Medicare

[Guest guest]

In a message dated 2/2/2004 4:30:33 PM Central Standard Time,

hevnbound1@... writes:

IF anybody had JUST Medicare as their insurer, I'd like to know how

much it cost you for the surgeon bill and the hospital, over and

above the program fee that Dr. K charges.

I just found out that BC/BS is requiring preauthorization even though

they are my secondary insurer!! And also that I will have to pay a

lot more out-of-pocket expenses than I planned on. I am wondering if

it would be to my benefit to drop BC/BS. The only reason I keep them

is to cover prescriptions. Medicare pays everything else. I pay

$1,300 per year to carry BC/BS and they sure didn't even pay close to

that amount of my medical bills last year!!

TIA

Hugs,

Laurie

in Bama

VBG 1982 (lost from 433lbs to 270's)

VBG to RNY1996 revision(Lost from 343 to 299)

RNY to DS revision Dec 2002 -down 118 lbs so far (377.7 to 259.4 and still

going

Homepage address- http://hometown.aol.com/mdl1031/myhomepage/profile.html

Many thanks to Dr. K willing to take on a 3rd timer....LOL

[Guest guest]

In a message dated 2/2/2004 2:30:35 PM Pacific Standard Time,

hevnbound1@... writes:

> I just found out that BC/BS is requiring preauthorization even though

> they are my secondary insurer!!

Hi Laurie,

When I was researching the whole Medicare/Blue Cross thing (I had BC as

primary), I was told if Medicare covered as primary -- BC HAD to cover it as

secondary. I don't know if that still holds true...but it is a place to start

research.

Good luck!

Hugs and blessings, Ann

[Guest guest]

In a message dated 2/2/2004 4:30:33 PM Central Standard Time,

hevnbound1@... writes:

IF anybody had JUST Medicare as their insurer, I'd like to know how

much it cost you for the surgeon bill and the hospital, over and

above the program fee that Dr. K charges.

I just found out that BC/BS is requiring preauthorization even though

they are my secondary insurer!! And also that I will have to pay a

lot more out-of-pocket expenses than I planned on. I am wondering if

it would be to my benefit to drop BC/BS. The only reason I keep them

is to cover prescriptions. Medicare pays everything else. I pay

$1,300 per year to carry BC/BS and they sure didn't even pay close to

that amount of my medical bills last year!!

TIA

Hugs,

Laurie

Laurie,

BC/BS CANNOT require pre authorization. If Medicare covers it they have

to pay their portion. If they are secondary, they pay without question. If you

are medicare only you will have your inpt co pay(mine was $887) and the

program fee. Nothing else as the program fee covers the extra amount that Dr. K

(medicare pays what? 80%?) charges. Of course post op meds and stuff, but If I

not

been forced to I was willing to drop my BC/BS.

in Bama

VBG 1982 (lost from 433lbs to 270's)

VBG to RNY1996 revision(Lost from 343 to 299)

RNY to DS revision Dec 2002 -down 118 lbs so far (377.7 to 259.4 and still

going

Homepage address- http://hometown.aol.com/mdl1031/myhomepage/profile.html

Many thanks to Dr. K willing to take on a 3rd timer....LOL

[Guest guest]

In a message dated 2/2/2004 4:30:33 PM Central Standard Time,

hevnbound1@... writes:

IF anybody had JUST Medicare as their insurer, I'd like to know how

much it cost you for the surgeon bill and the hospital, over and

above the program fee that Dr. K charges.

I just found out that BC/BS is requiring preauthorization even though

they are my secondary insurer!! And also that I will have to pay a

lot more out-of-pocket expenses than I planned on. I am wondering if

it would be to my benefit to drop BC/BS. The only reason I keep them

is to cover prescriptions. Medicare pays everything else. I pay

$1,300 per year to carry BC/BS and they sure didn't even pay close to

that amount of my medical bills last year!!

TIA

Hugs,

Laurie

Laurie,

BC/BS CANNOT require pre authorization. If Medicare covers it they have

to pay their portion. If they are secondary, they pay without question. If you

are medicare only you will have your inpt co pay(mine was $887) and the

program fee. Nothing else as the program fee covers the extra amount that Dr. K

(medicare pays what? 80%?) charges. Of course post op meds and stuff, but If I

not

been forced to I was willing to drop my BC/BS.

in Bama

VBG 1982 (lost from 433lbs to 270's)

VBG to RNY1996 revision(Lost from 343 to 299)

RNY to DS revision Dec 2002 -down 118 lbs so far (377.7 to 259.4 and still

going

Homepage address- http://hometown.aol.com/mdl1031/myhomepage/profile.html

Many thanks to Dr. K willing to take on a 3rd timer....LOL

[Guest guest]

In a message dated 2/2/2004 6:08:42 PM Central Standard Time,

hevnbound1@... writes:

Should I call

BC/BS and talk to them or what?

I'm feeling really ignorant regarding insurance.

Hugs,

Laurie

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

I'd call Bc and medicare both. There is a booklet that is on the website

medicare.gov that is " who pays first " but it doesn't say much about conflicts. I

don't know how they handle specifics but if Bc had been my secondary I was told

they would have never batted an eye and paid.

in Bama

VBG 1982 (lost from 433lbs to 270's)

VBG to RNY1996 revision(Lost from 343 to 299)

RNY to DS revision Dec 2002 -down 118 lbs so far (377.7 to 259.4 and still

going

Homepage address- http://hometown.aol.com/mdl1031/myhomepage/profile.html

Many thanks to Dr. K willing to take on a 3rd timer....LOL

[Guest guest]

In a message dated 2/2/2004 4:26:53 PM Pacific Standard Time,

hevnbound1@... writes:

> Do you have any ideas for me? lol Should I call

> BC/BS and talk to them or what?

Didn't you get your 2004 Medicare handbook? Look in there and they will tell

you about what happens when Medicare is primary. I am reasonably sure I am

right about BC having to cover, with Medicare as primary because Medicare says

if THEY approve it (and they DO approve the DS) then an insurance has to cover

it. Call the 800 number for Medicare and ask...they were really helpful when

I called. You may need to call and ask her for the surgery code for

morbid obesity and for the DS to have on hand for Medicare. I think they

will ask that question.

I wrote to them about a separate issue and they responded, but were a little

slow. I believe you will get this resolved in your favor!

Hugs and blessings, Ann

[Guest guest]

In a message dated 2/2/2004 4:26:53 PM Pacific Standard Time,

hevnbound1@... writes:

> Do you have any ideas for me? lol Should I call

> BC/BS and talk to them or what?

Didn't you get your 2004 Medicare handbook? Look in there and they will tell

you about what happens when Medicare is primary. I am reasonably sure I am

right about BC having to cover, with Medicare as primary because Medicare says

if THEY approve it (and they DO approve the DS) then an insurance has to cover

it. Call the 800 number for Medicare and ask...they were really helpful when

I called. You may need to call and ask her for the surgery code for

morbid obesity and for the DS to have on hand for Medicare. I think they

will ask that question.

I wrote to them about a separate issue and they responded, but were a little

slow. I believe you will get this resolved in your favor!

Hugs and blessings, Ann

[Guest guest]

>

I was told if Medicare covered as primary -- BC HAD to cover it as

> secondary.

Ann,

This is coming from at Dr. K's office. I didn't have to

mess with any insurance stuff for my RNY so I'm pretty clueless. The

office did it all. Do you have any ideas for me? lol Should I call

BC/BS and talk to them or what?

I'm feeling really ignorant regarding insurance.

Hugs,

Laurie

[Guest guest]

>

I was told if Medicare covered as primary -- BC HAD to cover it as

> secondary.

Ann,

This is coming from at Dr. K's office. I didn't have to

mess with any insurance stuff for my RNY so I'm pretty clueless. The

office did it all. Do you have any ideas for me? lol Should I call

BC/BS and talk to them or what?

I'm feeling really ignorant regarding insurance.

Hugs,

Laurie

[Guest guest]

Mel,

Thanks. I'll have to call BC tomorrow, and maybe too, to

see what's what. I'm waiting for a reply from to clarify

some things she emailed me about regarding the insurance. I'm get

really frustrated. I didn't think it would be a problem having two

insurances.

Hugs,

Laurie

[Guest guest]

When you say "fall short" does that mean you actually exceed the guidelines?? I have about another 10 months of the required 24 months to get benefits of Medicare. DelKathy Brunow <kathy-boo@...> wrote: Medicare Received yesterday a letter from the Social Security Administration..They completed their review of my eligibility, I still have coverage due to the cost of my medical needs.We fall short of the monetary guidelines by $10,000.00.. It is heck when your cash flow is to great to get help from the state, but you don't make enough to pay for medical services..I was certain they would approve my appeal based on need for ongoing services..Needless to say I am one happy lady here in Milwaukee WI. Kathy Brunow March 31st 2006...

Have a burning question? Go to Answers and get answers from real people who know.

[Guest guest]

We fall under the cut off amount by $10,000.00. Sorry I have problems putting my words down coherently..Boo

-- Re: Medicare

When you say "fall short" does that mean you actually exceed the guidelines??

I have about another 10 months of the required 24 months to get benefits of Medicare.

DelKathy Brunow <kathy-boosbcglobal (DOT) net> wrote:

Medicare

Received yesterday a letter from the Social Security Administration..They completed their review of my eligibility, I still have coverage due to the cost of my medical needs.We fall short of the monetary guidelines by $10,000.00.. It is heck when your cash flow is to great to get help from the state, but you don't make enough to pay for medical services..I was certain they would approve my appeal based on need for ongoing services..Needless to say I am one happy lady here in Milwaukee WI. Kathy Brunow March 31st 2006...

Have a burning question? Go to Answers and get answers from real people who know.

[Guest guest]

Don't fret about what...I think we all do.... my brain doesn't understand the simplest of instructions, or fails me little trying to perform little "easy" things. I try to figure out which would be the smartest thing to do....start the coffee first...or put a bagel in the toaster oven first? Then...Lord help us all if nature calls, because it would make more sense to put the coffee on before going to the bathroom but will I make it in time because the filters are in a new box and that will take more time.............. and it goes on and on.....LOL!!!!! and I wonder if I could hold a job, maybe......... hahaha Sorry, but I still have to ask, when you fall under the cut off amount, does that mean you bring home too much money (by their standards) to qualify? Surely it can't mean you don't generate enough income(so to speak...) by

$10,000.00 to qualify for help. That would make you need more help.... but they (medicare) told me I didn't need more money, because I couldn't meet my bills anyway, so they wanted to give me a lesser amount. If you don't want to deal with this anymore I DO understand that...... God Bless us All. DelKathy Brunow <kathy-boo@...> wrote: We fall under the cut off amount by $10,000.00. Sorry I have problems putting my words down coherently..Boo -- Re: Medicare When you say "fall short" does that mean you

actually exceed the guidelines?? I have about another 10 months of the required 24 months to get benefits of Medicare. DelKathy Brunow <kathy-boosbcglobal (DOT) net> wrote: Medicare Received yesterday a letter from the Social Security Administration..They completed their review of my eligibility, I still have coverage due to the cost of my medical needs.We fall short of the monetary guidelines by $10,000.00.. It is heck when your cash flow is to great to get help from the state, but you don't make enough to pay for medical services..I was certain they

would approve my appeal based on need for ongoing services..Needless to say I am one happy lady here in Milwaukee WI. Kathy Brunow March 31st 2006... Have a burning question? Go to Answers and get answers from real

people who know.

Check out the all-new beta - Fire up a more powerful email and get things done faster.

[Guest guest]

Del, what I did was photo copied every thing.. Including stuff from the W2 works (use to be the AFDC office) here in Milwaukee.. Where they said we had to much money to obtain Medicaid and all my bills and photo copies of medication bills and al that.. But we do fall under the amount they use to cut you off,, By 10,00.00 dollars so this is a good thing..If we had just 10 thousand more monthly coming in, well we wouldn't be getting this.Cause there is no way on God's green earth we can pay out of pocket for my rejection meds, you know the Cellcept and Prograft..Which by the way is just under 2 thousand monthly..then you count the monthly lab work, and other medical needs etc..And even though I have Tri---Care for life, they won't help with the rejection medications.. Strange but true!! I had the VA send me paper work stating what they would cover, which I also got photo copied and sent along.. The whole nine yards Del. And now I got continuing coverage.Kathy

-- Re: Medicare

When you say "fall short" does that mean you actually exceed the guidelines??

I have about another 10 months of the required 24 months to get benefits of Medicare.

DelKathy Brunow <kathy-boosbcglobal (DOT) net> wrote:

Medicare

Received yesterday a letter from the Social Security Administration..They completed their review of my eligibility, I still have coverage due to the cost of my medical needs.We fall short of the monetary guidelines by $10,000.00.. It is heck when your cash flow is to great to get help from the state, but you don't make enough to pay for medical services..I was certain they would approve my appeal based on need for ongoing services..Needless to say I am one happy lady here in Milwaukee WI. Kathy Brunow March 31st 2006...

Have a burning question? Go to Answers and get answers from real people who know.

Check out the all-new beta - Fire up a more powerful email and get things done faster.

[Guest guest]

THAT IS GOOD NEWS BOO GLAD THAT YOU STILL HAVE THE HELP YOU NEED KATKathy Brunow <kathy-boo@...> wrote: Medicare Received yesterday a letter from the Social Security Administration..They completed their review of my eligibility, I still have coverage due to the cost of my medical needs.We fall short of the monetary guidelines by $10,000.00.. It is heck when your cash flow is to great to get help from the state, but you don't make enough to pay for medical services..I was certain they would approve my appeal based on need for ongoing services..Needless to say I am one happy lady here in Milwaukee WI. Kathy Brunow

March 31st 2006...

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[Guest guest]

Boo, My social worker has in the past been bustin' my chops telling me I need to show some proof, like a trust fund or something, (she suggested a private company, that basically takes your money, promises to dish it out if needed, and in the meantime they invest it. The slower, SICK ones in the herd are easier to catch than the healthy ones I guess.. Life's Rules... Not mine. The amount that was decided is $4000.00 a year, which she says will probably be my co-pay. So.. it is my understanding I need to cough up four grand, give it to this'organization' ATT: Luigi Cordeleone.....of the of THE Cordeleone Family,,,(haha) for safekeeping... and then do it again for as long as I'm taking Anti Reject drugs.. I have Humana, and will try to, no will check with them to see what they cover post op.... When my extended

Cobra/Humana (2nd time around for me, then probably no more), runs out, is exactly when my inexplicably INSANE 24 month wait time ends with Medicare, and if I'm still upright and breathing, I get a break on drugs through them. Does ANYONE know anything about this??? Did y'all you have to have "front money" to get a transplant? Kinda' like payin' the maitre de' for a 'good' table? The way it is explained to me, is that they won't install a liver in someone that can't prove they can take care of themselves post op. Thus, knowledgeable, reliable caregivers... and now I guess a roll of cash big enough to choke a mule are not just a good thing to have, but mandatory. I can definitely see the hospitals point of view, and I understand why there are enemas, but my understanding doesn't make either one any more pleasant. Del Thank you

everyone. Kathy Brunow <kathy-boo@...> wrote: Del, what I did was photo copied every thing.. Including

stuff from the W2 works (use to be the AFDC office) here in Milwaukee.. Where they said we had to much money to obtain Medicaid and all my bills and photo copies of medication bills and al that.. But we do fall under the amount they use to cut you off,, By 10,00.00 dollars so this is a good thing..If we had just 10 thousand more monthly coming in, well we wouldn't be getting this.Cause there is no way on God's green earth we can pay out of pocket for my rejection meds, you know the Cellcept and Prograft..Which by the way is just under 2 thousand monthly..then you count the monthly lab work, and other medical needs etc..And even though I have Tri---Care for life, they won't help with the rejection medications.. Strange but true!! I had the VA send me paper work stating what they would cover, which I also got photo copied and sent along.. The whole nine yards Del. And now I got continuing coverage.Kathy -- Re: Medicare When you say "fall short" does that mean you actually exceed the guidelines?? I have about another 10 months of the required 24 months to get benefits of Medicare. DelKathy Brunow <kathy-boosbcglobal (DOT) net> wrote: Medicare Received yesterday a letter from the

Social Security Administration..They completed their review of my eligibility, I still have coverage due to the cost of my medical needs.We fall short of the monetary guidelines by $10,000.00.. It is heck when your cash flow is to great to get help from the state, but you don't make enough to pay for medical services..I was certain they would approve my appeal based on need for ongoing services..Needless to say I am one happy lady here in Milwaukee WI. Kathy Brunow March 31st 2006... Have a burning question? Go to Answers and get answers from real people who know. Check out the all-new beta - Fire up a more powerful email and get things done faster.

Need a quick answer? Get one in minutes from people who know. Ask your question on

Answers.

[Guest guest]

,

I get too much SSDI to qualify for Medicaid, but the state does pay for my Medicare B and D premiums. So, I get my full check every month without deductions.

Maybe they also do this in California? I'm in Ct.

Hope this helps...

Charlie

Medicare

I am 60yo, on SSDI. I recently received a letter from Medicare telling me that because I am entitled to SSDI I am automatically enrolled in Medicare parts A & B. It further states that Part B will cost me 115.40 and it will automatically be deducted from my SSDI. I can not afford this.

I live in San Francisco and all of my medical expenses are currently taken care of through White, a City Health Care Program and a low income assistance program at the medical center I go to. I can not afford, nor do I really need medicare part B at this time. My other concern with Part B is if I wait and for some reason need to sign up for it later, I will be charged a 10% fee for each year that I opted out of it.

Any clarification on this would be appreciated.

thanks

[Guest guest]

charlie & other chers---this is a link to a pdf of detailed notes from an educational phone conference call, hosted by CHAMP & prevention justice in may of 2009, about poverty and policy in the US. i found the following two reports from that conference very helpful in understanding not only how the US definition of poverty is used to jiggle our coverage, but also the stigmatization & profiteering that goes along with it. (i am sorry if all of the type is messed up. I cut & pasted these snips from the pdf, and now it all looks like a mish-mash on the screen and the formatting commands don't seem to work). i think both discussions are still significant in this "post-obamacare era" of healthcare reform: http://www.champnetwork.org/files/media/2009-05-27_HIVPJA_Call_Notes.pdfscroll past the initial sections to:Panel of Speakers:Lynn C. Todman, PhD, Director of the Institute of Social Exclusion (ISE) at the Adler School of Professional Psychology, Chicagoltodman@...Dr. Todman discussed the relationship between poverty and HIV, including who is poor in the US, anti-poverty approaches and why poverty persists. This thumbnail gives background info to aid in HIV PJA platform goals to shift the paradigm to the determinants of HIV/AIDS and think of the kinds of research to conduct to understand the issues of poor communities. and then scroll further

down to this report:Marisa Franco, National Lead Organizer, Right to the City Alliance: mfranco@... / www.righttothecity.orgMs. Franco discussed the Alliance's work as grassroots leaders in low-income, working class communities of color connecting battles against gentrification and displacement to other local and international struggles for human rights, land, and democracy. . . . In addition to gentrification and displacement, this is an era of privatization; government deregulation and cuts in social spending that have disastrous effects on our communities.

Gentrification and displacement are not just issues of housing and space, but as the name Right to the City implies, it encompasses all of the needs that people have in cities – the right to public space, community, culture, health care and education – and RTTC is composed of groups and allies that work on these issues.namasté ---rk aidswriteorg@...From: "WEBcfm@..." <WEBcfm@...> Cc: Sent: Saturday, January 29, 2011 4:00 PMSubject: Re: Medicare

,

I get too much SSDI to qualify for Medicaid, but the state does pay for my Medicare B and D premiums. So, I get my full check every month without deductions.

Maybe they also do this in California? I'm in Ct.

Hope this helps...

Charlie

Medicare

I am 60yo, on SSDI. I recently received a letter from Medicare telling me that because I am entitled to SSDI I am automatically enrolled in Medicare parts A & B. It further states that Part B will cost me 115.40 and it will automatically be deducted from my SSDI. I can not afford this.

I live in San Francisco and all of my medical expenses are currently taken care of through White, a City Health Care Program and a low income assistance program at the medical center I go to. I can not afford, nor do I really need medicare part B at this time. My other concern with Part B is if I wait and for some reason need to sign up for it later, I will be charged a 10% fee for each year that I opted out of it.

Any clarification on this would be appreciated.

thanks

[Guest guest]

Hey , White & the other programs that you mentioned are payers of last resort. This means if they realize that you are eligible for Medicare ,they ( White and City Health Care & medical center )will force you to take Medicare before paying for anything else. I recommend that you don’t decline it and there are extra help programs available with the premiums for both Part B & D. www.medicare.gov has the application for extra help for Part D. If your SSDI benefit is under $1,200 you will definitely get help with everything. Some of the assistance is also sliding scale. It varies upon your situation. I also suggest that you check with your case manager if you have one. If you don’t have a White case manager, I suggest that you call Project Inform’s hotline. Eddie Medicare Posted by: " " marblesp1@... marblesp1 Sat Jan 29, 2011 1:08 pm (PST) I am 60yo, on SSDI. I recently received a letter from Medicare telling me that because I am entitled to SSDI I am automatically enrolled in Medicare parts A & B. It further states that Part B will cost me 115.40 and it will automatically be deducted from my SSDI. I can not afford this.I live in San Francisco and all of my medical expenses are currently taken care of through White, a City Health Care Program and a low income assistance program at the medical center I go to. I can not afford, nor do I really need medicare part B at this time. My other concern with Part B is if I wait and for some reason need to sign up for it later, I will be charged a 10% fee for each year that I opted out of it.Any clarification on this would be appreciated.thanks

[Guest guest]

Eddie writes [in part]: <<If your SSDI benefit is under $1,200 you will definitely get helpwith everything. >>

But there is one other "catch" or prerequisite: [from: "Medicare & You"] for 2011. "...and resources below less [sic] than $12,510" for a single person. "Resources include money in a checking or savings account, stocks, and bonds. Resources don't include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person,) or life insurance policies."

Hence the "extra help" is based both on income and asset limitations. To clarify, monetary qualification for SSDI itself does not include assets; the "extra help" does include them.

[Guest guest]

Hi All-

I currently work at a level 1 facility so according to their regulations, we can provide surgery for patients who have Medicare.

We are running into an insurance issue with some of these patients who do not have renal disease or diabetes as comorbidities; therefore, Medicare will not pay for the visits to see the dietitians.

For those of you who are level 1 facilities and are accepting Medicare patients, how are you getting around this?

Are you doing group classes?

Any information would be greatly appreciated.

Thank you,

LaFleur RD,LD