![]() ![]() Then insurance would cover 100% of the infusion costs and everything else. Since you have $20k in Ocrevus co-pay, then the entire deductible & OoPM would be 100% paid by Ocrevus. It would cover the remainder of the OoPM no problem. Usually you have a 20% copay after deductible, which would be $5700 (way over $2.1k). $2500 to deductible, then another $2.1k to hit the OoPM at $4600. The billing is about $31k (I think is the normal cost for a full dose) to insurance would instantly hit your OoPM. Lets say your deductible is $2500 and your OoPM is $4600. Have your infusion center bill for the Ocrevus drug FIRST. Most of this was related to other drugs they give during the infusion and some other stuff. ![]() This was about $850 for me after insurance. The co-pay program only pays for two billing codes: 96413 & 96415. EXCEPT one little caveat you might have missed. The co-pay program will pay the remaining $3k. So let's say for example you are billed $20k for the drug and insurance pays $17000. ![]() Whatever is not paid (including whatever goes towards your deductible and out-of-pocket-max (OoPM)) will then be submitted to the co-pay program. Now, the infusion center will treat you and submit a claim to your insurance (assuming you have insurance). For example, the copay could pay $20k for the drug and $1500 for infusion costs. They send you a credit card that you can give to your infusion center to use to cover costs associated with the Ocrevus drug as well as some of the infusion services. I was a little confused how it worked at first, but after a friend explained it to me, I had a better grasp. So I had my first Ocrevus infusion this year (March). ![]()
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