My son takes care of all the IT for an 11 clinic system here in northern MN, & he was the first one to tell me about this low Medicare & Medicaid reimbursement & how much money his clinics lose because of this. Some doctors & clinics are no longer accepting Medicaid, how long before they won’t take Medicare? I had great insurance through my husband, but had to go on Medicare when he retired in 2007. So far I haven’t had a problem, but we go to the same GP at the same time each year, for the exact same check-up, & it is amazing how much more his insurance pays on his bill then Medicare does. The doctor just has to write off the difference. I don’t have any great answers, but I do know that my car insurance (Progressive) is so cheap because we are safe drivers in a pool of riskier drivers.
I think the concept of getting away with caps on insurance sounds great in theory, but in the end, someone else will have to pay for it. Back in 1981 when my son was born, he had to spend a month down at the UofMN hospital. There was a child in a coma across from him who was 3 years old, & the nurses already called him the million dollar baby. He would live out his life there, I have no idea whatever became of him. I was $478,000 into our insurance company before cheap cytoxan infusions arrested my CIDP. If I had had to stay on IVIG & PE I would have exhausted the insurance cap I had a long time ago. What is right, I don’t know.
My mother-in-law has been in a nursing home for the past few years. She is private pay & my husband writes out the check out of her checking account every month (she has severe dementia.) She is the only private pay resident there, the govt. pays for everyone else. I don’t know the answer to this quandry either…maybe if one can’t pay the family takes care of them? Whoever said Medicare or SS would take care of all of the elderly when they get older? Another interesting point to think about…
It is the PRINCIPAL of the thing right now!!!!!!!!!!! I’ll explain more about what’s going on. I bought (out of my pocket) a small power chair about six months ago from a medical supply dealer in my area. I chose to do this because I wanted a power chair that would meet my needs and I had to be able to see it and test drive it. I know that there are many dealers, you find them on the web and see them on TV, who do the paperwork and get medicare coverage, but I needed to see the scooters/bigger power chairs/ folding power chairs/ small lighter power chairs before I bought. The medical supply store I went to showed me a PRIDE GO CHAIR, which met my needs. The store salesman told me it was not approved by medicare and they insisted that it was useless to even try to apply for coverage, so I did not. I’m the kind of person who thinks of things “after the fact” and this was well after the fact. I FOUND OUT THAT MY SECONDARY INSURANCE “WOULD” COVER THE POWER CHAIR. The medical supply store must have thought I only had medicare. I AM TRYING TO GET MEDICARE TO DENY THE CLAIM I SUBMITTED, then they will forward their denial to my secondary insurance to see if they will pay. MEDICARE MUST SHOW MY SECONDARY THAT THEY DENIED COVERAGE, I could not submit directly to secondary.
IT IS THE PRINCIPAL OF THE THING. MEDICARE SHOULD NOT DENY ANY COVERAGE ON ANY POWER CHAIR WHEN SOMEONE WHO CANNOT WALK NEEDS IT. The mouse (me), must become a lion (voice) and roar.
It sounds like I have to get the ICD-9 diiagnosis code from my doctors office and not the medical supplier. I will be calling the doctors office tomorrow and I will ask to talk to someone who is familiar with medicare codes.
When I sent in the durable medical equipment claim form to medicare (and I paid attention and did send to right adddress) I included a copy, back and front, of both my medicare card and my secondary card. My social security number was always my ID number, but lately I’ve noticed a different ID number on summarys. So I submitted both my social security ID and the new number. I have 30 days to send medicare what they want.