Guest guest Posted May 20, 2004 Report Share Posted May 20, 2004 Mark, I have a headache just trying to do that math! Hang in there.... Jill Medicare And try getting a straight answer from anybody. For my therapist, Medicare is charged $233.05 an hour (I don't understand the 5 cents...). Medicare actually pays $79.90; I pay $7 at the visit and bills me $10.07 by bill; and the district " contractually adjusts " $142.17. This doesn't add up, however you do the math; but all I'm told is to pay it. My therapist was floored -- individual therapy with a social worker privately runs about $100 and hour, not $233. Another delightful problem is I have 30 days to contest each charge -- but Medicare takes 60+ days to tell me what they paid and what I am allowed to be billed. I literally don't know what to do about it; no one can tell me anything other than " this is the way we do it " . Talk about new math! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2004 Report Share Posted May 20, 2004 Mark, I have a headache just trying to do that math! Hang in there.... Jill Medicare And try getting a straight answer from anybody. For my therapist, Medicare is charged $233.05 an hour (I don't understand the 5 cents...). Medicare actually pays $79.90; I pay $7 at the visit and bills me $10.07 by bill; and the district " contractually adjusts " $142.17. This doesn't add up, however you do the math; but all I'm told is to pay it. My therapist was floored -- individual therapy with a social worker privately runs about $100 and hour, not $233. Another delightful problem is I have 30 days to contest each charge -- but Medicare takes 60+ days to tell me what they paid and what I am allowed to be billed. I literally don't know what to do about it; no one can tell me anything other than " this is the way we do it " . Talk about new math! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2004 Report Share Posted May 20, 2004 In a message dated 5/20/04 6:04:56 PM, Jill writes: > I have a headache just trying to do that math! > Oh yes. At the moment, I have about 20 open account numbers with the one district. Arg. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 17, 2004 Report Share Posted June 17, 2004 Hi, Art.... Dr. Amstutz has performed hip resurfacing on several patients with Medicare coverage. The Medicare intermediary in California , National Heritage Insurance, has paid the full amount for these cases based upon their reimbursement schedule for THR ( " DRG 209 " ). Medicare does not pre-certify surgeries/hospital admissions so there is always a chance that they could deny coverage when they receive the claims. Therefore, our Medicare patients are required to sign a " Notice of Non-Coverage " prior to surgery informing them that they will be responsible for payment if the surgery is denied. Fortunately, this has never happened and we are very confident that these cases will not be denied based upon our previous experience. Congress passed statutes in 1995 that enable clinical trials to be a covered benefit for Medicare beneficiaries up to the cost of " standard " treatment. The decision to approve claims, however, is delegated to the individual insurance intermediary companies. Again, we are confident that National Heritage will continue to approve these cases. I believe that it is fairly safe to say that most of the resurfacing surgeons are less inclined to perform the procedure on patients > 60-65 yo. Dr. Amstutz has no such reservations given that many patients > 60-65 yo remain quite active, have very good bone stock and are in excellent health. Regards, Chuck JRI - Los Angeles > Does anyone have any experience having Medicare pay for US resurfacing? Since this is > generally a program for people over 65, many surgeons will not accept such patients in > their trial or investigation. Are there any who do? > > Thanks > Art Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2004 Report Share Posted June 18, 2004 Hi Chuck & Art, I will chime in here and say I personally know of one resurface guy into his 60's when he got his almost 4 years ago now............ He had to do a bit of a search to find a surgeon willing but he was a very healthy active guy and wanted one, he felt it would suit his active life style far better............. He is happily doing very well on it still........... is a scientist type and leads bushwalking expeditions for a hobby............ Edith LBHR Dr. L Walter Syd Aust 8/02 > > cases. I believe that it is fairly safe to say that most of the > resurfacing surgeons are less inclined to perform the procedure on > patients > 60-65 yo. Dr. Amstutz has no such reservations given that > many patients > 60-65 yo remain quite active, have very good bone > stock and are in excellent health. > > Regards, > > Chuck > JRI - Los Angeles Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2009 Report Share Posted June 4, 2009 I have the same questions as Ellen. Â I have been waiting for almost three months for my first appointment at Cedars Sanai Hospital here in Los Angeles, everything moves at a snails pace, to see if I can get on transplant list. Â The only one in a hurry is me. Â I know I need to keep Blue Shield Insurance besides medicare when I go on permanent disability because Cedars will not except just medicare. Â I do not have all the answers yet about disability and medicare, I am now on just disability. Â But since I can not walk or talk for very long even with my oxygen, I know I can never go back to my job, but I will need to keep my health insurance. Â Has anyone tired Natural Healing medicine along with the few drugs we are given from the regular medical doctors?? Â I enjoy reading your emails, they are very helpful. Â I am 63 yrs old. Â Carroll Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2009 Report Share Posted June 4, 2009 Carroll, I am on SSDI and Medicare. In addition to Medicare I have a "Medicare Supplement". That pays my co-pays and the other stuff that Medicare doesn't pay. It's expensive because of my age. (I'm 49). Assuming I live long enough the price of my supplement will go down when I hit 65. As far as 'natural medicines' go.....I'm a bit of a skeptic. There is alot of expensive nonsense out there. Folks who will sell stuff to people like us who are desperate for something to inprove their conditions. That said, here's what I do. I follow a nutritional plan laid out for me by a nutritionist at the Duke Center for Integrative Medicine. It's an anti-inflammatory diet closely resembling the recommendations of Weil. Since I have an abundance of inflammation anything that may positively impact that I'm willing to try. I take a few supplements for the same reasons, to reduce inflammation and support the healthy functioning of my immune system. I meditate and pray daily. One of the doctors at Duke has suggested that I try a few sessions of acupuncture. I've not acted on that primarily because it's something that I have to pay for out of pocket. I will likely do it sometime this summer. Mainly my goal is to maintain my existing level of function. I know that currently there is nothing that will reverse the scarring that's in my lungs. Consequently what I want to do is prevent further scarring and deterioration. Is what I'm doing helping? I have no idea. None of it can hurt me however and all of it supports the best functioning of my impaired lungs and the rest of my body. Beth Moderator Fibrotic NSIP 06/06 Dermatomyositis 11/08 To: Breathe-Support Sent: Thursday, June 4, 2009 1:17:03 PMSubject: Medicare I have the same questions as Ellen. I have been waiting for almost three months for my first appointment at Cedars Sanai Hospital here in Los Angeles, everything moves at a snails pace, to see if I can get on transplant list. The only one in a hurry is me. I know I need to keep Blue Shield Insurance besides medicare when I go on permanent disability because Cedars will not except just medicare. I do not have all the answers yet about disability and medicare, I am now on just disability. But since I can not walk or talk for very long even with my oxygen, I know I can never go back to my job, but I will need to keep my health insurance. Has anyone tired Natural Healing medicine along with the few drugs we are given from the regular medical doctors?? I enjoy reading your emails, they are very helpful. I am 63 yrs old. Carroll Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2009 Report Share Posted June 4, 2009 Carroll, I am on SSDI and Medicare. In addition to Medicare I have a "Medicare Supplement". That pays my co-pays and the other stuff that Medicare doesn't pay. It's expensive because of my age. (I'm 49). Assuming I live long enough the price of my supplement will go down when I hit 65. As far as 'natural medicines' go.....I'm a bit of a skeptic. There is alot of expensive nonsense out there. Folks who will sell stuff to people like us who are desperate for something to inprove their conditions. That said, here's what I do. I follow a nutritional plan laid out for me by a nutritionist at the Duke Center for Integrative Medicine. It's an anti-inflammatory diet closely resembling the recommendations of Weil. Since I have an abundance of inflammation anything that may positively impact that I'm willing to try. I take a few supplements for the same reasons, to reduce inflammation and support the healthy functioning of my immune system. I meditate and pray daily. One of the doctors at Duke has suggested that I try a few sessions of acupuncture. I've not acted on that primarily because it's something that I have to pay for out of pocket. I will likely do it sometime this summer. Mainly my goal is to maintain my existing level of function. I know that currently there is nothing that will reverse the scarring that's in my lungs. Consequently what I want to do is prevent further scarring and deterioration. Is what I'm doing helping? I have no idea. None of it can hurt me however and all of it supports the best functioning of my impaired lungs and the rest of my body. Beth Moderator Fibrotic NSIP 06/06 Dermatomyositis 11/08 To: Breathe-Support Sent: Thursday, June 4, 2009 1:17:03 PMSubject: Medicare I have the same questions as Ellen. I have been waiting for almost three months for my first appointment at Cedars Sanai Hospital here in Los Angeles, everything moves at a snails pace, to see if I can get on transplant list. The only one in a hurry is me. I know I need to keep Blue Shield Insurance besides medicare when I go on permanent disability because Cedars will not except just medicare. I do not have all the answers yet about disability and medicare, I am now on just disability. But since I can not walk or talk for very long even with my oxygen, I know I can never go back to my job, but I will need to keep my health insurance. Has anyone tired Natural Healing medicine along with the few drugs we are given from the regular medical doctors?? I enjoy reading your emails, they are very helpful. I am 63 yrs old. Carroll Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2009 Report Share Posted June 8, 2009 Bruce... You just Joyce that Medicare will pay for Pulmonaqry Rehab. My doctor wants me to have Pulmonary Rehab 3x week for 8 - 10 weeks. I contacted Medicare here in Ohio and they told me that the cap for payment is $1,800. I'm trying to get a per vist rate from Rehab and I'm having difficulty getting the information. I told the doctor about this and that I'm not going to get the Rehab. I'm on Social Security and I can't afford a large monthly out-of-pocket expense. I have Medicaid only IF I meet my $1000 monthly spendown. They're NUTS! Oh well. To: Breathe-Support Sent: Saturday, June 6, 2009 5:06:00 PMSubject: Re: Recovery after Vats JoyceMedicare will pay for pulmonary rehab. Your Primary seemed to be verysupportive and since he's local you might get him to refer you. It'stremendously helpful but yet many doctors don't even mention it.As to the spirometer, I still use mine. You might try it just to see ifyou're still hitting the levels you were when you were using it. It'salways good exercise too.You talk about forcing yourself to do things. Yes, within limits. Keepan eye on your saturation levels. Don't overdo. But do what you can. Getout and about or walk in your yard. We all get tired and have to limitour daily activity, but understand you've had virtually none for a whilenow, with the surgery. It's natural you feel weaker. You need to learnthat balance that is right for you. But sitting doing nothing isn't goodfor you anymore than doing way too much. That's where rehab really doeshelp. You should definitely ask about it. It will help you get startedback and you'll be amazed.> >> > How long does it take to recover to your original state afterhaving> the VATS? It has almost been a month now and I am just not up topar. I> made scrambled eggs and bacon and waffles for my son and hisgirlfriend> and after they left I collapsed in bed. I was so fatigued.. I slept.When> I woke up in the afternoon my muscles still were weak. When I pick> something up my hand trembles. Things like that. I simply have no> stamina. My O2 is ok but I am not the same. Also I am coughing allthe> time now and I rarely coughed before the vats. Joyce Rudy AZ> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2009 Report Share Posted June 8, 2009 Bruce... You just Joyce that Medicare will pay for Pulmonaqry Rehab. My doctor wants me to have Pulmonary Rehab 3x week for 8 - 10 weeks. I contacted Medicare here in Ohio and they told me that the cap for payment is $1,800. I'm trying to get a per vist rate from Rehab and I'm having difficulty getting the information. I told the doctor about this and that I'm not going to get the Rehab. I'm on Social Security and I can't afford a large monthly out-of-pocket expense. I have Medicaid only IF I meet my $1000 monthly spendown. They're NUTS! Oh well. To: Breathe-Support Sent: Saturday, June 6, 2009 5:06:00 PMSubject: Re: Recovery after Vats JoyceMedicare will pay for pulmonary rehab. Your Primary seemed to be verysupportive and since he's local you might get him to refer you. It'stremendously helpful but yet many doctors don't even mention it.As to the spirometer, I still use mine. You might try it just to see ifyou're still hitting the levels you were when you were using it. It'salways good exercise too.You talk about forcing yourself to do things. Yes, within limits. Keepan eye on your saturation levels. Don't overdo. But do what you can. Getout and about or walk in your yard. We all get tired and have to limitour daily activity, but understand you've had virtually none for a whilenow, with the surgery. It's natural you feel weaker. You need to learnthat balance that is right for you. But sitting doing nothing isn't goodfor you anymore than doing way too much. That's where rehab really doeshelp. You should definitely ask about it. It will help you get startedback and you'll be amazed.> >> > How long does it take to recover to your original state afterhaving> the VATS? It has almost been a month now and I am just not up topar. I> made scrambled eggs and bacon and waffles for my son and hisgirlfriend> and after they left I collapsed in bed. I was so fatigued.. I slept.When> I woke up in the afternoon my muscles still were weak. When I pick> something up my hand trembles. Things like that. I simply have no> stamina. My O2 is ok but I am not the same. Also I am coughing allthe> time now and I rarely coughed before the vats. Joyce Rudy AZ> >> Quote Link to comment Share on other sites More sharing options...
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