OT: When MEDICARE Won't Pay or ZERO's out other Health plan(s) ... vent :-(

[Guest guest]

Medicare

One of my other non-EDS yahoo group members wrote in about waiting for

Medicare to start in a few years. I do not really like Medicare and here is my

reason.

Medicare can be bad. My late hubby and I were in family therapy over both of

our chronic severe illnesses. We found that a therapist, believe it or not,

let us talk not just about our illness but also he helped us fill out medical

forms and SSD applications. Our medical doctors only gave us less than ten

minutes to explain ourselves. I now know that with both of us with PTSD,

depression, ADD, ANS dysfunction, EDS, etc., no one had time with the minutes

the

medical doctors gave us to do anything. The therapist said no wonder we had

medical

paperwork problems. So for more than a year we saw this therapist. A medical

person who listened to us. He was the one that saw a connection between my

depression and my physical illness. Even now after Bill's recent death he is

still

helping me keep on track with my many bills and insurance forms to fill. This

guy has time to be human :-D.

THE INSURANCE THING:

Can you believe this!!! We have Aetna healthcare. It paid 100% for Bill to go

to the therapist. Since it was labeled family I was there listening. While

there the therapist saw my physical problems and we finally got me my own

sessions :-). You cannot explain EDS and Autonomic Dysfunction in a few minutes.

My

then Aetna insurance paid 100%. I could have as many sessions as I needed. You

signed up for ten sessions at a time and if the therapist thought you needed

more you got ten more sessions for " free. " Free meaning I had no co pay at

all. With me having fixed SSD income this was a great thing.

And then, I became MEDICARE eligible. This is after you are on SSD for 24

months. My Aetna health care became the secondary payer. Medicare became the

primary payer. And from that moment on they paid NOTHING for my therapy. Reason:

Medicare paid 50%. If they paid 50% then they would pay 50%. So, since they

paid the 50% there was nothing left for them to pay. Hey, I am not making this

stuff up.

So, Aethna/Megellan refused to pay ANYTHING for my treatment. It still paid

for my husband at 100%. It paid my care at zero!!! I was told that Medicare had

to pay first now. And that Medicare policy was to only pay mental health

charges at 50%. NOTE: At the beginning of every year I had a $100 deductible.

This

was in addition to Aetna who is REFUSING TO PAY. I am helpless with that

since I need Aetna for my medical bills. Their yearly deductible for a family

was

about $250 each.

So, as for the mental health doctor. Note that they pay 50% of 80% of the

remaining bill. If my bill was say $140 they would consider 80% and agree to pay

$112. Then they subtract 50%. So the doctor gets $56. I get billed for the 20%

which may be $28. So if I see the doctor four times in one month I pay $112.

But my spouse who was none Medicare got billed $560 and all of it was covered.

The last four months I had to stop seeing this doctor because of Bill's

cancer medicine expenses. He could still see Bill for free but I, the insurance

carrier could not afford to see him.

So Aetna said since Medicare paid the above they did not have to pay

ANYTHING!!! Aetna said that many members were shocked. In the end I could not

afford

to see this doctor.

This is to let you know and note that Medicare pays 50% of mental health and

80% of medical bill. Aetna would sometimes pick up the 20%, but not usually.

And my current monthly premium for Medicare is $66.00 PER month.

Yes, I suppose I am glad I have Medicare but things were better when I had my

one healthcare plan. Meanwhile, Aetna makes me have the Medicare. Vicious

circle if you ask me. Caro