In this blog, we dive into a subject that affects countless individuals on their healthcare journey: the often perplexing world of infusion therapy costs. At Uptiv Health, our mission is to put patients first, and that includes shedding light on the financial aspects of receiving vital, life-enhancing medical treatments.
We asked patient advocate and designer Sarah Stern, who is also an infusion patient herself, to share insights from a patient’s perspective and offer practical advice on how to navigate them.
Some key takeaways from this exploration include:
- As a patient, you have the right to choose where you receive your infusions.
- Site of care matters. Infusions at Uptiv Health’s retail-based centers cost 30-60% less than a hospital and provide a better experience.
- Prepare yourself and ask lots of questions from your infusion coordinator to help clarify your costs.
We understand that healthcare costs can be daunting, but with the right knowledge and support, you can confidently manage your infusion journey. Join us as we demystify the dollars behind infusion therapy costs.
Money works differently in healthcare
Think about the last time you bought something. Did the seller make it easy for you?
Let’s take a common purchase that can have an impact on your day — a morning latte. You might show up at your local café bleary-eyed, but if you mumble out an order and offer the cashier a credit card…voila! Hot coffee for a predictable price. You can feel confident going about your day, caffeinated and productive.
Healthcare makes important transactions more complicated.
Imagine that instead of your $4.99 latte, a doctor determines you need caffeine infused by IV-line to function. Unlike your morning latte, this infusion is a vital treatment that you will depend on for the rest of your life. This coffee doctor can’t tell you the exact price, but it will likely cost anywhere from $4,000 to $6,000 per treatment every six weeks, depending on your insurance, and you will only find out the exact cost after you jump through a few hoops, get your treatment, and get the claim processed by the insurance.
Yikes.
Infusion care can be costly and confusing
That’s what it felt like when I became an infusion patient. Once I was diagnosed with psoriatic arthritis, everyday tasks like walking or working required a large amount of money that I was on the hook for if I ever lost health coverage. Finances were hidden from me and instead handled by insurance, pharmacy benefit managers, and my health care provider.
The same is true for many people with autoimmune-related disorders such as Crohn’s disease, rheumatoid arthritis, lupus, Sjogren’s syndrome, ankylosing spondylitis, and ulcerative colitis. For these individuals, paying for infusions is complicated and, sometimes, surprising.
The first surprise was when I received a debit card in the mail from the manufacturer of the drug. It looked almost identical to other cards in my wallet — on the front was a 16-digit raised number, but above was the brand name of the biologic infusion I was prescribed. I learned this was called a copay assistance card. This card would cover part of the cost of my new medication.
You need a trustworthy partner to handle infusion finances and administration
All the new terms and processes were overwhelming, so choosing the right infusion center felt crucial. I chose based on location — walking distance from my office — and convenience, as well as a staff of communicative caregivers. They had a strong administrative coordinator who worked with the insurance companies and explained key concepts to me. It is important to remember that just like any other encounter with a clinician, you have a choice of where you receive care.
It was a big learning curve, but working with the right infusion center helped me understand how to navigate the system. I realized that for the expensive name-brand infusions, I preferred an insurance plan with a high premium (the monthly fee you pay for insurance coverage) and a low deductible (the cost you pay before insurance kicks in). Why? Because the copay assistance card will immediately meet the deductible. Your costs after the deductible might include a copay (a flat fee you pay for a health care service after you’ve met your deductible) or coinsurance (a percentage of the cost you share with the insurance company), both of which copay assistance often covers.
It’s a lot of terms, and truth be told, I didn’t fully understand the system until I took a public health class in graduate school. Most patients don’t have the time (or money!) to take advanced coursework to understand their healthcare. And nor should they have to!
If you’re new to infusions, these five tips will help you understand how to pay for them
- Ask questions if you’re confused. A supportive clinic like Uptiv Health knows infusions can be financially complicated, and they want to help you.
- Learn key healthcare terms such as deductible, premium, copay, and coinsurance so you can navigate infusion therapy costs and healthcare finances confidently.
- Take advantage of copay assistance programs if you are prescribed a name-brand biologic. In addition, ask about biosimilar (not name-brand) treatment options that may lower your costs and offer copay assistance (if your physician finds them to be an acceptable replacement from the therapeutic perspective).
- If your doctor determines you need a name-brand biologic, consider getting on an insurance plan with a high premium and low deductible as soon as you can.
- Choose an infusion center like Uptiv Health that can handle complex financial administration with health insurance companies, so you don’t have to.
Why choose Uptiv Health
With Uptiv Health, in addition to a personalized experience in comfortable private or family suites, you get a trustworthy partner committed to your financial well-being as much as your health. We work with major insurance carriers and Medicare to simplify the therapy coverage process. Our dedicated team does everything necessary to minimize your out-of-pocket expenses, assists eligible patients in applying for co-pay assistance, and provides clear and transparent cost estimation so that you can focus on your health, not paperwork or unexpected bills.
Request a referral from your provider to get started and change your infusion experience for the better.
About Sarah Stern
Sarah Stern is a designer and patient advocate based in Washington, DC. She holds a Master’s in Graphic Design from Maryland Institute College of the Arts (MICA) and a Certificate in Health Communication Design from Thomas Jefferson University. Her passion for designing information and visual identity for health sector clients comes from her personal background with chronic illness. She is a founding member of the Chronic Boss Collective and was on the publishing team of the recently released book “Artists Remaking Medicine.”
About Uptiv Health
Uptiv Health is redefining infusion therapy for patients suffering from chronic conditions such as multiple sclerosis, Crohn’s disease, ulcerative colitis, rheumatoid arthritis and others. Treating the whole person, Uptiv Health offers a hybrid experience with comfortable, highly personalized in-person care, including services to support patients’ overall wellbeing and a consumer-friendly digital platform. Via a user-friendly app, patients can onboard without paperwork, consult with their care team, schedule appointments, check-in, handle payments and monitor their symptoms. Uptiv Health accepts Medicare, is in-network with many health insurance plans in Michigan and provides completely transparent upfront pricing, at a substantially lower infusion therapy costs than traditional hospital infusion treatment centers.
