... call, write and bug the crap out of them till you get approval. I think mine was retro-active too, meaning that infusions that I had paid for already were re-imbursed.
Good luck.

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Things you can do

Advertisement

Advertisement

Discussion topics

Community leaders