You may be unfamiliar with the phrase “infusion therapy.” But if you’ve been pregnant and had an epidural, you’ve had a form of infusion therapy and perhaps didn’t know it.
Besides childbirth, infusion therapy is helpful in many medical situations. From temporary to chronic conditions, cancer treatment and more, it’s a quick way to administer medication, fluids and even nutrition. And while it used to only be available in hospital and clinic settings, at-home infusions have become common.
Here, we’ll go over what infusion therapy is used for. We’ll also go over the costs, what infusion therapy looks like both with and without insurance, and how you can save money and heal in the comfort of your own home.
Common types of infusions and why they are used
Infusion therapy can be administered in several different ways. The most common is intravenously (directly into the veins), but it can also be administered through epidural (injected near your spinal cord), subcutaneously (injected into and absorbed slowly through fatty tissue under the skin) and intramuscularly (injected into the muscle).
The reason intravenous is most common is that it has a faster and higher absorption rate than other methods. This is helpful in situations that need to be resolved quickly, like when you’re severely dehydrated or need antibiotics to start working immediately for a severe infection.
It’s also an easy way to administer medication to someone who is unable to ingest medication orally, for treating GI conditions where a doctor may want to bypass the digestive process of swallowing pills, and for pain management where it’s necessary for the medicine to start taking effect right away and not over time.
Infusion therapy can be done in a doctor’s office, in an outpatient facility, in a clinic or at home with a skilled nursing practitioner. It’s used to treat many conditions, including:
Types of infusion treatments include:
- Blood transfusions
- Chemotherapy
- Electrolyte therapy and fluids for hydration
- Immunotherapy
- I.V. antibiotics to treat infections
- Pain management
- And others
What determines the cost of infusion therapy?
The cost of infusion therapy varies due to many factors including, most importantly, whether you have health insurance.
A second primary cost factor is where you receive your infusion. In the past, infusion therapy was mainly done in hospitals. But it’s now frequently done at less cost in specialized infusion centers, clinics, doctor’s offices or at home with the help of trained home health specialists.
Other factors include the type of infusion you receive, how many infusions you need, and the cost and amount of the medication used, especially if you need a specialty or biologic drug.
Does health insurance cover infusion therapy?
Whether or not you’ll be covered depends on your individual health insurance plan. Typically, though, health insurance covers a portion of the cost for infusion therapies that your provider deems medically necessary, usually under your prescription drug, outpatient professionally administered injections or home infusion therapy benefit.
Remember that, depending on your plan, coverage may not kick in until you’ve met your plan’s yearly deductible. Also, you may be responsible for cost-sharing in the form of coinsurance or a copay.
Additionally, it’s important to understand any limits and restrictions set by your plan, especially because infusion therapy can be expensive. An important first step is to check whether the drug to be used is covered by your plan, and if there are specific coverage criteria or limitations.
If the drug is covered by your plan, you can take these additional steps to make sure you’re covered and that there won’t be any interruptions to your treatment:
- Check if you need prior authorization (you most likely will) and that there aren’t coverage limits. Also, check to see whether you should try less expensive or generic versions of the medication first.
- Determine whether the drug to be used is a specialty drug, which will impact how much you pay and may affect where you can receive treatment.
- If needed, work with your doctor to get a prior authorization or other documentation to get the infusion therapy covered by your plan.
You can also review your plan’s coverage criteria policies for additional information or contact Member Services with any questions about infusion therapy and what may be covered.
Cost of infusion therapy without insurance
It’s possible to receive infusion therapy without insurance, but it will cost much more. However, home infusion therapy without insurance typically costs thousands less than inpatient services. And many health systems offer tailored payment plans so you can pay for your infusion therapy on your schedule. If you don’t have health insurance, contact your preferred provider to see if they offer infusion therapy without insurance.
How to reduce the cost for infusion therapy
While the cost of infusion therapy seems high, remember that if you have health insurance, part of it may be covered. The best way to save is to ensure the care you receive is in network. If you can get infusion therapy in your home, that can save you even more. Speak to your doctor or your pharmacist about options available to you, and if you’re a HealthPartners member, contact our Pharmacy Navigators to determine if home infusion therapy may be a good fit.
After you receive infusion therapy, you may potentially be able to save on your bill further by working with a care coordinator or billing advocate, and by looking into programs like copay assistance, which may be offered by drug manufacturers and medical providers.
