I’m British. In addition to my dodgy heart, I’ve been (tentatively, but other explanations are thin on the ground) diagnosed with a rare neurological condition known as Multifocal Motor Neuropathy.
Standard treatment for this is a large ivig infusion, then much smaller maintenance doses. Frequency of dose depends on the patient, but can generally be 1-7 weeks. The infusion is typically done in the doctor’s office or hospital, but home infusion is available. ivig is a fantastically expensive substance.
My plan is to move to the USA in August for grad school, but something has just come to my attention. I have next to no understanding of the US health system, here in the UK things are free at the point of use. My prescription drug coverage is 40% co-insurance with no coinsurance maximum. If I do need regular ivig it could potentially put a stop to me hitting the USA, depending on…
[ol]
[li]Would the ivig be classed as a ‘prescription drug’, or as a more generic medical treatment, which would come under the rest of my insurance, which has a coinsurance maximum?[/li][li]Back of the envelope calculation, assuming it is a prescription drug: $55/gram, 1.5g/kg dose, I weigh 80kg=$6,600 per treatment. 40% of this is $2640. There is obviously no way this is affordable.[/li][/ol]
What’s excluded as a “pre-existing condition” and what’s covered and to what extent will be determined by what kind of insurance plan you’re covered under and in which state you’ll be living. It helps if you think of the USA as 50 different countries, each with its own set of laws, which subscribe to another common set of laws legislated and enforced by what would be referred to as The Federal Gubmint.
Each state has its own ideas about what insurers ought & oughtn’t be able to do, and the laws vary wildly. So…
Where you gonna be living?
Are you buying your own health insurance or will it be provided by your employer?
Welcome to The Dope, what’s “zhongguorenmin”? You Chinese? 'cause Chinese are Communists, and well, you know how we are about Communists. Except the Chinese. Who make almost all of our stuff for us. We like them just fine. I mean…ok, never mind. How about 1 & 2?
Thanks for your reply. I’ll be in North Carolina, and I’ve spoken to the insurer about pre-existing conditions - they’ll be covered fine because I’ve got (national) coverage now with no gap of 63 days or more before I take up in NC.
My insurance will be part of my grad school stipend.
My worry is that my ivig could be classed either as a medical treatment (20% co-insurance, $2000 co-insurance maximum: manageable) or as a prescription drug (40% co-insurance, no maximum: eek!)
Your best bet is to call the insurance company you will be working with. They all have their own lists of drugs they’ll cover and at what rate. My guess - which is only a guess - is that the ivig will be covered at the prescription rate and the cost of the nurse to administer it at the medical procedure rate. But that’s based on my experiences with my insurance, not yours, and they’re all different. Check the internet - your company will undoubtedly have a website with an 800 number or email address.