# Anyone get thyrogen that had BCBS ins?



## teri2280 (Feb 7, 2012)

I have an upcoming body scan in Dec, and was told that I'd be getting thyrogen injections. I was told that I "may or may not" get a call from the pharamaceutical company sending it to my doc. (Regarding co pays, which I have none for medical stuff, prescriptions are a different story.) The lady from the doc's office that I talked to said that some insurance companies consider thyrogen as a pharmacy benefit while others consider it a medical benefit. Anyone have Anthem BCBS that can tell me for sure? (My medical stuff has hit the out of pocket max - if it's medical, I won't have to pay a cent, whereas if they consider it pharmacy, I'll have god knows how much wrapped up in this.) Alot of you know I've been fighting bad headaches for a month now, so I'm just trying to figure out ahead of time if this will worsen the headache or keep it the same if I still have them in a month from now!


----------



## joplin1975 (Jul 21, 2011)

Terri,

I don't have bcbs so I can't answer your question directly, as I have MVP. That said, I did want you to know I got the thyrogen from a 3rd party pharmacy (Curascript) but it was billed as part of a nuclear medicine procedure and not billed as pharmacy services.


----------



## CA-Lynn (Apr 29, 2010)

What happens under one plan for the insurance company does not necessarily happen under another plan under the same insurance company. All factors are contracted individually.


----------



## teri2280 (Feb 7, 2012)

joplin1975 said:


> Terri,
> 
> I don't have bcbs so I can't answer your question directly, as I have MVP. That said, I did want you to know I got the thyrogen from a 3rd party pharmacy (Curascript) but it was billed as part of a nuclear medicine procedure and not billed as pharmacy services.


Thanks! Good to know!


----------



## teri2280 (Feb 7, 2012)

CA-Lynn said:


> What happens under one plan for the insurance company does not necessarily happen under another plan under the same insurance company. All factors are contracted individually.


Drat! Why am I not surprised that my endo's office got it wrong...? Do you think that what they said regarding the phone call was correct? (I was told that if I don't hear anything from an outside company, it's an approved medical benefit.)


----------



## CA-Lynn (Apr 29, 2010)

My guess is that the doctor's office did not get it wrong. They're used to contacting the insurance company and getting the right info for YOUR insurance contract. But mistakes do happen.....


----------



## teri2280 (Feb 7, 2012)

Haven't gotten a call yet, said I'd hear something by the end of the week if there were an issue. Keep your fingers crossed!  Thanks for the input, folks! Really hoping that they consider it a medical benefit and I don't have another $2000+ bill to add to the list!


----------



## joplin1975 (Jul 21, 2011)

I have a PPO with a higher deductible (so I can self-refer). My final bill for the thyrogen, scan, and u/s was $1,056. Ouch...

(Last year? Nothing. I paid all of $150...and that's with surgery involved!)


----------



## teri2280 (Feb 7, 2012)

Ew. Yeah, that's pretty rough. I've already got about 8K I'm paying on to Cleveland from the surgery, path, etc. I guess it could've been worse had I not had insurance, but I'm REALLY hoping it's considered a medical benefit. When you make between 20 and 21K a year, 8K is a crap ton!


----------

