posted
Medicare has decided not to pay for my shots that are finally helping me to get well. I have been on them for 5 months.
It seems that the prescription side of Medicare is different from the doctor side. So the prescription side wants me to schedule weekly doctor visits to get the shots. That way they avoid paying for them.
We live in a very rural area. Going anywhere is a big deal for me. We also need to give the shots at bedtime, let them warm to room temp, use ice packs, etc.
There are few docs who will deal with me since I am considered an at risk patient. My pain doc needs months in advance to schedule a visit.
I am so furious that I told them I would stop them and they could then pay for the hospitalization I would eventually need. Last time is was $50K+ and 6 weeks, two of them in critical care.
We know a lawyer who handles complex Medicare suits. I am thinking of taking this all the way: file a lawsuit against Medicare.
Anyone have some suggestions? Anyone care to shoot me and put me out of my misery? No, just kidding. But, I am really mad!
-------------------- DOCTOR: "I don't think you are sick." PATIENT: "We are all entitled to our opinions. I don't think you are a doctor." Posts: 697 | From Northern California | Registered: Jul 2009
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Make friends with the nursing staff at the doctor's office. You should not need an appt with the doctor each time you go for your shot. Schedule a nurse appt, they will bill it as such.
If you ask nicely I'm sure that the nurse will warm the Bicillin for you and administer it slowly. Sit on ice while you drive to your appt.
You should have no copay for a nurse visit. So basically you are getting your medication for free. It might be worth a try.
Posts: 5237 | From here | Registered: Nov 2007
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Sammi
Frequent Contributor (1K+ posts)
Member # 110
posted
farraday, I can understand your frustration. My insurance will also only cover Bicillin if it is given in a doctor's office.
The only doctor's office I could find to do it is 30 miles away one way. I put Lidocaine on the site before I leave the house.
I know it is difficult to deal with, especially on the harder days. Since it is really helping you, maybe someone could give you a ride and you could go as late in the day as possible?
I hope you can work out continuing the shots.
Posts: 4682 | Registered: Oct 2000
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posted
Thanks for the good tips. We called the local hospital and they have a place where they give dialysis, iv's, etc. My husband explained the situation and they will work with us until we get it straightened out.
It is about 20 minute drive and I have to register, etc. People don't understand what a big deal that is for me. Some days I cannot even get out of bed. I think my doctor will go to bat for me with Medicare. He is too far away to give me the shots.
No wonder people don't trust the government to run medical care! The cost of this little exercise will be more than double the cost of doing it at home! And that doesn't count the time lost from work for my husband and the pain and suffering for me.
I have to continue them because they really do help me. My son saw me today and said he was amazed at the difference in my appearance and energy! I am losing weight like crazy. Soooo I guess I have to play the game. This disease is a royal pain in the &*()_(*!!!!
-------------------- DOCTOR: "I don't think you are sick." PATIENT: "We are all entitled to our opinions. I don't think you are a doctor." Posts: 697 | From Northern California | Registered: Jul 2009
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posted
I didn't know a Medicare Part D plan could suddenly stop covering a drug that is included in its annual formulary list.
Since Bicillin is so expensive, I assume you already verified that it was still included in your plan's 2010 formulary with no new restrictions?
If so, then certainly appeal! It may be legal for a Part D program to stop covering a drug on its formulary if that drug suddenly is covered by Part B? If this is what happened, then you still might as well try to appeal with your doctor certifying that you're housebound.
Another idea: Medicare Part A covers home nursing services if your doctor writes an home health order indicating that you're housebound. If you can get the home nursing through Part A then the Bicillin may also be covered through Part A, and then it shouldn't cost you anything!
Posts: 408 | From California | Registered: Apr 2008
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