springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Upon first note i was told Medicare does not cover any IV home infusions or care.
But upon talking to the home health care people they said that if I was to have the infusions during business hours that there are clinics set up that Medicare will cover fully.
Now I have to infuse at 7am and 7pm but talked to my doctor and it may be workable to change it to once a day and during business hours.
I called medicare to ask this question and at first the guy pretty much laughed at me and tried to give some bogus answer to just call my doctor office and he would be willing to give me an address to do so? I patiently asked to talk to his supervisor whom I repeated the question.
I was put on hold and she came back and told me that her preliminary answer to the question is Yes they would pay for infusions done during business hours but that it has to be verified through another department whom has to call me back in the next 48 hours.
I was wondering if anyone gets IV infusions through Medicare and if it was covered in this manner?
Anyones experience would be helpful..
Thanks
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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bettyg
Unregistered
posted
i've never read of anyone getting this done thru medicare! but i've never gone thru this and DO NOT read all posts about this. good luck.
DOCUMENT, DOCUMENT .... dates, times. who you talked to, and i type my comments as they talk since i can't read my writing any more; that really scares them!
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
im curious about this too.
Springshowers- did medicare return your call?
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- This is why I did not do IV when I had an out-of-state doctor who said it was the only way for my advanced state. Kindly, Roche, donated several months' of rocephin to me - but I had no way to infuse it. At that time, my home-town GP would hear nothing of this, so I was working long-distance but could no longer travel or afford this.
Had I even been able to go to a clinic, I would not have been allowed to use my donated medicine, I would have had to buy it through the clinic. But I could barely walk and was home bound, anyway.
There was no way that I could have even gone to a clinic to do this - even once - not to mention every day.
There have been some patients who were more able who have done this and it worked out okay for them. I don't know if there is time limit on this, such as 30 days (which is what it was when I explored this option), so be sure to check.
Also, I'd be careful not to tell anywhere were you would go for the IV of your dx. You can be vague. It's none of their business. --
If you are in a state that recognized lyme, and you also have MedicAid coverage, that can cover some of the home services. -
[ 09-25-2009, 08:27 PM: Message edited by: Keebler ]
Posts: 48021 | From Tree House | Registered: Jul 2007
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
I am still working on this. Medicare did call back and said that they do cover IV Abx but it has to be done by a medicare provider.
Ok. So who is a medicate provider who can or will do the infusions? The is the problem. Even if I am able to get up and get somewhere to get this done I have yet to find somewhere that does it. They would not give me that information and said I have to search using medicare provider search directory.
So that is the next step. I did start going through it but have not found anyone that would match this need.
So I guess I have to call around hospitals clinics and or doctor offices that are providers and start asking until I get somewhere.
Time may run out for me to figure this out. I am getting home health care and it is being billed through my secondary insurance.
What I did hear too is that If medicare will infuse they will not cover the meds. And if the other insurance covers the meds they will not cover the infusions.
Somewhere in there since I have two tier insurance they should split this cost. But Medicare wants to be out of it unless I find a provider.
Ok. So anyway.. If anyone has any ideas of how to find a medicare provider that makes sense that might do infusions let me know. I was thinking maybe a cancer clinic or such?
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
Springshowers- I was reading through some old posts on here about this and some said that if you go to a hospital to get the infusions daily that it is covered.
Is there possible a clinic in your area that treats lyme using alternative IV's that takes medicare that might be willing to work with your LLMD?
Did they mention how long IV would be covered if you do find a medicare provider?
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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bettyg
Unregistered
posted
also if you put your STATE IN SUBJECT LINE; you might get input from others living there ... so edit it
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Yep. Looks like I will be just calling down the list starting Monday and hope to find somewhere. Maybe starting at hospitals and urgent care and the ideas you gave such as aids clinics etc. I have been searching under Medicare Provider list but have not found any AMA lists that would say which are medicare or not and looked through nursing lists too but will have to cold call them.
I am confident something exists I just have to find it.
I wish I had looked through all these details prior to getting the orders but sometimes you do not know exactly what will happen via these insuarance and doctors until the orders go through because when you call they give you all the jargen of medical necessity and they can not tell you enough details to get it figured out.
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
PS The Home Health Agency I work with has a clinic on site but they said they are not allowed to let me use it because you can not hand carry in the scripts of meds and because by law they have to deliver the meds to my home. I am still trying to figure that one out. I think it is tied to the doctor order that says I have to infused at 7am and 7pm. SO that puts me out of the daily hours of 8 to 5. It may come down to that. We will see
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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posted
Why can't you infuse at home by yourself? Why do you need to have some else do it for you?
If you get a port rather than a PICC line you can infuse anywhere anytime.
James
Posts: 872 | From New York City | Registered: Jun 2008
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Hi. I do have a port and I do the infusions myself.
But the Home Health does not and will not bill the items as a script but the whole process as a medical procedure code and therefore .. Medicare denies coverage when it is done this way.
I am trying to figure out a work around to this problem but not yet have been able to.
The home health also says by law they have to deliver the stuff to my home because the infusions are scheduled 12 hours apart.
Maybe that is a big glitch ? Its frustrating...
If I was able to get the doctor to change the infusions times to during working hours I then have to find a clinic that will do the infusions. At that point medicare says they will cover the cost 100 percent.?
So.. its really stupid if you ask me. What if the out of medical necessity you have to have your infusions at this 12 hour apart point. I guess I could get the doctor to write up one of the infusions during business hours and the other not and maybe save 1/2 the costs?
Something does not seem right with this picture.
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Amanda
Frequent Contributor (1K+ posts)
Member # 14107
posted
Most hospitals take medicare. So, try calling the hopsitals first. Call up the outpateint services department. Tell them you need IV antibiotics, and you have medicare, and could you come there and have medicare pay for your daily infusions.
IF they tell you no, we don't do that, ask them which clinics will do it. If the hopsital doesn't do those procedures, they typically know who does.
Good luck to you.
-------------------- "few things are harder to put up with than the annoyance of a good example" - Mark Twain Posts: 1008 | From US | Registered: Dec 2007
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Hi Amanda yes that was going to be my plan of action and am going to start those calls here on Monday. I think your exactly right on where to start and keep asking down the line until I get a good lead..
I also read that if your doctor will write you a note that you are homebound that medicare will cover the home health infusions.
Thanks for the idea
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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posted
if your dose is 1g every 12 hrs.. try having your Dr rewrite Rx for 2g every 24 hrs.
coordinating IV care is frustrating.. i have Medicare now and wonder if they would have covered 238 days like my insur did.
i ended up purchasing $10,000 in meds from Canada after a sudden discharge from US Infusion company.
trying to get foreign meds mixed by a US pharmacy was the next battle.
it was a hassle but what i did was see a reputable LLMD in NJ.. they sent me to their local compounding pharm with an Rx to mix meds.
syringes were shipped weekly from east coast. home care consists of PICC line care (bandage change) once a week.. i injected my own meds daily via syringe for 20 mins.
Medicare customer service seems useless when it comes to Lyme Tx and/or out of network claims (1490s).. somehow we have to crack the code.
please share any info you find.. thanks and good luck. -- sonicbmx
-------------------- "The hell with Drs.. we have each other!" My story began here:
posted
ok, few things i can try to tell you and hope this helps !!!
you have a homehealth agency in house already- ok, they should be setting all this up for you !!! talk to Director of Nursing at that agency FIRST. try to explain as go on so u know where u stand and what to expect of them.
from what i gather you have medicare AND secondary right?????
1) homehealth - covered my medicare at 100% if following are met (well, not 100% tech. but homeheath takes the % medicare pays- in ur contract should say they will not bill u for the difference. is a contractural agreement)
a) SKILLED need- port access IS SKILLED need. we dont teach pts to access own ports- tooooo risky. needs to be accessed by RN and site assessed, dressed,etc. now- may can teach u to de-access. i do my own, but am RN so diff. story. not something a pt. should do without LOTS of teaching, understanding and able to show nurse u can do several time and without verbal assist,etc...going on limb here but with lyme and usual memory issues...NOT good idea. if pressure pulled on port when removing huber needle can damage port. remeber port is threaded into veins and pressure up on it can dislodge placement so you have skilled need of at LEAST port access every monday and de-access after last infusion...now, nurses have to teach you how to do ur own IV's. at first they may have to be out there for the am and pm. sometimes this may be a staffing issue. if so, you have right to change to another agency that can meet ur needs.
b) you have dr's orders that are valid, and dr willing to sign orders, communticate with nurses. sound like u have that on board
c) homebound...have to be homebound for medicare if it is primary. IV care is only one sometimes can work with bc ports are skill within a skill.
ok, next issue - medicare itself usually does not pay for the IV med or the supplies for the port (dressing kit, huber needle, ext line, end cap...etc)..this is billed to your rx policy what ever that maybe and means what ever deductables involved. The infusion company handles this.
so- you may have either an infusion company with IV nurses preforming the weekly port access and teaching you infusion --- OR ---- infusion company is **primary*** agency (they have trump card with IVs) and then THEY contract a home health company for the nurse to come out if they dont have one. this is where you can either keep nurses/homehealth you already have in place or may have to change companies
there are MANY times that infusions are not during normal office hours...
if you go to infusion suite- you are now not homebound..homebound laws read that takes sustained effort to leave ur home, only for short duration (like dr appt) and requires use of assistive devices or assit of person...
2xday to infusion suite and now loose home health.
now- if you need to, maybe and infusion suite can assess your port get you started and then u can do your PM doses??
would start by googling that or yellow pages for your local area for fee standing infusion suite/site/care...any of those may help u
what i dont understand is why homehealth nurse not getting you set up?????
normally- the home health gets the IV orders and either sets up the infusion company for meds/supplies and they r contracted nurse or they explain they have to send your case to infusion company.
can tell you this- can NOT have nurse from homehealth and infusion company nurse.
medicare will NOT pay for "duplication of services"
i would start with case mngr of home health company. explain u have IV orders, have a port, when was last time flushed ( THIS is VERY important--- port has to have been maintained..if not MD or the surj may have to access it first to verify is patent, risk of clog/clots if not been flushed as required)..if case mngr is clueless talk to director of nurses. if that person cant help you- call another agency in your area, tell them you need to find out about homehealth for IV.
hope this makes since enough to help you out ....
PM me if you need more help and will call you if would help....
very, very sorry you are having such trouble. nurses already out there should have had this under control or been able to explain to you the hold up (such as infusion company wants to send their nurses out and that means they loose ur case and the $$$ if u are medicare and in the middle of a 60 day episode of care, that is how is billed to medicare)
best of luck !!!! start with who is alreay coming out, dont jump to calling outside companies first. they may not be giving u best info since you have homehealth already...again...double billing means someone not gonna get paid!!! and since home health already has you in "open episode" IV if separte will NOT take a loss- they have to be able to bill.
really hope my lyme brain got this out to make sense enough????????
-------------------- i am not a Dr. any info is only for education, suggestion or to think/research. please do not mis-intuprest as diagnostic or prescriptive, only trying to help. **
dx in 08:lyme, rmsf, bart, babs, and m.pneumonia. Posts: 422 | From TX | Registered: Oct 2008
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Oh My.. THANK YOU SO MUCH FOR writing all that and
I READ it.. And I will have to re read it. I am getting confused now.
Just to clarify one thing. I am set up already and they came out once. My doctors office is doing the Port Access so I only had one nurse come out one time and that was it. Then they just deliver the meds and supplies.
From what I gather I sounds like i really just should stay with what i have and deal with the cost and not expect medicare to pay or help pay.
Then it kicks over to my secondary and that one has a nice large deductable so therefore I will end up paying for all of this.
So that is why i was trying to figure another way. I am being billed for medications and all the supplies and services. This is what they call a medical treatment and they do not bill the prescription coverage I have for anything?
So I really do not think that is fair?
But not much in this disease is fair.
Thanks so much. i will PM too and clarify a couple things.
Thanks so much
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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posted
all of my IV care fell under "Major Medical" with my previous insurance.
initially i thought medication would have to go thru my Rx company (Medco) but that wasn't it the case due to (i'm guessing) medical necessity and/or the severity of my condition.
i am certain Medicare would cover 80% of costs if Home Health/Infusion provider is in network and bills with proper Dx & CPT codes (reinforced by positive and abnormal test results).
you might consider contacting Medicare Part D (Rx) for details if you have it: 800-928-6201.
many times Infusion & Home Health Services are bundled under one roof (all in one).. some of it is covered under Part B.
the ordering Dr will usually set you up with their preferred company.
it's your responsibility to make sure they are a NETWORK provider with your insurance (Medicare, Medi-Cal or private carrier).
hope this helps.. -- sonicbmx
-------------------- "The hell with Drs.. we have each other!" My story began here:
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