Medicare Nightmare

[JeanGrey]

I am always amused when I read about how "good" Medicare is. I just got a slew of Medicare EOB's for cancer treatment mostly labs. Here is an example: Total lab bill: $111.30. Medicare approved: $12.92. They paid: $12.92. Refused to pay (disallowed) 28.50, 57.67 and 12.21. Said based on the "info" they had it wasn't covered. One of these tests was a CA-125 cancer test! And I'm there for cancer treatment! So I called Medicare and was told that according to the "info" and diagnosis put on the claims that is why they were refused. I said fine, tell me what was on there and I'll all the doctor and get them to resubmit correctly. The customer service man says "oh no, the claim has been submitted, you cannot change it". I said "what do you mean?" and was told my only recourse was to "appeal". Let me tell you what that means. It means that they will look at the claim a second time, using the same stuff and deny it again.

So out of a $111.00 bill I owe 98 bucks.

The next person who tells me how great medicare is I'm going to kick in the groin. Do you really think POOR people can pay premiums for this nonsense and get this kind of coverage??

We are so fucked. And we deserve it because we have NOT PUT a candidate out there who will fight for single payer, so we have none but ourselves to blame.

And don't whine with "well we're just not ready". People are dying.

Yes by all means expand Medicare. Snort.

[Richard Steele]

1. K&R

[Donnachaidh]

2. Those who advocate expanding Medicare are in for a HUGE shock to the wallet.

Most on medicare already know what a laughable program it is now. And another point that the pro-medicare dweebies REFUSE to see -- Doctors are also starting to DEMAND that patients pay UP FRONT on bills that haven't been submitted yet. This is because the doctors have been turned down so many times for treatments they already KNOW what will happen. So, you not only have to pay any co-pays, you have to be prepared to pay the *rejected* portion of the bill before the procedure is done.

Makes it really hard for seniors or disabled people who need the treatments, but cannot come up with the ready cash, doesn't it? :sarcasm:

And that does not even touch on the many, MANY doctors who refuse to see Medicare patients outright.

Considering what the two show pony candidates are offering - I consider the universal healthcare DEAD in the water. Both candidates have taken millions of dollars in contributions from the medical community. NEITHER of them give a rat's ass about the middle class and it's money or health problems.

Yeah -- push for the expansion of a system that DOESN'T work -- that will slam a stake through the heart of any true universal program. And we'll only have ourselves to blame for it.

[nichomachus]

4. Up-front medical payment the wave of the future

Doctors are also starting to DEMAND that patients pay UP FRONT on bills that haven't been submitted yet.

It's not just Medicare. The new trend among regular doctors is that they will not accept insurance assignments. They make you pay upfront and then they will submit your claim for you. Then, you have to deal with the insurance company for reimbursement.

It's already started in my area and I imagine it will be spreading very quickly. Doctors are sick of all the fighting with insurance companies and the paperwork.

[JeanGrey]

16. It makes those of us sick worn out and ready to just

throw in the towel which the bastards know.

I told the guy at Medicare that I hope we get National Healthcare and he gets fired and he just laughed at me. Can you believe that?

[JeanGrey]

15. Oh, absolutely. It makes me sick. Everywhere I go I have to

sign a wavier that says I understand that if Medicare doesn't pay (i.e., probably won't) I am responsible for the difference.

I even kept a VERY expensive secondary policy to fill the gaps and guess what? It ain't working. The other day they actually told me if Medicare refused it they didn't have to pay it either, and I was lucky my secondary wasn't a PPO because if it was, we "don't pickup medicare deductibles".

Understand, folks?? Go into the hospital and get a 900 hundred dollar hospital deductible and Medicare won't pay it and neither will your other insurance!!

I get so angry when I hear them talk about expanding Medicare, good god...............

[Liberty Belle]

3. Get a reporter to call someone high up in MediCare;

you might get a different answer. Or call back yourself, not a low-level number, look up the media relations number for MediCare if they have one, and tell them you're going to hold a press conference on the hospital steps if they won't pay a more reasonable portion of your bills.

Also contact your Senator and Congressional representatives and get them to pressure Medicare for you, and urge them to reform the laws.


While this could be the newest Bush method to deny people help, it could also just be a lazy bureaucrat or local office with idiotic rules.

The squeaky wheels are the only ones getting any grease these days in the healthcare system.

[JeanGrey]

17. I know all about squeaky wheels but god it wears you down.

Today I spent thirty minutes just holding for Medicare, I was cut off twice and had to go through those endless "push this button" bullshit over and over. Same for the secondary and you get a different answer no matter who you talk to.

I once got a fantastic claims person about four years ago when I had some huge bills and thanks to him I got everything paid, but without him everyone else I talked to was dumber than the proverbial "box of rocks". They get these people and pay them eight bucks an hour and you get what you pay for. Most of them are responsible for 1/100th of the puzzle and that is really all they know and they don't know that very well.

When I did this for a living I did retirees and I always did ANYTHING I could to help, even using my lunch hour to go through elderly people's mail they would bring me because they were so confused.

I always had patience, several of them had alzheimer's and actually couldn't remember. When coworkers or my boss would say "why do you do that?" I'd always reply "you'll be old and sick and helpless one day IF YOU ARE LUCKY and you'd better hope to god someone is willing to wipe your butt for you".

They shut up after that.

[nancyr]

5. That's why I have supplemental insurance.

I understand your anger, but have you considered a supplemental plan to pick up the amount Medicare doesn't pay? So far, this has worked well for me. The monthly premium is reasonable and I've never had to argue over anything. They just pay it and that's that. I'm a senior on a fixed income and this is my only option.

[asjr]

6. Same here but I had to drop

my supplemental insurance. When the premium was raised to 152.00 a month I couldn't afford it. I am on SS also--my only income.

[Blue Diadem]

8. May I ask how reasonable?

My neighbors shocked me when they told me how much they pay for their supplemental plan. Their monthly premium is over $900 for the couple. They're in the late 70's now, pretty healthy other than the wife recently being diagnosed with diabetes.

My parents were lucky, they had an employer paid retiree plan, so they (and us kids) didn't have to worry about premium cost or extra medical bills.

[nancyr]

9. Approximately $88.00 a month.

[Blue Diadem]

12. Wow..

That is reasonable. I'm wondering now why my neighbors pay so much. It scared the life out of me, wondering how we'd ever be able to afford it in 10-15 yrs.

[Hestia]

23. You need to tell your neighbors to get down to SS office pronto!

There is no way in hell that any supplimental costs that much! SS can get the overage reimbursed to them if there is a problem. They have signed up for way too many plans, too. SS will straighten this out in person. Have them call and make an appointment.

[JeanGrey]

18. Yup. They are giving me shit too. They have decided that

they shouldn't be paying for anyting that "Medicare doesn't approve". They told me today that because I had Medicare as primary payee I could no longer have a case worker to follow my cancer treatment! I'm not kidding. My old case worker I called four days ago and there is a recording that says she is in a different job, if you need help call here, and four days later I still haven't gotten anyone but the nasty girl who said I wasn't getting another one.

[JeanGrey]

19. By the way my supplemental policy (secondary to medicare)

costs my hubby and I $671.00 per month. So with the Medicare premiums we are paying $1,000 a month for insurance premiums, not counting co-pays, deductibles and disallows.

If I weren't taking cancer drugs and anti-rejection medicine I would drop it, and any day I'm waiting to be told that I have to pay 30% of my more expensive drugs, and then I don't know what we'll do.

[BigDaddy44]

7. Deleted Message

[Vinca]

10. This country needs to scrap Medicare, Medicaid and the VA system

and combine it into single payer, universal healthcare, paid for by taxes. No deductibles, no co-pays, no excuses. I also know someone who was paying $900 a month for Medicare and Supplemental insurance. It's frightening. I can't afford insurance now and if I survive to age 65, I won't be able to afford supplemental insurance.

[JeanGrey]

20. That would be hubby and I. We pay around a grand a month.

Our monthly income is about 2700 so 1/2 is going to healthcare counting deductibles, etc.

Last year are supplemental went from $444.00 a month to $671.00 a month - that was the increase in one year. And I'm a disability retiree so I'm waiting for my company to decide I am costing them too much and to get that letter that says they will no longer carry insurance for me. Trust me, it's coming........................

[Lars39]

11. If everybody is covered, it would improve.

Everybody would have a stake in it.

[mitchtv]

13. Put congress on Medicare and take away the plan

they have now. It will pick up pronto.

[JeanGrey]

21. What a wonderful idea!

[LSK]

14. do you understand the concept of starving the beast???

Congratulations, you are falling right into their hands. The GOP want to UNDERFUND all Government programs to the point where people like you make posts saying how Medicare sucks. Their most famous example of this is FEMA but they are doing it everywhere in the federal Government. They want to take programs that used to work well and underfund them so badly that they get labeled bad names.

The answer is to FUND Medicare, not ditch it. Because what is your alternative? For profit insurance companies???

Don't fall for their trap.

[JeanGrey]

22. I am not falling for ANYTHING. Of course they need to fund

the damn thing!! That is what I am saying! But Medicare as it stands is quite poor, sorry! The for profit insurance companies can kiss my big fat ass. They should ALL be destroyed and all healthcare should become single payer. Hold your breath.