New to forum with big question

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Ysabet
New Member


Date Joined Aug 2010
Total Posts : 3
   Posted 10/4/2010 7:38 AM (GMT -6)   

I am new to the forum and just wanted to say Hi!  

My Hubby was diagnosed with rectal cancer back in early March.  He has gone thru the chemo & radiation and then surgery where they installed a permanent ostomy.  We are learning to deal with it and all the new stuff we need to know about

I do have a big question tho and am not sure where it should be in forum.  So gonna just ask it here and you guys can direct me to which part of forum it should be.

We are signed up with Edgepark but I have found another site that sells for less than half of what Edgepark does but you have to fill out your own Medicare billing.  Is there anyone that does that on their own?  Or is the hassle worth the extra to have the supply company do it for you?

Any advice you guys may have would be greatly appreciated!

Thanks 


flchurchlady
Veteran Member


Date Joined Jul 2007
Total Posts : 2765
   Posted 10/4/2010 6:43 PM (GMT -6)   
Hi! I don't know the answer to your question, since I don't have Medicare, but I wanted to welcome you to the forum! :-)

I hope you're husband is doing well. Hopefully, someone will come along and answer soon.

Take care,
Cecilia
Dx'd Crohn's in '99 at age 28. Proctocolectomy and permanent ileostomy in '06.
Disease-free and medicine-free since surgery and very thankful to be healthy again.

not creative
Regular Member


Date Joined Mar 2007
Total Posts : 469
   Posted 10/5/2010 10:30 AM (GMT -6)   

I don’t have Medicare, but I do use Edgepark. I used Shield before it and tried liberty and other but none were as good as EdgePark. I love it, they do everything for me and delivery is very quick.

The thing about submitting claims yourself is that it can take a long time to get reimbursed- especially from Medicare. The supply company can afford to not get paid back immediately, but can you? Assuming your forms are perfect the first time, they can still take up to 45 days to pay the claim, if you can wait that long to get reimbursed, then I say go for the cheaper company, but you definitely have to weigh the benefits.

 


Ysabet
New Member


Date Joined Aug 2010
Total Posts : 3
   Posted 10/6/2010 9:49 AM (GMT -6)   
OUCH !  smhair
 
If that's the case I certainly don't want to bother with it. 
 
Looks like it's EdgePark for me.   I do have to say they were concerned and calling to check on us before home health released us and I was able to start ordering from them.  I have my own rep and she is great!  yeah
 
It just seems a shame but there is a BIG mark up with everything medicare is billed for.   Even Doctors visits are twice what they were before we started with medicare.  nono But possibly it is because of the way it's so hard and long dealing with them.   idea

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 10/6/2010 11:40 AM (GMT -6)   
That's right...they have to mark up to deal with the red tape skull

I use Edgepark but have found that it is easier/cheaper to order the items, not covered by my insurance, from one of the online sites. They are half the price and the sad thing is...my orders SHIP FROM Edgepark! It's a racket mad

Welcome to the forum...glad you found us turn
Crohn’s dx 1989
some terrible years before my
temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!

polishdan
Veteran Member


Date Joined Mar 2010
Total Posts : 1595
   Posted 10/6/2010 8:43 PM (GMT -6)   
All of my supplies are paid by medicare. I am not sure but some of it might be paid by blue cross. I believe that medicare pays a certain amount for supplies regardless of what is billed. Did you ever look at a dr bill to medicare? They might bill $75 for an office visit but medicare pays $30. When a dr accepts medicare or any insurance they agree to accept what is paid, not their inflated bill. Just an example. Medicare and insurance companies pay a certain amount for each service performed. The same for supplies. Let them do the billing.

Dan

not creative
Regular Member


Date Joined Mar 2007
Total Posts : 469
   Posted 10/7/2010 9:05 AM (GMT -6)   
Dan is right. Medicare has its own set of fee schedules. They pay "Medicare rates" no matter what the bill says.
AFAIK, the Medicare split is 80/20 meaning you pay 20% of the "Medicare rate." This is where supplemental insurance can be beneficial, they will pay all or some of the 20% for you if you have it.
Health care insurance can be very complicated.
Laurenne, 26 Graduate from University of California, Davis. BA-Anthropology
Dx'd w/ IBS and CD in 2002. Was in flare from 2006-2010 with almost no relief from any meds I tried.
On: Remicade, Zoloft, Abilify, 6MP
3-9-10: Total protectomy and Sigmoid colostomy installed. Haven't spent more than 2 minutes on the toilet since- it's fantastic!
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