Medicare NIGHTMARES

[JeanGrey]

Today I just received about six EOB's (explanation of
benefits) from Medicare and this I hope will demonstrate the
nightmare that is medicare.

I had a visit with my primary physician last October 10/07,
medicare has refused payment.  Why?
"This physician is not eligible to receive medicare
payments".  Problem?  It isn't true.  He IS eligible and
always has been in the 20 years I've gone to him.  I called
Medicare and of course got nothing from them but the stone
wall.  The doctor's insurance crew tell me medicare just
decided last fall to tell them they weren't eligible for about
a two to three week period where they stopped paying claims,
then just started back.  They don't have a clue why.

There is also another 100 bill from August of 07 that is being
refused "as it is too old".  This is how it works. 
They refuse payment and STALL and then say "too
old".

My oncologist sent me for a cat scan of my brain due to
headaches and I stage four cancer, which it isn't unusual to
get mets to the brain.  $170.00 refused because it was
"medically unnecessary".
So now Medicare purports to know more than my oncologist.  I
guess I should've just said "oh well, it's probably
nothing, it's only my brain, why bother?

So now I have ANOTHER five hundred dollars they haven't
covered and my secondary won't cover it either, because
"medicare didn't".

What a joke.

[ingac70]

1. If it sucks so bad go buy a private policy....

and quit using Medicare all together. Good luck.

[JeanGrey]

12. I HAVE A PRIVATE POLICY. You don't seem to understand.

If medicare doesn't pay the secondary one WON'T PAY EITHER.

[Oregone]

2. Of course, Medicare should pay for all necessary procedures & treatment from enrolled providers

But do you think your nightmare would be diminished at all if you were covered privately?

[JeanGrey]

13. I am covered privately. If medicare deems it unpayble,

the secondary insurance won't pay it either.

[MineralMan]

3. What's the source of this stuff from 2007?

Is this your story or someone else's? 2007?

[JeanGrey]

14. My Medicare EOB I just got in the mail today.

Apparently they've been trying over and over to get Medicare to pay this because all you get is "resubmit" and now they're getting "it's too old".

[MineralMan]

56. OK, thanks. I just wanted clarification.

[JeanGrey]

58. No problem.

[tritsofme]

37. That sounds right, timely filing for Medicare is 10/01/07

They won't pay claims before that date.

[JeanGrey]

45. It was after the date one was 10/7 and the other was after the

cutoff 8/27. But this is the FIRST EOB I've gotten on any of this and my doctor hasn't said one word. His insurance clerk said Medicare was driving them nuts, and they had been trying to get it paid for a year, that many others had bills rejected as well.

I usually do better by letting the office handle it because any time I have ever called medicare I get nothing from them, when I ask why I get the same answer that is on the EOB, if you try to argue you get nothing.

So I don't know if it would have helped if I'd known, maybe the doc is going to eat it, he did tell me the last time I was there he was thinking of dropping Medicare.

And once again we're stuck in the middle.

[mdmc]

4. try HIP private insurance (or Blus Cross)

then ya can pay for the same nightmare.. although it sounds just like some bad communication

[JeanGrey]

15. I already HAVE Blue Cross I pay 1,000 a month for it.

Unfortunately if medicare won't pay it, Blue cross doesn't have to either.

[ohheckyeah]

62. Why in the world are you paying

$1,000 a month for blue Cross when you have Medicare? All you need is a supplemental plan and they damn sure don't cost $1,000 a month.

[JeanGrey]

70. Because I have some drugs that cost 4,000 a month!

Do you think medicare will pay for those? I had a liver transplant in 04 and my anti-rejection meds ALONE cost over a grand a month, not even counting the 20 some other pills I take (I am stage four cancer).

If I only had medicare I'd be bankrupt in a month!

Plus Medicare refuses a lot of bills for payment and when they do pay they don't pay anywhere near 80%, I wish. I kept my BC for drugs and silly me thought they'd pick up what Medicare didn't pay.

[defendandprotect]

116. What drug program did you sign up for . . . are you getting any advice from anyone

familiar with the plans, etc????

[JeanGrey]

132. I didn't sign up for any Medicare part D program. None of them

would come close to covering the expenses I have. For instance, I had to take a shot every day that boosted my red or white cell count I forget which now, it was about 2,000 a shot, times ten.

I'd be into the "donut hole" on my first prescription. I also am taking Tarceva now, a chemotherapy pill, that costs about 4,000 a month. My Bluechoice covered it with a $25 copay which shocked me.

I also take anti-rejection medicine that runs about a grand a month. Just covering that drug alone with a 25 copay makes up for that premium. My sleeping pill, Lunesta, runs about $250 a prescription, and I've had several life threatening infections that I have had to take a new antibiotic for, and it was about ten dollars a pill.

I keep the blue choice mainly for drugs, but it would kill them to pick up what medicare doesn't cover!

[mdmc]

130. sounds like all the insurance companies are out to get ya my friend

:toast:

[JeanGrey]

133. If you had my drug bills you'd understand.

[mdmc]

180. I've got my own - I do understand

I am currently paying $200.oo per month for my health, and can't afford the additional treatments I need to completely heal.

[JeanGrey]

184. delete

[JeanGrey]

185. I am so very sorry. I understand, 1/2 to 2/3 of our income is

spent on Medicare and BC premiums, co-pays and the like. Thank god our house is paid for or we'd be on Section 8 probably or worse. I hope you get what you need!

Maybe Obama will wake up and realize WHAT we need.

[mdmc]

197. Bernie does

I doubt Obama will. But we need to take what we can get.

[YOY]

5. Say...what's with the crazy font?

The only time I see font like that is when...oh...got it.

[Systematic Chaos]

8. +1!!

:rofl:

Medicare Troll is trolling about Medicare!

[YOY]

11. I swear it's like a red flag...I see that font and it. all. makes. sense.

Just like the end of "The Usual Suspects"...except that Kevin Spacey's character is played by Orly Taitz.

[JeanGrey]

23. I don't know why I bother. Why are you people so sad?

My oncologist charged 47,000 for an office visit! Two chemotherapies. Why in the world would anyone make this up?

We NEED national health care but we need a single payer that stops this nonsense. If the insurance companies and the drug pharms are kept we're doomed......

I couldn't believe the chemo prices. Unreal.

[YOY]

24. Yeah, sorry.

I jumped the gun. Didn't flame though did I?

[JeanGrey]

40. For thanks for not flaming. Why is it when someone says

anything negative about medicare everyone assumes I am some kind of right wing spy?

I have stage four cancer and this really upset me, getting these EOB's. ESPECIALLY the one where the doctor charged 43,263.00 for the day.

It was

200 bevacizumab injection 1 hour (27,500.00)
150 pemetrexed injection (14,625.00)

I assume those are the rightful names of Avastin and Alimta, the two chemo's I staying stable on.

When you see this kind of stuff you just want to cry. I am still crying at the hopelessness of this.

[Mariana]

73. Are they refusing to cover any of the $43,263.00?

How much are you actually on the hook for?

[JeanGrey]

77. They paid 19 grand on the chemo (and refuse a cat scan

for brain mets) :crazy:

It leaves a possible co pay of 2,296.16 plus 1,444.82 on the other. If Blue cross doesn't pay.
I think they will on this one because medicare didn't outright refuse. (fingers crossed).

It's the other 4-500 that they won't pay like the almost 200 for a cat scan that was certainly medically necessary.

I just don't get it.

[defendandprotect]

119. Most people check what the charges are going to be before they get the

treatment . . . didn't your doctor discuss with you what the costs would be and

what Medicare would pay in ADVANCE ...... ?????

[JeanGrey]

134. Er, No. No doctor has ever done so.

[pipoman]

160. Look

I feel for you with your medical issues and wish they were paying 100%. It seems like they are paying A SHIT LOAD more than you could have possibly paid out for your coverage?

[JeanGrey]

186. Had I known they were paying this kind of money for

chemo I would have protested, because I'm not sure my oncologist takes medicare assignment which means I could be responsible for 3 to 4 grand.................

[defendandprotect]

118. Yes . . .we need MEDICARE FOR ALL with a full drug program which disconnects . . .

insurance companies and bargains with drug companies for cheaper drugs --

$47,000 for for one office visit? Maybe you need some new doctors?

Why in the world would anyone agree to charges like that?

I think you have something very strange going on with these doctors --

they seem more mercenaries than doctors!

[JeanGrey]

131. From what I understand those are standard charges for the

chemo's avastin and alimta. I never dreamed it could be that high! I almost passed out when I got the medicare EOB.

[JeanGrey]

135. Apparently chemotherapy (some of them) are extremely

expensive, and this is how I understand that oncologists make most of their money.

It was 20 grand something for one and 19 something for the other. I am working on making this EOB into a jpg so I can get it posted.

[Ilsa]

159. ITA: Single Payer is the only real reform. We need it, badly. nt

[JeanGrey]

17. I don't know how I got that font!

I wondered myself. My regular font is fine.

[Lone_Star_Dem]

39. as to the font

You clicked the check box before this text on the posting page, "Check here if you want to format your message in plain text. Use for posting code snippets."

No worries there, it happens occasionally.

As to your issues with you're health and lack of proper health care, I'm deeply sorry for all the hassle and stupidity you and so many others have to deal with on a daily basis. Especially since it smacks so many in the face at a time when a person needs to be focused on getting well, rather than bureaucratic BS.

[JeanGrey]

42. You're right. I DID check that box. I post very few articles

and start few discussions, I don't know why I clicked it, just thought it was the right thing.

Thank you. Every day is like an uphill battle and when you get this stuff even though you're paying 1/2 of your income or more to insurance premiums and you are still stuck trying to find more money, or you get an EOB that shows the last chemo treatment your doctor gave you was billed to Medicare for $43,263.00, you just want to scream.

That is why I KNOW if we leave "profit" in the picture we are screwed.

[orleans]

176. amazing. it does sound like an absolute nightmare

and this should demonstrate how important health care reform really is.

the prices that are being charged, those doctor visits??? unfreaking real! i don't care *what* it is for--those charges are absolutely outrageous. this should not be allowed.

i'm sorry you're going through this--both with the illness and then with all this $$$ crap.

didn't obama's mother go through something similar as she tried to recover and pay bills at the same time?

come to think of it--i think you should contact the white house and obama. this is a story they need to hear.

so does congress.

please take this public--more public than just on du.

this is a story that needs to be in the news, on the tv, in people's living rooms. right now. this month. (is there someone that could help you with that?)

also--i'm sorry this thread got unrec. i think it's horrifying and eye opening. and those of us who think medicare is the perfect deal need to understand why it doesn't go far enough. (remember the congressional vote with the pukes ramming it down everyone's throat and they kept the vote open till 3 in the morning to fuck up medicare? it needs to be fixed!)

[JeanGrey]

187. I'm just sad and crying all the time because we need real

reform, and that cannot come with insurance companies and their profits and big pharm and theirs!

I have written to the white house many times.

[orleans]

210. i don't know where you live, but if i were a journalist i would definitely

be interested in this story.

maybe contact a few papers in the area--or a local news show--sometimes they do little investigative reports on various topics. this is a hot topic--real hot--and even if you don't want the attention, the attention you could bring to this could be one way to fight back at this system.

honestly, people don't know about this until it happens to them--people don't get it, the general public doesn't know the outlandish costs of health care.

call the papers and find out who you would talk to --who might be interested in covering this very real human (and national) interest story.

i know you're sick, i know you're not feeling well--but your story is definitely a story people should hear.

best wishes jean.

[DevonRex]

36. I wonder why that is.

But you're right. It always IS a red flag.

[YOY]

43. It's not 100%.

As this case may very well prove.

[JeanGrey]

47. I checked the "use plain text". Another poster showed

me. I don't post many discussions and did it in error. I guess I thought it wouldn't look right if I didn't check it.

Hey some of us are new at this and don't post discussions as much as others.

[sinkingfeeling]

6. Try dealing with a for-profit insurance company. It's the same stuff.

[JeanGrey]

18. Well, I have a for profit secondary backup, I pay blue cross

1,000 a month for my husband and I, but you see, if Medicare doesn't pay it, blue cross doesn't have to either.

[ohheckyeah]

68. Supplemental plans should not cost anywhere near that. n/t

[JeanGrey]

72. It's for hubby and me both. It went up last year from 671 to 970

for the both of us. Insurance is very expensive. Especially when you're a liver transplant with stage four cancer!

[ohheckyeah]

108. I understand, but supplmental to Medicare plans

should not be that expensive. I suggest you talk to an independent insurance agent. I did and he saved me over $500 a month. Never hurts to try.

[JeanGrey]

136. Hon, I am a liver transplant in stage four cancer.

No one will insure me for ANY amount of money. That is why I kept the high BC.

[defendandprotect]

120. Call AARP and see what they would charge you for supplemental care . . .

[JeanGrey]

137. I am not insurable. I am a liver transplant and I have

stage four cancer. NO ONE will insure me. If I didn't have this policy carried over from work I would only have Medicare, god help me.

[classof56]

7. Sorry to hear you're having these serious issues with Medicare.

In the six years I've been on it, eight years for my spouse, we have had mainly positive experiences. I'm now dealing with settling a relative's estate, have learned he had cancer, but had dropped Medicare Part B before being diagnosed, and it's been a real eye-opener as to the negative financial implications that caused. Not trying to advocate for Medicare beyond saying it has worked well for me, my spouse and most others I know who are in the system. I am aware that there are doctors who do not take Medicare assignments, so I'm grateful for the ones who do.

Again, I am sorry to know your dealings with Medicare have not gone well, especially with the serious medical conditions you have. I sincerely wish you all the best.

Blessings.

[JeanGrey]

19. Thanks. It isn't just their fault totally. I also got my EOB

from April, my last chemotherapy treatment and the oncologist charged (ARE YOU ALL READY?)
#27,500.00 for one chemo and $14,625,00 for another, for a grand total office visit that day of $43,263.00.

And we think we can get a public payer system allowing this kind of stuff?

[defendandprotect]

121. A private system would be LESS LIKELY to cover this stuff for you . . .

We are all paying now what the most luxurious of health care systems would cost--

Switzerland's, for instance!

The only difference is we don't get the care --

Meanwhile, we're also not getting cures for cancer -- we're getting more and more

treatments which cost more and more. There are now more people working in cancer care

than there are people who have cancer.

Yes -- EVERY OTHER NATION HAS SYSTEMS WHICH WORK . . . ARE YOU SAYING AMERICA CAN'T DO

AS WELL AS EVERY OTHER NATION????????????????

Let's ask why we have so much cancer -- that would be an excellent start!!!

[JeanGrey]

138. I totally agree. But we need a system that doesn't depend

on profit.

[defendandprotect]

175. Medicare isn't a "for profit" system . . .

I'd have to suggest, however, that cancer care seems to be a GOLD MINE for many

doctors --

Again --- try to get someone to work on all of this with you --

and I'd certainly ask a lot of questions of your doctors re drug costs, etc. and

what is and isn't covered before you have the treatments.

[JeanGrey]

188. Would you believe that no doctor has ever talked cost to

me? Once they find out you have two insurance coverages they are all happy.

It's the cost of chemotherapy. It is unbelievable.

[defendandprotect]

204. Cancer care is a GOLD MINE . . .

[BlooInBloo]

9. Maybe you'd be better off without any Medicare then?

Thought not.

[JeanGrey]

20. Of course not we have to have something.

But to think that the working poor can dig up 4, 5 or 900 dollars every other month when they get sick to pick up what isn't being paid is unreal.

[defendandprotect]

122. You're have most of your problems in covering your drugs . . .that's a BUSHED program . . .!!!

Granted the prices your doctors are charging you are also questionably exorbitant --

Maybe you should try some other doctors?

[JeanGrey]

139. Apparently the prices for these particular chemos aren't

out of line with what others charge. Yes I realize Bush started Medicare D but before that there was NO drug coverage under medicare.

[defendandprotect]

174. Again, most patients/doctors discuss whether Medicare covers all of the treatment . . .

or not. You doctors never advised you of the immense costs of this care and

what would not be covered by Medicare?

And, why are the billing DATES so odd -- so old???

[JeanGrey]

189. No. I've never had a doc discuss cost with me.

Not once they find out I had insurance. Originally before medicare it was an HMO and I was at HMO docs so why would they discuss cost? Then I had medicare as well so they probably assumed it was 100 percent. I did too.

[proud2BlibKansan]

10. Better drop it then and get a different plan!

[JeanGrey]

21. Sigh. Once again, it doesn't matter if you have a different

plan (I do). If Medicare won't pay it, they won't either and if you're eliglible for Medicare and don't have it they simply refuse 80 percent of the bill.

[Beetwasher]

16. Why Don't I Believe A Single Word Of This Post?

:shrug:

[JeanGrey]

22. Because you don't want to. I have a fax machine and I'd

be happy to fax you a copy but I have my personal info on it, thanks.

[Beetwasher]

29. Sure

n/t

[JeanGrey]

48. Can I scan this and turn it into an html that I could put in

my answer? I don't have a clue how to do this.

[Stephanie]

71. Sure

Scan it, save it as a jpeg, upload it to www.photobucket.com or www.flickr.com, then paste the link in your post.

[JeanGrey]

74. I'll try.

[sakabatou]

25. This is the POE of medicine.

[dysfunctional press]

27. because you've never had to deal with medicare..?

i have.

it's true.

[defendandprotect]

124. On the other hand, few of us have treatments this expensive . . .

this is catastrophic health care --

but I still think you should talk with Medicare on the telephone or

get some social service agency to give you some advice on what's happening here.

For one thing, I thought most patients had chemo treatments at hospitals?

I'd certainly check out other doctors, hospitals, etc for prices on these treatments.

[JeanGrey]

140. No. Most patients do NOT have chemo at hospitals!

That would raise the prices even faster. Chemo is almost always done in an outpatient setting. I never go to the hospital, even when I have to have blood transfusions it is done in the cancer building at the infusion center, not across the street at the hospital.

[defendandprotect]

173. Still, it seems suspiciously strange that any doctor would not advice you inadvance . .

of the extreme costs -- OR THAT YOU WOULDN'T HAVE CONTACTED MEDICARE TO ENSURE

THAT ALL OF THE TREATMENTS WERE COVERED?????

That's what most patients do.

[JeanGrey]

190. I've never done that. Why would I? I have two coverages.

No doctor has ever discussed cost with me.

[defendandprotect]

205. ...because you want to be sure that what you are going to have done is covered . . .

[cornermouse]

28. Jean's right.

Insurance companies don't have to follow medicare/medicaid rules but if they think that it might benefit them, they can and sometimes do.

[Beetwasher]

30. I Believe Everything I Read On The Internets

[cornermouse]

34. It doesn't really matter what you believe.

[Beetwasher]

65. So?

:shrug:

[nolabels]

52. I only listen to the ones i can cross check

The lost part of the equation in all this medical discussion is of prevention and price fixing. The big three (insurance companies, pharma and hospital corps) think the public is too stupid to understand how they have been manipulated into the situation. I hope this all drags on long enough for the big three to get a rude awakening

[cornermouse]

54. You have no idea what's going on.

[nolabels]

In that you are debating about the original poster trying to scare people?

To be quite sure, she obviously doesn't have all of her facts straight. That in itself does not give way fact the public is being raped and fleeced for health care.

If you need to debate if i have that correct, post on :shrug:

[JeanGrey]

78. Pray tell what facts are wrong?

[nolabels]

110. Perhaps the wrong word known as 'fact'

The price (however outrageous) is obviously a going rate they can charge and get away with it. The people who make a living off of it are not all millionaires, the supporting staff make a wage just like the rest of us. To them that is what it costs for them to get paid. The crooks that practice the extortion have legitimacy because in terms of business model they fit in. For many people a lot of the things that the health care industry do work and there is mostly no alternative.


I don't know where all the middle-men fit in but no doubt there are a lot of them. As a mechanic myself i once question why brake drums and brake rotors cost so much. I found out for the factories actual cost to produce them was one or two dollars but by the time got in my hands they were sometimes past the two-hundred dollar mark. The middle men all along the way made this so. Nowadays, the price that hardware is half or even a third even though the things now cost a little more to make. The reason, they are all now mostly made in China.


That price we see probably has some things that are not accounted for and probably will not be paid in full at any rate

[JeanGrey]

141. I read an interesting article that a friend sent me from a cancer

board I belong to. Apparently it was notes from an oncologist who admitted that the biggest return cancer docs get is in the prices they charge for chemotherapy. In their defense they say they have to have assistants, insurance people, front desk people, nurses, etc and it all costs money.

That if they could only charge say 100 bucks per person they couldn't meet their bills.

[cornermouse]

88. You don't have it correct.

Failed medical necessity is when one of the cpt procedure codes does not have the icd-9 code that justifies its use, depending on the LCD for the area that you're living in.

You don't know what you're talking about.

[JeanGrey]

91. Fine. So how is this fixed? It shouldn't be MY problem,

I'm sick, and I have to stay on the phone for an hour to try and get this cleared up?

This is why we have to do away with levels of FORMS like this, do away with insurance profit and not buckle to big pharm. This is much of the cost!

[cornermouse]

99. This is really confusing.

I wasn't answering you Jean. I was replying to no labels.

What cpt is failing medical necessity?

[JeanGrey]

101. Sorry I answered the wrong person I think!

[cornermouse]

103. self deleting

but what I said still applies

[defendandprotect]

125. Keep in mind that some of this billing stuff is privatized . . . I think . . .

however, you can get Medicare itself on the telephone --

you can also get people to go over all of this with you --

and especially the drugs . . . are you getting very highly priced

drugs? Perhaps generic versions could be substituted?


Meanwhile, what Medicare is suffering is corporate rip-offs . . .

and certainly this cancer care sounds like a rip-off.

[JeanGrey]

142. I was just shocked at the price. I knew these two chemos to

be high but 42 grand for one day!! It almost made me sick. I called the oncologist's office and spoke with the front desk person and I asked "could this be correct?" And she assured me it was. So apparently I'm not alone.

They know I have two insurance coverages.

[defendandprotect]

172. It's also very odd that the doctor didn't advise you in advance of the costs . . .

and, further, most patients, IMO, double-check with doctors to ensure that they are

only getting treatments covered by Medicare. Anything that outrageously priced seems

like a rip-off, but especially if you weren't told in advance!

Very odd, indeed!

[JeanGrey]

195. I've always had an HMO so why would I discuss cost?

Now I have Medicare and an HMO secondary. No one has ever discussed "cost".

[defendandprotect]

206. ...obviously, you have to concern yourself with costs BEFOREhand . . .

[cornermouse]

95. You're wrong. Flat out wrong.

Failed medical necessity is when one of the cpt procedure codes does not have the icd-9 code that justifies its use, depending on the LCD for the area that you're living in.

You don't know what you're talking about.

[JeanGrey]

100. Thank you for the advice, cornermouse.

Tomorrow if I'm stronger I will try to battle this.

[JeanGrey]

60. Bingo! That is why I am posting all of this.

Expanding medicare isn't the answer. Single payer has to be the only solution. If profit isn't taken out it isn't going to work. For god's sake they charged $43.263.00 for three hours of chemo!!

[LanternWaste]

104. That's excessive, absurd and disheartening...

"$43.263.00 for three hours of chemo!!"

That's excessive, absurd and disheartening-- all at the same time.

My hope's are there for you, JG.

[JeanGrey]

143. I know. At the same time I've lived three years on a disease

that usually kills in six months. An argument can be made that this care, however high, giving me the latest and greatest lines of therapy, has stretched my life. And how do you put a price on that?

[JeanGrey]

49. Thank you! I figured that many people just don't understand

how medicare can work. It isn't just a straight 80% I wish it were.

[cornermouse]

50. Please check your email.

[JeanGrey]

61. ok.

[inna]

33. how ridiculous and mean-spirited. i don't understand why this thread got negative ratings btw.

:shrug:

i totally sympathize with the OP. good luck! :hi:

[Quantess]

38. Nobody trusts courier font. n/t

[wickerwoman]

165. I sympathize with the OP,

but the story is anecdotal and irrelevant to the larger debate.

If she didn't had Medicare she would be going through even worse with private insurance companies. And if she didn't have private insurance or Medicare she wouldn't be alive.

For all it's flaws, I'd take Medicare in a second if I could get it seeing as how my current health care plan is "find a cave I can curl up and die in."

The government *can* run a first rate, competitive system. My parents get excellent care through the VA. My brother and I are both uninsured. I can't get insurance because of a bullshit pre-existing condition. Both of us would *love* to have Medicare even if paperwork and bureaucracy were involved.

[JeanGrey]

191. Then let's have a good system and not something second

rate because it's better than "curling up and dying". What do you say?

[DevonRex]

35. I don't buy it either. My mother's coverage has been great. Better than ours

is, in fact. We get denials all the time for CTs and MRIs. She has never had a denial. If she needs to have something done, she has it done and Medicare covers it.

[JeanGrey]

51. I think she's been lucky.

[tritsofme]

46. Makes sense to me.

Sounds like they have a Medicare supplement plan that only pays when Medicare does.

They might benefit from finding a different type of supplemental coverage, or see if a Medicare Advantage plan might work better.

What sounds unbelievable? Medicare can be quite messy as well.

[JeanGrey]

53. Actually it isn't Medicare Supplement. It is the same plan

I had when I was working, but I got to keep for high premiums when I went out on disability. Once I'd been disabled two years and eligible for Medicare they fall back to a secondary role automatically.

I keep them for the drug benefits. But it would be nice if they would pick up what medicare doesn't pay occasionally. Now and then they pay 6 here or 30 there but not much. Any every bill that medicare refuses they do too!

[Cleita]

26. Eh, try to get those things done without Medicare and see where you are.

I have Medicare and I haven't ever been refused a procedure, an MRI, a surgery or an office visit when I needed it. If your physician isn't submitting the billing in a timely and procedural manner, Medicare will question the billing. They are under pressure to do so to catch fraud. Maybe you need to change physicians. If what you say is true, I think Medicare is having problems with your physician. Have you tried to call them directly and find out what's going on?

[JeanGrey]

57. I've had the same physican for 20 years and he has always

seen medicare patients. When Blue Cross was primary I rarely had these problems. Once Medicare became primary, a mess has resulted. I thought I'd get better coverage not worse.

I called medicare and they said he wasn't a medicare doctor then and he was! His office insurance person says they've been fighting them for a year on this, that they hadn't done ANYTHING to drop medicare that medicare dropped them for about a two week period that year and they still don't know why. All I got out of medicare is the same wall they give you on EOB's.

Sometimes the doctor codes wrong and I've even asked Medicare well what code did they use and they'll say "we don't have to tell you that".

Great.

[Cleita]

64. If you are that upset with Medicare then don't use it. Pay for your

health care in cash or you could also sign off your Medicare benefits to a Blue Cross Medicare advantage plan if you think they are that great, but remember when you sign off your benefits, Medicare won't cover you when Blue Cross won't. My husband got stuck with almost $10,000 in medical bills that his Medicare advantage plan wouldn't pay because of a technicality that Medicare would have paid. Once we put him back on traditional Medicare we had no further problems.

[JeanGrey]

67. I can't afford to "pay" in cash. Can you afford a 43K

chemotherapy bill for one day?

I have to have Blue Choice for my drugs. The medicare drug plan would break me in a month.

[Cleita]

76. So do you have traditional Medicare with a Blue Cross medigap policy or do

you have a Blue Cross Medicare Advantage plan? I'm not familiar with where Blue Choice falls in there. If you have the latter, you have signed your rights off to Blue Cross and Medicare no longer handles your health care. It's Blue Cross that calls the shots so you shouldn't be blaming Medicare.

[JeanGrey]

79. No. I'll explain once more. I had Blue Cross when I was working.

I retired disabled. THAT plan was primary (our only insurance) until I'd been disabled two years and became eligible for medicare. Once medicare became primary blue cross became secondary. As long as I pay the premiums I get to keep it. I keep it mainly because our drug costs are unbelievable. I'm a transplant and a stage four cancer patient. If I relied on Medicare D I'd go bankrupt in a month. So I pay the almost grand for hubby and I. They pay secondary to medicare and pick up most of my drugs. I keep waiting for them to say I can have Medicare D and don't need their drug plan.

Everything was fine until Medicare came in the picture.

[Cleita]

90. Okay you have a medigap policy. True the medigap will only

supplement what Medicare approves of. I really still think the problem goes back to your doctor. I'm not saying he isn't a good doctor, but maybe whoever does his billing aren't doing the job the way they should because honestly, it has been my experience with my parents, my late husband and myself that Medicare is far superior in coverage than most private insurance. If you really hate Medicare maybe you might want to look into some of these Blue Cross Medicare Advantage programs.

http://gateway.destinationrx.com/PerspectiveContent/Wellpoint/WPmapdPlans.html

[JeanGrey]

92. It is not a medigap policy. It is the SAME policy I had when I

was working. It just became secondary when Medicare became primary, it has nothing to do with "medigap".

But they can still deny based on Medicare accepting, as a blue cross representative just told me for the 1000th time.

No, I don't want an "advantage" program they are just like HMO's and tell you where and when.

[Cleita]

105. That's what a medigap policy is. It's the secondary one to your Medicare.

You get yours from Blue Cross and I get mine from United Health Care, but they all cover more or less the same thing. If you want to stop having problems, then support those of us who are trying to get single payer for everyone. It's the only way we will get comprehensive health insurance that covers everything and everyone. Sure there still will be Medicare, the VA and the other public plans but there will also be a plan that covers everyone and everything those plans don't.

[JeanGrey]

144. No. It is not "medigap". If it were it would pay more. It is

the same primary policy I had when I was working. My company doesn't offer a "medigap" policy. Medicare simply became primary because of the rules of insurance when you've been disabled for two years. If I didn't have medicare they would still be primary payer. They don't just change names and policies like that.

When I knew medicare would become primary I actually called them and asked them could I switch to a "gap" policy and they don't have one. They said if I continued the premiums I could keep BC but it would automatically regulate to secondary status. And I really keep it for drugs, mainly.

[Cleita]

163. Medigap does not pay more. It only pays the twenty percent not

covered by Medicare and Medicare sets the fee. So if your doctor bill is for $300 but Medicare only pays for $200, that is the fee set. Medicare will pay for 80% of the $200 or $160 and your policy will pay for the 20% or $40. They are not going to pay the extra hundred dollars that your doctor thinks is worth billing for. Apparently your Blue Cross rep wasn't entirely honest with you.

[JeanGrey]

183. Once gain, it is NOT medigap. It's the SAME policy I had when

I was working. My company offers medicare supplement but you are only eligible for it when you turn 65. I am 55 and disabled. Hopefully you understand now?

Since they aren't a medigap policy they don't have to pay what they don't want to pay. There is no "representative" this is all handled through my companies employee service area.

I thought about dropping it because of the expensive but once again it does save me a fortune on drugs.

I just started on Tarceva which is about 3,000 to 4,000 a month. I wouldn't get far on Medicare D.

[JeanGrey]

192. I meant it would pay 20 percent. My blue cross doesn't

always. It isn't MEDIGAP

[tritsofme]

85. This may be the real problem

If the claims are not coded exactly to Medicare's specs, they will not be paid.

It's my understanding that this is a fairly common problem as the codes are often different between Medicare and private plans, the provider needs to make sure it is coded correctly.

[JeanGrey]

93. No doubt. But this shows how we are wasting money still

with claim forms. I hear all about "electronic" processes and yet there are still tons of errors made and claims are being refused.

[defendandprotect]

126. You're saying you're better off with Blue Cross . . . ????

Less problems?

Why not just go back to Blue Cross???

Again -- it sounds like your doctor may have gotten "Bushed" but you have to check

all of this out with Medicare on the telephone.

[JeanGrey]

145. You can't just "go back" to Blue Cross as primary!

I've been disabled two years and Medicare is now primary. If I don't take medicare Blue Cross only has to pay 20%, estimating what Medicare WOULD have paid if I had taken it as I should have. And if you refuse Medicare when it is first offered, they penalize you two years time should you ever need it again.

I wish I COULD just drop medicare and have Blue Cross as primary again! They allowed me to go to another state when I had a blue cross hmo and paid 500,000 for me to have a liver transplant and never blinked an eye.

Yes I'd go back.

[Cleita]

164. Well, you can do the Blue Cross Medicare advantage if they don't

deny you for preexisting conditions. They are a hundred percent Blue Cross but you say you don't want an HMO. Sorry but those are the choices.

[JeanGrey]

193. That is more restrictive than my HMO was.

We can do better.

[defendandprotect]

170. I think something pretty screwed up has happened with your care package . . .

and it might benefit you to find a social service agency which would work on this

with you. I believe there are available -- and maybe your Senator or Rep could put

you in touch with an organization that could help you???!!!

[defendandprotect]

171. So you'd go back to Blue Cross if you could . . . they paid $500,000 for a liver transplant .

. . ."and never blinked an eye" . . . !!???

You've certainly had some amazing luck with PRIVATE insurance --

and some pretty BAD luck with Medicare --

so much so that it sounds . . . eh, fairly suspicious.

I think something pretty screwed up has happened with your care package . . .

and it might benefit you to find a social service agency which would work on this

with you. I believe there are available -- and maybe your Senator or Rep could put

you in touch with an organization that could help you???!!!

[JeanGrey]

194. Yes they were fantastic. When we got to the Mayo clinic

we spent about a half an hour in financial and and two days later they called me and said that it would be covered. No problem.

I also go there for yearly checkups. I do have to ask permission and fax them my schedule ahead of time but in five years I haven't had a problem.

I used to pay insurance claims myself for ten years, so believe me nothing happened to my plan. This was the best I could do for what I was offered.

[defendandprotect]

207. Blue Cross "was fantastic"/paid $500,000 for a liver transplant . . .

amazing that we hear so LITTLE of stories like yours . .

evidently, everyone else is exaggerating the problems they have with private

insurers!!!

People who are disqualified from having surgery paid for because they didn't

report a yeast infection in their past medical history!!

Quite amazing . . . !!!

[Shagbark Hickory]

31. That is awful. The solution is a single payer system where you never see the bill.

[defendandprotect]

127. Absolutely . . . but we're not going to get anything like it if we don't get busy . . .

and I don't mean on websites, e-mails or telephones!

GOP is OUT THERE . . .NOW . . .!!1

I think we should be . . . ????

[JeanGrey]

146. I do everything I can with my health. We have no money to

give but I do try to bring up healthcare every chance I get, and talk up a single payer system. I firmly believe that unless the insurance companies and big pharm are dealt with, there will be too many problems.

Getting rid of paperwork and administration is what is supposed to pay for our plan, how can we do it if we don't get rid of them?

[defendandprotect]

169. I don't mean you or even myself specifically... I mean the general

expectation re the general lack of getting out there --

The Democratic Party, the labor unions, women's groups should be calling

us out to demonstrate -- organizing it! Where are they?

There should be rallies for single payer health care!

GOP can put thugs out there -- they can run fascist rallies to stop vote counting --

but Democrats can't even organize rallies?

[JeanGrey]

198. I don't know and I'm not sure why.

The insurance companies and the drug centers have too much power. I'm afraid to even hope.

[DevonRex]

32. My mother has Medicare. She has had brain CT scans, breast cancer surgery,

along with chest CTs, MRIs of her knees and neck, cataract surgery, and a whole list of other things. All have been paid for by Medicare. She doesn't have supplemental private insurance because she can't afford it and wouldn't let us pay it for her when we offered. We had been worried that Medicare wouldn't cover everything. It has. She was right. We were wrong. Medicare does a great job.

Edited to change the tense of a verb.

[WillieW]

44. Medicare paid for my CT Scans, xrays and other tests plus two major surgeries. I am delighted that

the bills are being paid right of way. The cost is only $100/mo.

[DevonRex]

55. Thank you. It seems to work pretty darned well. :)

[JeanGrey]

66. I hope it stays that way. I have stage four cancer

and I have bills every week. And they aren't getting paid anywhere near 80%

[WillieW]

69. I am very sorry that you have stage four cancer. I pray that you will be doing well.

I had cancer as well (stage 2) 1-1/2 years later, I am cancer free. I don't know what I would have done without Medicare. Best of luck.

[JeanGrey]

80. My oncologist just charged medicare $43,000 dollars for one

chemo treatment that leaves about five grand unpaid. So I suppose you can afford those copayments?

[WillieW]

111. Medicare 80%. secondary 20%

[JeanGrey]

147. It was less than 80, medicare of course cut all the charges.

But it was still quite a bit of money. I hope to god BC picks up the balance because it's about five grand.

[JeanGrey]

59. Not for everyone. The cat scan they refused was of my brain.

I am stage four cancer and brain mets are a common problem when you have stage four that spread. I was having headaches and the doc did a cat scan to see if there were mets.

Medicare said "not medically necessary". I guess they don't care if I have a brain or not.

[WillieW]

75. I had to switch doctors. Some do not accept medicare.

[JeanGrey]

81. Mine all do.

[SeeHopeWin]

182. The OP is lying...nt

[WillieW]

41. From the White House

Your medicare is safe, and stronger with reformRobert Kocher of the National Economic Council debunks the myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform would simply eliminate waste and unnecessary subsidies to insurance companies.


I have been on medicare for a number of years - never had a problem. I thank God that I got it.

[JeanGrey]

82. Can I switch with you then?

I'd like to have your medicare and you can have mine.

[cynatnite]

63. Hmm...that is indeed strange...

My aunt is on Medicare and got her CAT scans covered when she had a late stage brain tumor. Not a problem.

My grandmother is on medicare and has never had a problem whatsoever...even with her numerous medical problems.

As far as the "eligibility" issues with your physician...many times medicare will stop payment when fraud is suspected.

Very odd story.

[JeanGrey]

83. No, not odd at all. Are you telling me that all these coverages

were covered at 100%? Nothing ever refused? Then something is wrong because this has happened across the spectrum of my doctors. My oncologist is on the biggest practices around. My primary physician I've had for 20 years and never had an insurance problem with.

I guess I just want the medicare you guys seem to have.

[cynatnite]

89. Yes, they were covered 100%...

Nothing has been refused for my aunt or my grandmother. Medicare has been wonderful for them with their health issues.

Oh, and my mother-in-law got a medicare-paid-for hot tub, too. The doctor said she needed it and she got it.

I'll take Medicare over our crappy overpriced private insurance.

We have fought with our private insurance on getting bills paid and HAVE to see the doctors they tell us...even though they will deny claims 2/3rds of the time. They will deny care if they think it's not a medical necessity...that means NO CARE.

You do have the same medicare as everyone else.

Like I said...odd story.

[JeanGrey]

94. If your mother gets 100 percent coverage she has a different

medicare, I'm sorry.

Medicare has never paid 100 percent. Never.

[cynatnite]

107. I just talked to my mother...

She was telling me how they fought with medicare years ago over my grandmother's colostomy bags. There have been problems with them, but not recently from what she said. My grandmother does have a supplement, too. I asked her about my aunt and she said they pick up everything because the cancer disabled her and she's not able to work.

I misspoke. Sorry about that.

[JeanGrey]

148. It's ok. :=)

[JeanGrey]

84. By the way they didn't KNOW if I had a brain tumor.

They were checking to see if I did. I'd had headaches for two weeks and I already have mets to the bone, liver and stomach so, it is natural to look in the brain when headaches are present.

Nope. Not necessary. Whew.

[defendandprotect]

86. Bush administration contrived to corrupt Medicare and was NOT paying doctors . . .

Bush administration did all it could to destroy Medicare and to destroy citizens' confidence

in Medicare/Medicaid!!

They not only attacked patient care, they attacked doctors, themselves by withholding payments!!

Hopefully the Obama administration is getting this straightened out ...

Write to the White House about it . . .

http://www.whitehouse.gov/contact/

[JeanGrey]

96. Already have.

[defendandprotect]

115. Presume you've also contacted Senator, Rep . . .

Good luck -- I hope it works out --

[JeanGrey]

149. Yes when I'm not sick I fire off emails.

[Dappleganger]

87. Whoever is unreccing this

has their head up their ass. Medicare needs a major overhaul in addition to the other health care issues which are ongoing. We struggled monthly to stay on top of the list of denied services/meds for my mother after her first stroke, in particular with regard to rehab. What a HUGE PIA it was to deal with them, especially having to re-send claims after they lose filings! The only place I've dealt with which was even more ignorant was Blue Cross/Blue Shield with their regular rejections due to having to prove no secondary insurance several times a year. Grrrrr.

[JeanGrey]

98. Gee I was just told Medicare would pay for me a hot tub!

Where do I sign up?

[Barack_America]

97. None of your complaints are specific to Medicare.

Each of these issues exist with private insurers as well.

1. Your doctor likely delayed in submitting paperwork to Medicare. Whether this was due to claims your doctor filed and Medicare disputed, I don't know. What I do know is doctors have similar agreements with private insurers and if these agreements lapse, so to does the doctor's participation in that network.

2. Bills have to be submitted in a timely manner. In my experience, Medicare's window for payment is actually larger than many private insurers (I used to be a medical biller and my mother still is).

3. Both Medicare and private insurers demand that any given test be not only informative, but more importantly, will help alter the patient's course of treatment. That being said, I have a hard time believing that any insurance company would deny a CT of the head with your background and symptoms. I suspect an error either in your oncologist's submission of the paperwork of that exam or in the processing of said paperwork. Regardless, the denial of necessary treatments as "medically unecessary" is a much bigger problem with private insurers than it is Medicare.


Most of all, I wish you the best of luck with your health and I very much hope you are getting good care and are able to recover.

:hug:

[JeanGrey]

102. Thank you. But this demonstrates we have to do away

with profit in health care, claim forms and all this other nonsense. If we continue to throw profits to private insurers and big pharm these problems will never end.

[Barack_America]

106. On that we certainly agree.

Except I disagree with that stance regarding the third point, the CT of the head.

There I think the doctor having to justify the necessity of the test is a very important thing. It is well known that doctors these days are increasingly resorting to diagnostic tests to tell them the same thing that a thorough physical exam can tell them. This behavior not only increases risk to patients, as every diagnostic test comes with it the possibility of greater harm, but drives up costs as well.

In your case, why should your doctor expose you to the high levels of radiation that a CT scan entails without first doing a thorough neurological exam himself? The neurological exam is able to not only detect a potential tumor, but, more importantly, the specific deficits the defect is causing. If the exam yields a finding, knowing the location of the defect would be also be enormously helpful in detecting the problem on CT. I don't presume to know what your doctor did or did not do, I just wanted to discuss a bit the thinking that goes into these decisions of "medically necessary" or not. It's not all about protecting the bottom-line.

Our doctors have gotten ridiculously lazy and even incompetent when it comes to conducting good physical examinations. This, in my opinion, is one of the greatest threats we face in the effort to drive medical costs down and improve medical care for our nation.

[JeanGrey]

157. Because a neuological exam will not tell a oncologist that

someone has mets to the brain. The sooner the mets are caught the better the chance that radiation might zap them in time.

A cat scan HAS to be done. They don't have xray vision.

Many things can cause a cancer patient symptoms of mets to the brain. Only a scan will tell for sure, especially if the mets are small.

I had a friend who was jerked around by her primary doctor for six months complaining of chest problems and three times he wrote her useless anti-biotic prescriptions and sent her home. She had cancer. By the time it was discovered, it was too late and she died four months later. I still harbor a terrible resentment against this jerk who yes, was an hmo doctor and I'm sure just didn't want to order that cat scan!

I will always, always believe that had they done the right thing and scanned her, the cancer would have been caught much earlier. Especially in the case of lung cancer. Caught in stage 1 lives can be saved. Caught at stage four, no.

[defendandprotect]

128. We also need doctors who are something more than medical mercenaries . . . . .

[Blue Diadem]

109. Have you gone through the appeal process?

http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_alp.php?p_sid=MU1dj7Mi&p_lva=&p_li=&p_accessibility=0&p_redirect=&p_page=1&p_cv=1.70&p_pv=&p_prods=&p_cats=70&p_hidden_prods=&cat_lvl1=70

It all sounds so frustrating and when you're ill, having to deal with the red tape is the last thing you need. :hug:

[JeanGrey]

150. You bet it is. Some days I am so sick I can hardly type or

hold my head up and I think they take advantage of that. And I used to pay claims for a living. I can't imagine what rookies do!

[gleaner]

112. I have medicare..

and I have never had a problem getting my claims paid. I also have secondary insurance as a dependent on my husband's policy and medicare communicates with them electronically after the health provider bills. I get summaries of payments every several months but not EOBs for every individual service. Those come from the private insurance. I wonder why yours is different?

I paid for supplemental plans for both my parents and not that long ago I priced them for myself when I got sick of my husband's insurance. There is no way they should cost that much. If you go through AARP or an agent you can get them for much less. The figure you are giving sounds like sole insurance through Blue Cross, not a supplementary policy.

Are you going to write us another post and tell us that medicare is insisting on a "death panel" for you? A non existent does not exist death panel? If you are it would explain a lot of things about your post which just don't compute.

I'm sorry if you are ill, and I'm sorry if you're having trouble with your health care coverage, but this doesn't sound quite right. Not in the original presentation and not in the information you are giving when questioned about discrepancies. Medicare would be my coverage of choice if it had a decent prescription plan. It pays well, the people you talk to there are helpful and they pay for things that private insurance just doesn't cover. They do, in fact pay for all of the things you say they are denying you. Your dates are very confusing too. Medicare does not accept billings from patients. Only the health care provider can bill, and I can't think of a single health care provider that would wait so long to bill for services rendered. 2007? No way. No insurer medicare or private will process a claim that is more than a year old. You need to check your facts, I think.

[JeanGrey]

151. Nothing "doesn't compute" because it's the truth.

And I found that SOME Of my claims electronically go to medicare, about half don't and then I have to get an "itemized bill" and a medicare EOB to match to send to blue cross.

I asked my doctor's insurance person (who frankly didn't sound like the sharpest knife in the drawer) why this had drug on so long without my knowledge? and her answer was "well, we've been fighting this for simply forever".

I wanted to say something unkind.

[gleaner]

158. I am not here to argue for the sake..

of arguing, or to try to make your life miserable.

I noticed, and still notice that every time Simone points out something irregular in what you are writing you give a different answer. Some of them are contradictory.

If you knew that an amount from 2007 was not being billed, why didn't you press it with your doctor? I'm sure he doesn't work for free. This answer like the others tend to put responsibility for things that happen to you on everyone but you. The world doesn't work this way. I am responsible for myself and my actions, you are responsible for yourself. Not a medical biller, not Blue Cross and not medicare. Medicare stopped sending per service EOBs a few years ago because they were trying to cut costs by processing paperless claims whenever possible. I dealt with my mother's medicare when I was taking care of her during the last years of her life and even with a small supplement she was getting through AARP, they exchanged information electronically. Why would a huge corporation like Blue Cross do it any differently?

Does anyone else receive EOBs the same way, and bill for their own supplemental payments? Medicare stopped producing per service EOBs and allowing patients to bill for themselves in the early part of this decade. My husband was still working at Social Security at the time and they got a lot of complaints from beneficiaries who did not like the change over. He worked at Social Security for more than thirty years, so he has a fairly good knowledge of the programs they help administer. Like medicare. We also followed up on our own, and my mother's billings and insurance. Most people do. If you don't watch out for yourself, some people will try to take advantage of you.

[JeanGrey]

196. Sigh. I just got the EOB I didn't KNOW anything about the 07

charge until yesterday!

I Usually keep my eob's (when I get them) which are stacks and stacks but I don't read every one unless I get a bill.

[gleaner]

208. You must be...

The only person in the country who still receives those paper EOBs. Don't you find that remarkable? I sure do.

What did you say your initial diagnosis was? Was it brain cancer, stage 4, or am I mistaken? Did you see an oncologist? When was this diagnosed? Was that 2007? Was it stage 4 then? Did your oncologist explain to you what stage 4 means? It means that the cancer has metastasized. With a stage 4 metastatic tumor in your brain it is nothing short of miraculous that you write as well as you do, that you think logically and even that you can type at all.

My mother in law has metastatic cancer. It is lodged in her throat below her esophagus. It is now stage 4. This type of cancer, atypical carcinoid does not metastasize quickly, but when it does it will go up into her throat and cut off her breathing or up into her brain. She is beginning to experience confusion as to such basic things as what day it is, or what time it is, or even what she did five minutes ago. Her oncologist gave her two years to live at the time of diagnosis. Now she has small cell cancer evidencing itself as well, so her time is much shorter. I don't know how much shorter, but I see her suffering, barely able to swallow food, her body covered with huge bruises because of the sis platen they gave her to try to reduce the size of the tumor in her throat. The sis platen crashed her blood. It caused a major psychotic episode and it would never have killed the cancer. The cancer was inoperable because of where it is located. Radiation is out of the question for the same reason, and chemo does not work on atypical carcinoid. Her oncologist was trying to get her some relief from the pain she is in by giving her the sis platen and hoping it would affect the tumor enough so that she could eat and breathe more easily.

Now here you are, chirping away like the blue bird of Blue Cross talking about an even worse cancer that you say is affecting you. I see no evidence in your writing. I truly hope for your sake that you do not have it. But to say that you do, over and over again while appearing to be fine in your speech, writing skills and being able to come up with a swift excuse to contradict something else you say when you are caught in a mistake, indicates something else that is not as it seems. If you don't have what you say you have, have you thought even for a moment how you are making cancer patients and their loved ones feel? And for what?

So you can keep on misrepresenting your situation simply to promulgate more fabrications about medicare which is a well run and well controlled program to help seniors and people with disabilities get health care they might not otherwise have. By the way, I called Blue Cross/Blue Shield in my area. I chit chatted with a nice lady about how they process claims they coordinate with medicare. They do it electronically. They have been doing it that way for some time. Now do you want to repeat that particular part of your story, or do you have another excuse for some phantasmagoric "misunderstanding" that is, as always, someone else's fault? I will be waiting with great interest to see.

[Hepburn]

113. And private insurance is better?

:rofl:

[DevonRex]

114. It seems she is trying to say "government-run health care BAD."

:rofl:

[JeanGrey]

153. No, I'm not, actually. We need government run

healthcare but it needs to be WITHOUT insurance companies!

[JeanGrey]

152. It was better because I didn't have to fight with two insurance

companies and gather EOB's and do all this work. Blue Cross paid for me to have a liver transplant in another state when I couldn't get one here and the bills for over 500,000. I ended up owing about $1300.00.

Now it seems that Medicare wants to deny payments on half the stuff, either for codes, or not medically necessary, or too old or one thing or the other, and blue cross says "well, medicare didn't pay we don't have to either".

Medicare isn't the easiest people to talk with they just give you the same reason. I've tried to reason with them.

Not that I haven't had some blow ups with BC as well! But at least I only had to deal with one and not two. I always taught two was better and I'd have more coverage.

I want to see our country have ONE single payer system. Nothing involving blue cross or any other insurance company. More has to be covered. If we get rid of insurance companies we should save enough to pay this.

[Greyhound]

117. I spent nearly all day, every day just trying to get my sister through the nightmare

of her "top of the line" private health insurance as a Federal employee. She has a deadly disease and can't even get the tests required to schedule the care she needs to stay alive.

I'm sorry that you are going through this crap and we all know that the Medicare system needs to improve, but the bottom line is, you got the tests and the care you needed.

[JeanGrey]

154. Yes I did. I am not saying I didn't. But this is the aftermath.

I am so sorry about your sister. Can I ask you a question? Do you really believe her care would the same as a congressman's? The same insurance policy I mean.

[Greyhound]

178. No, but that is the popular myth.

We are too accepting of the class distinctions in this "classless society". I also fight with Medicare for my MIL and, in my experience, they are far easier to deal with.

The fact that we have to fight with anybody just to get the care we need is obscene. Some days I think there is no hope, we've gone too far down the road to Idiocracy.

[TexasObserver]

123. Thank you. This is what so many people do not get.

Having coverage means you have a shot at getting the care you need, but no assurance. It means fighting with health care providers, Medicare (when applicable), and other insurance coverages.

[JeanGrey]

155. Yes, thank you. And when you are battling fatigue, throwing up,

weakness and are on oxygen 24/7 you don't need this shit.

[TexasObserver]

162. The truth is if you can't get well quickly, they want you to die fast.

It's simple math to them.

[Sgent]

129. It sounds like the provider f'ed up

In 2007 around that time Medicare instituted a mandatory change to provider numbers from the old Medicare Provider number system to the NPI system. If your provider didn't request an NPI, and use it as part of their claims filings, then Medicare wouldn't pay. Medicare like all insurance has a large share of bureaucratic hoops to jump through -- its just that Medicare spells theirs out better than other insurers.

One thing you should be aware of is that if Medicare rejected the claim, (ie its was not considered non-covered), then the doctor is limited to billing you 105% of the Medicare allowed amount.

Good luck.

[JeanGrey]

156. I didn't know medicare made any changes like that but it

certainly sounds like it could be. They insist it was only a "few weeks". If that is true and they screwed up they shouldn't charge us anything, IMHO. But I'm sure they will!

[roamer65]

161. Medicare is a government plan trying to play in private plan nation.

The price inflation induced by the privater insurance companies are killing Medicare. It's all a game to the private insurance companies. They keep allowing hyperinflation of the "resonable and customary" reimbursements to doctors and hospitals and then just pass the costs along to us. Current Medicare cannot compete against this kind of price inflation machine. The result of this battle is the rejections for reimbursement you get in the mail.

Private health insurance companies are public enemy #1.

[Cali_Democrat]

166. You're the same person who told us to write off Ohio, N. Carolina and Virginia during the election

You said to write off those states because Obama had absolutely no chance. You were a Negative Nancy and never had anything positive to say about Obama and Dems. You were also glowing about Sarah Palin. I've got a good memory.

Now you wanna discredit medicare. Why should I believe a word of this post?

You're full of it.

:thumbsdown:

[orleans]

177. links? n/t

[JeanGrey]

199. No I didn't. Not Ohio. I was shocked at North Carolina and

I still am, but grateful!

[GodlyDemocrat]

167. I went to my doctor today and he did not accept Medicare either

[JeanGrey]

200. I'm sorry.

[jpak]

168. Move to Canada

Their system is superior.

[TexasObserver]

179. You say that like it's an option.

[JeanGrey]

201. Why should we have to do that?

We can have a superior system here.

[SeeHopeWin]

181. You are either dumb, a liar, or you don't know that you don't have straight Medicare, you have an

Advantage Plan, which is a so-called Medicare HMO.

Medicare does not deny the shit you are claiming here, I am a Medicare biller.

[JeanGrey]

202. Well you're wrong. They denied my office visit by saying

my doctor wasn't eligible. He is and has always been, according to him. I have gone to him for OVER 20 years and he has always taken medicare.

sorry. jI'm not dumb because I've paid claims too. For years.

[defendandprotect]

211. Yes . . . BEWARE . . ADVANTAGE PLAN .... bad medicine . . .!!

Randi Rhodes was talking about this the other day . .

[SeeHopeWin]

213. And they sell them like a medicare plan, HMO salespeople called them medicare!!!

THEY ARE NOT!

[walldude]

203. So fight it.

Your headline "Nightmares" make it seem like there is nothing but problems with Medicare. And there are problems. But all in all it serves most people well, it has a high approval rating and generally works for the people who use it. That's why you are getting flamed, you use your one example as reasoning for calling Medicare a nightmare, and it may be for you but you are the exception not the rule.

[JeanGrey]

209. I didn't say that. I'm trying to make a point that expanding

Medicare isn't a great idea UNLESS medicare is improved. They leave too much uncovered. Working poor and people with no money still won't be able to pay the co pays. I am a fan of single payer and don't really understand why the President isn't getting us what we need and why our Congress is hanging us out to dry!

I'm sick tonight, can't eat, and tomorrow is my phenergan injection and pain meds.

I will try to get back on when I am stronger.

[defendandprotect]

212. What you're saying makes no sense . . . go discuss this with people qualified to inform you . . .

you obviously have something very wrong going on and it isn't with Medicare --

MEDICARE FOR ALL is what we need!!!

Why are you here asking people who aren't qualified to answer your questions?????

It seems you're more interested in spreading poor faith in Medicare than in

getting your problems reconciled . . .??????????????????