Roxie.

Listen to everything Rose says about the IVIG, she knows her stuff.

However, one thing is different with Alan and that's how it was billed.

And we didn't do a thing, his neuro arranged absolutely everything. Our job was just to call the IVIG and confirm everything. After the 10th time, you get used to it.

Alan's neuro, when ordering the IVIG, does it under Durable Medical Equipment. The whole kit and kaboodle was ordered under Durable Medical Equipment. Nothing went through Medicare Part D. because that's when you hit the donut and who the hell can pay all the co-pays.

When we first started this, I was on the phone with the insurance company to confirm that yes indeed, he had been approved, and I wanted to make sure that this was COMPLETELY covered for Alan. Because this stuff (2 times a month) was about $8000.

I was assured by his insurance company that there was no charge at our end. For anything!!!!

So if you have to make some calls, make them. Now I don't know if there are co-pays at your end or if it's done under the Medicare Part D.

All I know is how Alan's neuro did it. They know what they are doing, believe me.

All the best,
Melody

HI!
I'm not on disability....yet. I may end up having to apply for that but right now my insurance, Aetna is taking care of it. I've had SOOO many dr. and test expenses I'm maxed out what ever part it is for my copays and coinsurance costs and they have been having to cover everything 100%. I'll call tomorrow to make sure they will cover this stuff at 100% because we can't afford to pay thousands for all this. I've been lucky that they have been covering all the tests. One of my MRI's was $7,000! Whew!!!!!
Do you have to be off work for a certain amount of time before you can apply for disability? I was on MFLA for 5 weeks before school was out. I'm off of it now because school is out.....but may have to return on it for a while till the infusions are over with. Roxie

I belive you have said you dont have a traditonal Medicare Plan - this makes a big difference... Under the traditional plan nursing at home is covered by medicare, the med itself is the recipients responsiblity so Plan D comes into play.... and co-pays... again, depends completely on the insurance plan.... Private Insurance is handled and paid differently also.... With the IVIG - the donut hole is reached within first two months of care! And usually with private insurance - catatrohic levels are also reached very quickly... with an HMO etc I belive costs are much different.....

Its the nature of the animal! (the insurance industry)

Also, Roxie, if your doc says you can no longer work - you need to apply for disaiblity as soon as possible... If you are a teacher I believe you have your own disability plans vs SSDI - but you must have a doctor who states you can no longer work at all, and its a long process - so if this is the case its important to look into asap.... I would reserach all the information you have at home regarding your benefits, and then if necessary contact Human Resources... you may have a short term policy you can draw on - FMLA will only allow you twelve weeks off until you can be legally terminated.

I definately talk to your doc about this...!

If you are asking about applying for Social Security Disability, (assuming you will no longer go back to work), you just go down to the Social Security office and they ask you "when was your last day of work?" Then they write everything down and you answer all the questions. I assume everything is done by computer now.

After they get your application, they will send you an appointment letter for you to go into their offices that give the medical examinations. You will be examined by a physician. If x-rays are need, they do them there. You pay for nothing by the way. You will also be questioned by a psychiatrist who asks you to remember numbers, and he'll hit you with a barrage of questions. (this is exactly what happened to Alan and myself). Now if they have changed this method, I have no idea but that is how one applied for SSD years ago.

After you finish your medical examination, they even give you car fare home.

So you wait for the approval or the refusal letter.

It took me two refusals and a lawyer to get Social Security Disability for my arthritis and that was age 45 or so.

Alan got his neuropathy at age 47. He worked till 5 years ago. He applied (at age 55), and went down for the medical exam. The doctor did the tuning fork thing on his feet and an emg. The doctor looked at Alan incredulously and said "you mean to tell me, you don't feel what I'm doing to you"?? Alan said "what are you doing to me?" The guy said "oh my god". Alan got approved on the first round. We spoke to many people that day at this place. They were on their third go-around with the Social Security administration. Some of them even had brain cancer and they were refused two times and had to get a lawyer and go in front of a judge (just like I had to).

Alan never had to go through any of that. The guy who said "oh my god", must have written a note to the Social Security Administration, because Alan got it within 6 months and that's unusual.

But you don't get medicare right away, unless you have end date renal failure, or Lou Gherig's disease. Everybody who gets on Social Security Disabilty has to be on it 2 years before they get the medicare.

That's how it was for me. Alan also. (Perhaps it's changed, I have no idea). Oh, when you get approved, (let's say it took me two years to get approved), the first check you get is retro-active back to when you first applied for disability.

So if I applied two years ago, and I get approved tomorrow, my first check will be for two years worth of social security. Kind of like winning the lottery.

While it's nice (to get that big check), what do people do when they can't afford to wait two years to get approved?? They apply for SSI. If one is qualified, I believe you get that immediately. It's very confusing. Believe me.

Now if you are not talking about Social Security disability, and you are talking about disability from your workplace, then I believe you are talking about workman's compensation and that's a whole other discussion.

Love ya,
melody

Kmeb:

I have a Medicare HMO (same one as Alan) and we both have medicare Part D. That's how we get our meds, (antibiotics, Alan's zoloft, etc.). We pay $8.00 per generic med. We rarely use the formularies because a co-pay for that is $28.00. Alan gets generic zoloft, so he only pays $8.00.

Now when Alan was first talking about getting the IVIG, I was on the phone with the IVIG people and they told me "it's all in how the doctor bills it, if he or she bills it under Medicare Part D, you'll be screwed because you'll hit the donut". But if it's billed under Durable Medical Equipment, then it's a whole other ball of wax. I remember the conversation.

So I made sure they knew what to do, and since this neuro knows what to do, she knew how to bill it.

I believe it's all up to the doctor's and the billing department and they know which codes to put in. It's always about the codes.

I'm still getting letters from the Diagnostic place where I had a shoulder x-ray. They keep telling me "your insurance refuses to pay for this x-ray". When I call my insurance, they tell me "tell them to put the right code in".

I did. Haven't got a letter since. It's all about how it is billed. At least it was in our case.

Mel

HI Mel,
I was talking about SSI and how to apply for that. So after you apply and go through all that you have to wait 2 yrs to get help (a check) after you are finally accepted. This is exactly why Micheal Moore made Sicko! To bring to the for front what sick people are going through in this country! I have no idea what people are expected to live on during those 2 yrs while they are waiting for their Big check!
My husband injured his back at work last week and hopefully will get workman's comp for the 4 days he's missed work and they'll pay for his dr. bills. So we were hit with a double whammy......me with no work check and Mike's check will be small this pay period.
Right now my health insurance is covering at 100% since I've maxed out all my copays and coinsurance expenses. I have to call tomorrow and make sure everything is A-OK with them paying for these infusions. Roxie

Melody - thats the difference - you have a Medicare HMO! Costs are very different!

Meds, at least in Calif - are not consided DME (durable medical equipment)...

Again, in California all SSDI claims are made by mail - you are contacted by phone with a plethera of questions - and then requests for your doctor statements etc. ensue..... if you have been working you are entitled to continue your insurance under COBRA - 18 months if you are not approved for SSDI before that time frame is up, 28 months if approved after that date if approved for SSDI during that time period..... after that you are allowed to purchae Medicare.

Again, depends on the individual's situation, state they live, and their company policies etc.....

Medicare plans differ greatly by the area you live in regarding plans offered etc also.... each individual needs to check into them very thoroughly.....

Bottom line - requires a great deal of research on the part of the individual... and unfortunatly yes, can be very financially stressful!

Kmeb:

Know what confuses me??? If medicare is a government run program, why is it different from state to state!!!

Wouldn't it be the same rules for each state?? I guess not, from what you have written, but it confuses the hell out of me.

So if you are on medicare and live in New York City, it's different if you are on medicare and you live in California?? Different rules apply??

Good Lord, I'm not moving anywhere. Too confusing!!!

Mel

Hi -
There are lots of options under Medicare for the insurance plan you choose - HMO's, PPO's, I have whats called a Medi-Gap Policy which has to be underwritten so thse of use with disabilities can only enroll without underwriting the first six months we are eligible (I can go to any Medicare provider with no referral anywhwere in the country and it pays all my co-pays)... the benefits on the Medi Gap Plan you choose are govenment regulated -preimus are not - and depending on your geographic location different HMOS', etc. are offered. For example, in the area I live - there is no Medicare HMO that has a decent neurolgist - a must for me...

And of course Plan D now adds to the mix - the first four years I was on Medicare I had no prescrition coverage - it was an astromonical cost... now with Plan D at least can pay for some coverage....

I take lots of meds because of my gastroparesis (the paralyzed stomach, heart meds, etc) so its a cost I can justify...

I could go in as a day patient to the hospital for IVIG and med is included - but I have no one to drive me, and getting home would be a nightmare on Access as you never know how long you have to wait for meds in hospital (and Access, at least here, can leave you if you arent ready and wont come back) and the infusions make me so woozy I need to be pushed into bed....

At home Medicare and my Medi Gap policy cover the nursing, but I have a co-pay on the med.... I have no idea how your doc can get it thru as a DME - cause its not! But maybe the HMO you belong to allows for it - HMO's seem to each have their own rules and regs....

Again, the area you live in really determines whats avilable in your area - if they have them with great docs - you're very lucky!!!!!!!!! (hang on to that plan and that doc!)

I know I'm lucky. So is Alan. And we both have our Dr. Fred. So that makes us double lucky!!!!!

I guess we got a good HMO. I'm not saying a word. Dont' want to jinx it!

Mel