Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 01-19-2008, 10:25 PM #1
fern fern is offline
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Join Date: Mar 2007
Posts: 293
15 yr Member
fern fern is offline
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Join Date: Mar 2007
Posts: 293
15 yr Member
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my response is for medicare only and has nothing to do w/WC as I do not have experience in that area.

I suggest that you go to medicare.gov or get the book "medicare and you--2008" and look into the health plans you qualify for in your area. The plans vary quite a bit in diff. states and diff zipcodes. You can do the research yourself and you can see a counselor in your area to get started. There are several different styles of plans and you would want to figure out which kind suites you best if you are going to go on Medicare. You have to realize that there is a waiting period from the time you get SSDI to when you get Medicare. I think it's 24 mos--- but that may not apply as you mentioned that you are appealing.

I have been mostly happy with my experiences. I have tried both an advantage plan that replaces Medicare and now am on a supplement. It can take some work and creative problem solving but by in large I've gotten to see each doctor that I wanted. On the HMO Advantage Plan I sometimes had to see one or more of their doctors before I could go out of the network but I was never denied a consult and surgery but I'd have to make a request and possible appeal (which can take some effort and time). I was denied ongoing treatment w/a neurologist I preferred so I paid out-of-pocket. And things like massage therapy aren't covered at all. One time I switched groups w/in my plan to be able to see a certain PT. Not all the drugs are on the plan formularies but I've been able to petition for drugs and quantities and even lower copay amounts. The dollar limits for things like drugs and PT can be problematic if you need a lot so if you have an option to continue on something better you may want to consider that too. But you have to evaluate if you are penalized by not taking Medicare. It's a case by case issue and you basically have to research all of your options.

Last edited by fern; 01-20-2008 at 04:18 AM.
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