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increase in costs?
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Posted by: bebs daughter
03/12/2004, 09:48:00


Is anyone familiar with a new, dramatic, increase in the cost of botox and a decrease in the Medicare reimbursement of the drug? My mother has been getting these injections for over 15 years and suddenly her doctor, Dr. Biglan of Pittsburgh, PA, says she must purchase the drug herself and bring it to his office for the injections. He says he cannot afford to purchase the drug with the low reimbursement from Medicare. Any others running into this trouble?



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Re: increase in costs?
Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: June in Toronto
03/12/2004, 17:24:49


Others from the U.S.A. should post back to you (I'm in Canada) - but I do remember a discussion a while back on this bb that doctors were not getting reimbursed for the botox quickly enough (it was suggested it took 6 months in some cases I think). They got fed up with this procedure and said the hospitals should administer botox injections and deal with it. I'd hoped that the price of Botox would come down (all over the world) because of the enormous cosmetic use of the stuff. I'm sorry your mother is having to go through this.

June in Toronto




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Re: increase in costs?
Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: Lyn Down Under
03/12/2004, 19:03:08


Yes, it is the same in Australia. The last couple of times I noticed I was not getting as much back when I went in to claim the rebate. I just checked my receipts and although the charge has remained the same for the Botox component of the bill, the actual Government rebate is nearly $14 less than it was last year.

On closer inspection of the bills, what has changed is the item number for the Botox. My doctor is still charging the same amount as previously, but the scheduled fee (the amount the Government sets as a fee for a service and of which 80% is rebated though doctors can actually charge what they like) has now almost halved which is why my rebate has fallen so much.

I think I will ask my doctor why the Botox is now given under a different item number.

I don't know what the situation is at the Botox clinic at one of the public hospitals here - I think it is completely free of charge there but having found a great doctor who doesn't rip me off like some I would rather stay where I am.




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Re: increase in costs?
Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: dottie
03/13/2004, 10:01:58


I have a Dr. appointment Mar. 16th, with a Dr Buerger, in Cranberry. I hope you are familiar with the area since it is not to far from Pittsburgh. I have not had botox for a year I have been trying other methods. As far as his procedure on botox I will find out on Tuesday. I am very interested in Dr. Biglan of Pittsburgh. I have not had success with botox. I would appreciate any information
Dottie


Modified by dottie at Sat, Mar 13, 2004, 10:02:40

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Re: increase in costs?
Re: Re: increase in costs? -- dottie Top of thread Archive
Posted by: bebs daughter
03/15/2004, 09:02:05


Dottie: Dr. Biglan was one of the pioneers of botox injections in the united states. He has three offices: one in (ironically) Cranberry...one in washington, pa and one in murrysville, pa. I don't know Dr. Buerger, but if you could let me know what you learn about the costs, I'd appreciate it. bebs daughter



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Re: increase in costs?
Re: Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: dottie
03/16/2004, 12:43:06


BEB daughter, I had the appointment with Dr. Buerger, but did not get the botox injections. They have their main office in Oakland, and they keep the botox at the Oakland office. I made another appointment for April 6th then Dr. Buerger will inject the botox. He stated that the botox has be frozen he will take it to the Cranberry office the botox will be there for my appointment. I am also on medicare. I had an limited myectomy with Dr Anderson in Salt Lake City and Dr. Buerger spoke very highly about Dr. Anderson. Even recommends some patients to see Dr. Anderson. Medicare will pay 80 per cent of the cost, but it has to be at least 90 days between injections. I hope the information helps. Dottie


Modified by dottie at Tue, Mar 16, 2004, 12:44:01

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Re: increase in costs?
Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: Karen
03/14/2004, 10:25:35


Hi.

I'm not old enough for Medicare yet (age 54), so I can't comment on that part.

But I have to say I was shocked at how much the charges were for me to receive my first Botox injections 3 weeks ago.

I received the bill and insurance statement on Friday and wow! I was billed $1031.00 for 10 injection sites using a total of 25 U. Outrageous! Thank goodness my deductible is close to being met for this yeer already, and there was a total of $103 deducted because my Opthalmologist was "in network".

I can't imagine having to pay for this myself. If that were the case, I would not be able to afford to have the Botox.

It's so sad what they make a person go through and all because they want to line their own pockets! Grrrr........to pharmauceutical companies.




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Re: increase in costs?
Re: Re: increase in costs? -- Karen Top of thread Archive
Posted by: APhair
03/18/2004, 16:58:17


Karen, if you were billed over $1,000 for the botox injections and you only got 25 units, don't blame the pharmaceutical company for that. Blame your Doctor. For some reason, they think it is OK to charge hundreds of dollars for two minutes worth of work. I do realize that the botox certainly isn't cheap but I know exactly what it costs the doctors and while it is expensive, it is not where near what they make it out to be.

Your Doctor is obviously taking advantage of the fact that you have private insurance and is makingup for the lower fee that he gets from Medicare. shame on him. By the way, if you have private insurance and have prescription coverage that pays for Botox with say only a $10 or $15 co-pay, tell the Dr. to write you a prescription adn you will bring in your own botox to him. That way, you will save some money. If he tells you that you cannot gring it in, tell him he is all wet...Alan



Modified by APhair at Fri, Mar 19, 2004, 08:16:58

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Re: increase in costs?
Re: Re: increase in costs? -- APhair Top of thread Archive
Posted by: Karen
03/18/2004, 23:48:31


Alan---Wow! Thanks for your info. I will definitely talk to her about the charge because I think it is extremely high for the amount I was given. And here I thought it was the pharmaceutical companies charging so much. And, rats, it's the Doc instead. Grrrrrrrrr.



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Re: increase in costs?
Re: Re: increase in costs? -- APhair Top of thread Archive
Posted by: Virginia in AL
03/19/2004, 07:52:29


I have prescription coverage, but my insurance company will NOT pay for the botox if I pick it up and take it to the doctor. PLEASE, everyone, check with your insurance company before you ask for a prescription.

Charges for giving botox vary considerably, as we have discovered. Some of the doctors I have been to "overcharge", but the insurance only reimburses what it allows. It does put people without insurance at a disadvantage - not only do they have to pay the whole bill themselves, they don't have a big insurance company to negotiate a smaller fee.

Virginia in AL




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Re: increase in costs?
Re: Re: increase in costs? -- Virginia in AL Top of thread Archive
Posted by: APhair
03/19/2004, 08:22:05


Virginia. Good point to reinforce. That is why I mentioned to make sure that the botox is covered. I know that for several years I was getting the botox atthe Dr. office and paying the 20% which was a lot of money and then I switched Dr.'s and ended up paying only a $10 co-pay when I picked it up. The same Dr. now that I am on Medicare and have no RX coverage does suppy the Botox for me and bills medicare and my AARP plan through United Health picks up the difference...Alan



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Re: increase in costs?
Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: Dee in OR
03/14/2004, 10:46:29


Yes, there has been some recent problems with Medicare & botox. I suggest you contact Allergan, the makers of Botox and talk to them. They have a patient assistance program and they will be able to help. Contrary to what most people think, the medical use of botox far outweighs the cosmetic use, at least that is what I was told by an Allergan Rep and I believe him!

Cheers,
DeeOR


Related link: http://www.botox.com

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Re: increase in costs?
Re: increase in costs? -- bebs daughter Top of thread Archive
Posted by: Kathleen
03/15/2004, 09:08:26


I, too, was surpised at the cost of the injections and am very glad that my work provides me with an excellent insurance plan. Another good reason to keep working as long as I can, I guess. For those of you who rely on Medicare, I wouldn't hesitate to contact your US congressmen and make them aware of the fact that your physicians are balking at the reduction in coverage and that you are suffering as a result. They do have a lot of power over what CMMS interprets into rules for Medicare and Medicaid and I bet most of them don't have a clue that botox is used for anything other than cosmetic purposes.



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