PE and Medicare
October 13, 2009 at 5:14 pm
Can anyone help me understand this Medicare stuff (my coverage is due to begin in January)? I was told today by Medicare that they do not pre-cert anything and that plasma exchange was not on their list of approved procedures. IVIG however, is on the approved list under part B.
The hospital told me if Medicare denied payment for PE I would be responsible for the entire cost. Having PE every three weeks out of pocket is not a financial option for me.
Is anyone getting PE approved and paid by Medicare and if so, how did you get the exchanges approved? Thanks,
AnonymousOctober 14, 2009 at 9:46 am
I’m not on medicare, but am on medicaid.
*I’ve been on it since age 18, and didn’t have enough work credits to qualify for SSDI/medicare.*
Anyway, the 2 systems are somewhat similar I believe, and whenever I have had something that wasn’t on their “approved list”, I just got my doctor to say I’ve tried other treatments, and thats why I needed to go on that med.
They send paperwork (pharmacy/doctor/insurance), and usually by the end of the day its been approved.
There was only once that I had to go on a different medication for a dental procedure.
But there was an alternate medication that I could take in that situation.
So, if your having issues with insurance, I’d get your doctor to fill out paperwork to say this is what you have, and why you need it.
October 20, 2009 at 6:44 pm
Thanks Kelly and diagnonsense.
I just found out that the new insurance has to retain me for 18 months as the primary carrier and I can use medicare as secondary coverage which may pay some of the deductibles and co pays, etc. I am hoping that if the new insurance company accepts the doctor’s letter of medical necessity for PE, medicare will follow suit and accept it too. Time will tell.
October 21, 2009 at 4:48 pm
I have had PE over 150 times and medicare has paid each time with no hassle.
You must be logged in to reply to this topic.