Insurance and coverage

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pokey79
Regular Member


Date Joined Aug 2007
Total Posts : 144
   Posted 1/1/2008 8:56 PM (GMT -7)   
Hello all and Happy New Year! I have a question about insurance coverage.For the past year and a half I have been getting steroid infusions at home.During the middle of my last treatment the agency called and said I was done because I can drive a car and am not homebound. I have medicare primary and a regular secondary I think they werent billing right. I of course appealed but my dr.s nurse was no help..He ordered these treatments for another year when I was there in Nov.I can drive a car but......................I cant get out by myself we get snow here when the time I am due for another round.The secondary insurer says i am 100% covered yet they want me to travel to an infusion center.I do not think I can do that so I guess my question is do you just stop taking the steroids or is it something you need to be weened from?And this is the way it was ordered from the begining and medicare didnt pay highmark did. I am just running into brick walls all the way around. I am not near my sixties yet so there isnt much I can do.Any advice would be greatly appreciated..pokey79
diaganosed 1983
avonex once weekly
steroid infusion every three months for three days
mycoline three times a day
fosamax once a week
bladder meds. daily
calcium/multivitiams
synthyroid
 
 


uppitycats
Veteran Member


Date Joined Jun 2005
Total Posts : 2135
   Posted 1/2/2008 7:39 AM (GMT -7)   
I'm not clear why not being in your 60's has any relevance here?  Many people younger than their 60's are on SSDI or other forms of disability income, if that is the question.
 
You should NOT suddenly stop the steriod treatment. If you do intend (or need) to stop, you have to taper off, or you'll suffer some serious side effects. Talk with your doctor about how to do that.
 
As for getting to the treatment center -- do you have a senior citizen transportation center in your town?  Even if you're not of "senior citizen" age, they'll take you to medical appointments if you are disabled and need a ride. You might call them and see how to get on their schedule . The one here will ONLY take people to medical appointments and a once-a-month grocery store shopping thing (no where else, not even to the senior center!), but that might at least help you get your treatments.
...I am not a doctor, nor health professional, and don't pretend to be one, here.....


pokey79
Regular Member


Date Joined Aug 2007
Total Posts : 144
   Posted 1/2/2008 8:09 AM (GMT -7)   
Thank you for your reply. Being under the age of 60 means for me that I am stuck in the middle.Yes I am on ssdi meaning medicare..Everything around here is geared for seniors not 40ish yr olds.As far as getting through to my dr. they will not pput me through to him I keep getting the nurse who in my opion doesnt have a clue.My pcp may be able to help but she didnt order it.And the key file got sent to their other office and was deleated......So the nurse is back in the picture.I dont know what to do...And the town I live in is pretty small so seniors may get rides to the dr. but not somebody like me..This whole mess started when they saw I was on medicare and have a "working person's" secondary plan. I havent worked fo almost 5 years but they let me keep the insurance.By the time I see the dr. I will have missed 2 treatments.I call and call each time same thing..Iasked to talk to the dr.but i keep getting the nurse.And that dr. is 45 mins. away from me out of my driving range...Again thanks for answering......pokey79
diaganosed 1983
avonex once weekly
steroid infusion every three months for three days
mycoline three times a day
fosamax once a week
bladder meds. daily
calcium/multivitiams
synthyroid
 
 


uppitycats
Veteran Member


Date Joined Jun 2005
Total Posts : 2135
   Posted 1/2/2008 10:18 AM (GMT -7)   
Don't give up on the senior ride thing! I live in a town of 500 people. And they do indeed have transportation for seniors AND people with disabilities, **regardless of age**. I've used it in the past and I was in my mid-50's when I moved here. I haven't had need for it in the recent past. Even now at 61 I'm not eligible as a "senior", but AM eligible as a "disabled person". So check.

It's rare for doctors to directly talk with patients about insurance matters. They will let their nurses or office staff deal with that, so what is happening with you is common. It does sound like a glitch in the insurance coverage. You say you appealed...does that mean you called the insurance company directly, and WROTE to them? Often the person at the end of the phone will brush you off; a letter will get more attention, and they'll have to write back.
...I am not a doctor, nor health professional, and don't pretend to be one, here.....


pokey79
Regular Member


Date Joined Aug 2007
Total Posts : 144
   Posted 1/2/2008 11:03 AM (GMT -7)   
I called and wrote an appeal.All my drs. nurse had to do was fax in a request it could have been settled.She told me I am not his only patient.........We do have an area on aging here(6 miles away) I have tried and tried to no end just to get a medi-gap plan noooooooooooo not for anybody my age regardless of disability or what. I am just so frustrated..Paying for both those plans isnt cheap for an ssdi check...pokey
diaganosed 1983
avonex once weekly
steroid infusion every three months for three days
mycoline three times a day
fosamax once a week
bladder meds. daily
calcium/multivitiams
synthyroid
 
 


uppitycats
Veteran Member


Date Joined Jun 2005
Total Posts : 2135
   Posted 1/2/2008 12:12 PM (GMT -7)   
I'm of course not talking about another insurance coverage like a medi-gap plan, but free or very inexpensive transportation for medical visits through (usually) your county's "aging" program. Here rides cost $5 round trip. I'm also on SSDI and know how expensive health insurance can be for folks like us on limited incomes.
...I am not a doctor, nor health professional, and don't pretend to be one, here.....


pokey79
Regular Member


Date Joined Aug 2007
Total Posts : 144
   Posted 1/2/2008 1:47 PM (GMT -7)   
Oh I am sure you do how expensive it is. I can drive there it is just making sure I have assistance getting in..It is very annoying when for over a year I had no problems.Now I am pretty close to a flare-up.When one messes with an already comprimised nervous system.And to make the call to me when I was in the middle of a treatment. They did give me the third one but needless to say I was aggitated............................If I wouldnt need or have to be on the medicare my other policy covers everything..I just dont think they know how to bill it. All they have to do is bill medicare first if they refuse bill highmark.I even know that.I am sure that is where the problem is coming from.Again thanks for listenening to me.pokey
diaganosed 1983
avonex once weekly
steroid infusion every three months for three days
mycoline three times a day
fosamax once a week
bladder meds. daily
calcium/multivitiams
synthyroid
 
 


msmomof4
New Member


Date Joined Jan 2008
Total Posts : 14
   Posted 1/4/2008 6:14 PM (GMT -7)   
Wow, I would call and speak to someone else besides the Nurse and get them to have the Dr. call you directly. Explain you can't get in and out of a car by yourself, so you cant come in personally. But I have been steroids for a Long time. Everytime I have done the high dose Solumedrol 1000mg...My Neuro has me do a prednison taper 100 mg down. Your Body produces a Natural Steroid, and when you take them(especially long term or high dose) Your body quits making it. So that is why they taper you, otherwise its really not good for your heart! And Im sure somehow you can fight this, Sometimes we are the only one looking out for our best intrest. But if you are persistant, they will eventually listen. Even If you have to call the nurse several times a day. How long have you been off the Steroids? If its been a while, then really no point in a taper. But if your just comming off, you need something!

I hope you can get through to them! I know its rough, but Hang in there!!!

pokey79
Regular Member


Date Joined Aug 2007
Total Posts : 144
   Posted 1/6/2008 4:17 PM (GMT -7)   
Oh I am not off them yet my next dose is set for march......I got somebody else in the doc's office she treated me worse than the nurse!So i called my pcp and they are going to see what they can do for me...My secondary insurance covers in home infusions 100% so I have to just wait.I wrote all this down and when I see him I am going to let lose.....After all He works for me He didnt pick me off the street and say oh you have MS i can help you.I have confidence in him but that office.......They forget they work for me indirectly too.Terriable treatment from one of the top MS doctors around I shudder to think if I really got sick and needed him...Thank You for your reply...pokey79
diaganosed 1983
avonex once weekly
steroid infusion every three months for three days
mycoline three times a day
fosamax once a week
bladder meds. daily
calcium/multivitiams
synthyroid
 
 

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