Does anyone know how to get an actual answer out of medicare?
This is so frustrating and I am so sick.
Most of them cant tell me anything or dont want to...
the last one said when the bill is submitted then they decide if they will approve it...
so I said so I can run up a $50,000 bill before you can tell me if it is covered
and if you dont then I get stuck with the bill
she said yes and when I told her that insurance has a set of covered and non covered things
she said we dont and hung up on me after me waiting on hold for about 30 min.
Oh and I think that was about the 4th person today I tried to get answers from ... and I forget how many yesturday
Trying to find out about IV coverage for 2 days and no one at medicare will give me a real answer.
So frustrating Posted by Kayda (Member # 10565) on :
My nurse told me last week that Medicare will not cover IV antibiotics.
Dr. J in NC said legally they allow 28 days of IV antibiotics.
I do not know who is right. I wish there were a way to find out.
Sorry, this isn't much help. There seems to be quite a bit of confusion out there. It seems to me that you should be able to find out ahead of time what's covered & what's not. Maybe your senator could help you find out. I doubt they'd have the courage to put him/her on hold and then hang up on him/her.
I think it is important for senators to know how their constituents are being treated.
Kayda
Posted by trueblue (Member # 7348) on :
No matter what you ask... Medicare will tell you they do not preapprove anything. They will not answer (I don't think they really know).
As far as I can tell the best way to find out is to ask the IV company (infusion center) if these things are generally covered (possibly the billing dept). They'd be the people that really know.
I'd go that route first, or next, as the case maybe.
My understanding is you almost always have to go to a facility to have IV covered. Even then my understanding is they will only cover 28 days. That maybe forever, not sure, as no one will say.
Also, I learned the hard, and expensive way, that Medicare will only pay Medicare providers. (a lab misrepresented themselves) You can't ever submit anything on your own other than for a denial to show other insurance in case they will pay.
Posted by trueblue (Member # 7348) on :
Oh...
one other thing, sorry...
Try calling whoever handles medicare claims for your state and not the federal level, they are sometimes more forthcoming. I was told they do pay for IV Clinda in my state (but not if they would approve it for me). More than I knew before I called them though.
Posted by AZURE WISH (Member # 804) on :
Thank You..
Looks like IV isnt an option right now.
Thats ok though have new meds... so hoping.
Posted by trueblue (Member # 7348) on :
Good luck with the new meds, Azure! I'm hoping for you too!
I didn't wind up on IV, this time, either but figure there's 28 days worth waiting somewhere down the line if need be. (I'm hoping if that's the case I can beg, borrow or somehow get the additional meds on my own after I run out but have a line.)
I know, dare to dream. Posted by trueblue (Member # 7348) on :
Thanks for that, Cave.
I don't know about Azure but since I am ineligible for secondary (medigap) coverage the cost for a part D drug plan is more than half my annual income.
Meds given as an inpatient (or at an outpatient infusion center are covered but apparently the IV is limited to 28 days). Like they pay for meds for surgery and stuff, too, as it can be considered part A and you pay a portion that no one can predict. (part A is not 20% copay like part B, it's seemingly random)
I'll be paying off the gallbladder for a while.
Posted by tickedntx (Member # 5660) on :
I am fairly certain, though please verify, that medication administered by IV comes under Medicare Part A, not Medicare Part D (which is the Prescription Drug Program).
Posted by kelly06 (Member # 10417) on :
My elderly friend here in Md just went through 6 weeks of IV antibiotics for Lyme. Medicare part A covered it. This included the weekly visit from a homecare RN for blood draws and dressing changes. Good Luck to you !!
Kelly
Posted by AZURE WISH (Member # 804) on :
Trueblue - I actually do have part D cuz I am poor I get it paid for I was 23 when I became disabled and had mostly worked summers while in school than college.
(It does not cover IV meds though)
Have you tried to see if you qualify for help paying for medicare (part B and/or part D)?
Medicare said they do not pay to infuse at home.
The having to infuse at the hospital everytime is insane. I am too sick to go anywhere everyday - much less drive myself there and hang out till I infuse - then while I infuse and then drive home.
Posted by trueblue (Member # 7348) on :
Thanks Azure, Unfortunately, I don't qualify. (I pay for part B) I am waaaaay under the income level but have some small amount of assets they want me to pay down first.
I refuse; so am using it to supplement my income and now it's just a matter of time until it's gone.
I had home IV while on Medicare about 6 years ago; it was extremely hard to attain homebound status. (I had the meds donated, paid for all the supplies and a portion of the price to insert my line. The nursing was paid for by part A.) It is near impossible, now, from what I understand. The infusion center in the hospital across from my house is only open 5 days a week during normalish business hours. Which is also problematic unless you're pulsing something in a once a day dose.
I use any PA programs I can for meds and my treatment is limited to what I can get or pay for. A good price on Malrone would be really helpful around now. Pfffft... I can't catch a break on that one.
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