Re: Medicare Coverage

[Guest guest]

I will be in the same position in a couple of months so I am

interested in any information available on this.

Oklahoma has just upgraded their flu to " epidemic " . Caution and care

in full effect....

On Feb 28, 2008, at 5:11 PM, Terry wrote:

> Greetings, Heavy Breathers

>

> Insurance coverage re Xolair is obviously a can of worms from what

> I've seen on posts. I have a question I hope can be resolved easily,

> but I doubt it. I've been receiving the shots for about a year.

> According to my pulmo, in order to have Medicare cover the shots, I

> have to go to a local (12 miles) hospital outpatient services

> department for the shots twice a month. Medicare covers part and

> BCBS picks up balance, so Xolair costs me nothing except for gas.

> However, I'd like to get the stuff at home and let my wife, an RN,

> give me the shots. Is anyone covered by Medicare and BCBS able to

> get the stuff for free at home??? With my miserable susceptibility

> to upper respiratory infection (I have a pic line in my arm now for

> antibiotic infusion), I'm becoming agoraphobic and want to avoid

> crowded, disease and infection laden places - obviously, a hospital

> falls into that category - and with the flu vaccine being only 40%

> effective, I'm concerned. Help!

>

> Ohldepharte

>

>

[Guest guest]

Ron,

I live right on the border with Oklahoma and the flu is bad here too

but has not been declared an epidemic. I don't know why because all 3

of our hospitals are full of people who started out with the flu and

it developed into pneumonia or other complications. The schools are

not having enough to close classes; I guess that's it.

I don't know if it is the flu shots we took or not, but as of yet, my

wife, 82 year old mother in law and I have not had even one sign of

the flu in hour house.

My problem is the weather changes. One day, cold, then next mild, the

next even warmer, then back to cold again. Thanks to the Xolair, I

don't need pred, but I do have to use Pulmicort in my neb 2-3 times a

day during these periods.

Doug

Group founder

[Guest guest]

Doug,

The last time I got the flu it went to Pneumonia. I was hospitalized

for 14 days. My pulmo said he would not have been able to save me if I

had not had a flu shot. He said people " underestimate influenza " . This

was 2-3 years ago pre-Xolair. So far I've been good since starting

Xolair, but both the wife and I implemented all the precautions stated

on this forum.

I have the same problem with the weather changes. My wife, who is

relatively healthy stated after a 2 week cold that she believes the

weather changes, up and down temperatures, contributed to her cold and

wreaks havoc on our system. As my Pulmo says, I have no medical prof,

but I see it in enough patients that I have to believe what they are

reporting.

I hope your family stays well.

Ron

On Feb 29, 2008, at 7:47 AM, uca79iii wrote:

>

>

> Ron,

>

> I live right on the border with Oklahoma and the flu is bad here too

> but has not been declared an epidemic. I don't know why because all 3

> of our hospitals are full of people who started out with the flu and

> it developed into pneumonia or other complications. The schools are

> not having enough to close classes; I guess that's it.

>

> I don't know if it is the flu shots we took or not, but as of yet, my

> wife, 82 year old mother in law and I have not had even one sign of

> the flu in hour house.

>

> My problem is the weather changes. One day, cold, then next mild, the

> next even warmer, then back to cold again. Thanks to the Xolair, I

> don't need pred, but I do have to use Pulmicort in my neb 2-3 times a

> day during these periods.

>

> Doug

> Group founder

>

>

>

[Guest guest]

I was switched from a company that allowed self-injection to one that

didn't. My doctor's response was that, once it got to him, he could do

with it as he pleased, and he gave it to me to self-inject. I drive to

hois office and simply pick it up, two months at a time.

Of course, if anything happens it is on his liability,but nothing has

ever happened in the years I have been taking it. If your doc will go

that route, it is an option.

Happy Spring!

Kitty

>

> Greetings, Heavy Breathers

>

> Insurance coverage re Xolair is obviously a can of worms from what

I've seen on posts. I have a question I hope can be resolved easily,

but I doubt it. I've been receiving the shots for about a year.

According to my pulmo, in order to have Medicare cover the shots, I

have to go to a local (12 miles) hospital outpatient services

department for the shots twice a month. Medicare covers part and BCBS

picks up balance, so Xolair costs me nothing except for gas. However,

I'd like to get the stuff at home and let my wife, an RN, give me the

shots. Is anyone covered by Medicare and BCBS able to get the stuff

for free at home??? With my miserable susceptibility to upper

respiratory infection (I have a pic line in my arm now for antibiotic

infusion), I'm becoming agoraphobic and want to avoid crowded, disease

and infection laden places - obviously, a hospital falls into that

category - and with the flu vaccine being only 40% effective, I'm

concerned. Help!

>

> Ohldepharte

>

>

[Guest guest]

> HI EARL: I was diagnosed in Dec. of 1998, and went through the

Interferon/Ara-C only for a few months before it became toxic to my

liver. I am not on Medicare yet, but you should fight it with them. I

do not know if the PCR is more expensive than a BMB, but tell them that

this is the way they determine your status to be sure you are in

remission. They probably feel that if your routine blood work is

holding steady that you do not need the tests. My oncologist told me

to just get the PCR's every 6 months, so they do not have to keep going

into my bone for biopsy. I would tell them they will be paying out a

lot more if your status goes into blast phase, and thats why testing is

needed to keep track. I hope you get the right answers. We have been

very blessed since 1998

Suzzie

> I was diagnosed with CML in Aug. 1998. After 26 months of INF, I

> started Gleevec and have been doing well ever since. Along the way,

> I had 16 BMB's, but for the past several years, I have been monitored

> by PCR/FISH blood tests every 6 months. About a year ago, Medicare

> stopped covering these tests for me. According to Quest Labs,

> Medicare reports that these tests " are not medically necessary "

> and " do not meet Medicare Guidelines to support the medical need for

> the test " . My supplemental ins. will not cover these tests because

> they have been denied by Medicare. My provider claims they have not

> changed the diagnostic codes and can't do anything more. Before

> contacting Medicare (which can be an arduous undertaking), I decided

> to find out what others have experienced.

> Thus, my question is, have any of you who are on Medicare had a

> similar experience with coverage denial from them?

> Thanks for your replies and suggestions.

> Earl in Tucson

>

[Guest guest]

My bmb day of testing is 16,000. Including pcr test all bloods ekg, dr visit

blah blah blah... Everything but lunch and parking!!!

Sent from my Verizon Wireless BlackBerry

[ ] Re: Medicare coverage

Date: Friday, November 14, 2008, 6:08 PM

Suzzie: Thanks for your reply. BMB costs $1000+ and the PCR/FISH is

$115.17. It's a no brainer. I con't figure why Medicare refuses to

pay. Earl

> > HI EARL: I was diagnosed in Dec. of 1998, and went through the

> Interferon/Ara- C only for a few months before it became toxic to my

> liver. I am not on Medicare yet, but you should fight it with them. I

> do not know if the PCR is more expensive than a BMB, but tell them

that

> this is the way they determine your status to be sure you are in

> remission. They probably feel that if your routine blood work is

> holding steady that you do not need the tests. My oncologist told me

> to just get the PCR's every 6 months, so they do not have to keep

going

> into my bone for biopsy. I would tell them they will be paying out a

> lot more if your status goes into blast phase, and thats why testing

is

> needed to keep track. I hope you get the right answers. We have been

> very blessed since 1998

> Suzzie

> > I was diagnosed with CML in Aug. 1998. After 26 months of INF, I

> > started Gleevec and have been doing well ever since. Along the way,

> > I had 16 BMB's, but for the past several years, I have been

monitored

> > by PCR/FISH blood tests every 6 months. About a year ago, Medicare

> > stopped covering these tests for me. According to Quest Labs,

> > Medicare reports that these tests " are not medically necessary "

> > and " do not meet Medicare Guidelines to support the medical need for

> > the test " . My supplemental ins. will not cover these tests because

> > they have been denied by Medicare. My provider claims they have not

> > changed the diagnostic codes and can't do anything more. Before

> > contacting Medicare (which can be an arduous undertaking) , I decided

> > to find out what others have experienced.

> > Thus, my question is, have any of you who are on Medicare had a

> > similar experience with coverage denial from them?

> > Thanks for your replies and suggestions.

> > Earl in Tucson

> >

>