CF Patients & Nursing Home Placement

[Wheezie]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>kybert</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Wheezie</b></i>The insurance wouldn't authorize the prescription IV meds to be used in the home.</end quote></div>



wtf? not only can they decide whether you can or cant have a drug, they also decide where you can have it? now thats odd! especially considering doing home iv's would save them money.</end quote></div>

It would save them money too if they'd authorize regular prescriptions when I need them filled instead of making me wait 2 weeks to get "pre-authorization", while I get sick due to lack of antibiotics and end up in the hospital. This is a CA insurance I'm referring to this time, not Medicare. But I need this other insurance because Medicare won't pay for these drugs in the first place!

 

[Wheezie]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>kybert</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Wheezie</b></i>The insurance wouldn't authorize the prescription IV meds to be used in the home.</end quote></div>



wtf? not only can they decide whether you can or cant have a drug, they also decide where you can have it? now thats odd! especially considering doing home iv's would save them money.</end quote></div>

It would save them money too if they'd authorize regular prescriptions when I need them filled instead of making me wait 2 weeks to get "pre-authorization", while I get sick due to lack of antibiotics and end up in the hospital. This is a CA insurance I'm referring to this time, not Medicare. But I need this other insurance because Medicare won't pay for these drugs in the first place!

 

[Wheezie]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>kybert</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Wheezie</b></i>The insurance wouldn't authorize the prescription IV meds to be used in the home.</end quote></div>



wtf? not only can they decide whether you can or cant have a drug, they also decide where you can have it? now thats odd! especially considering doing home iv's would save them money.</end quote></div>

It would save them money too if they'd authorize regular prescriptions when I need them filled instead of making me wait 2 weeks to get "pre-authorization", while I get sick due to lack of antibiotics and end up in the hospital. This is a CA insurance I'm referring to this time, not Medicare. But I need this other insurance because Medicare won't pay for these drugs in the first place!

 

[Wheezie]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>kybert</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Wheezie</b></i>The insurance wouldn't authorize the prescription IV meds to be used in the home.</end quote>



wtf? not only can they decide whether you can or cant have a drug, they also decide where you can have it? now thats odd! especially considering doing home iv's would save them money.</end quote>

It would save them money too if they'd authorize regular prescriptions when I need them filled instead of making me wait 2 weeks to get "pre-authorization", while I get sick due to lack of antibiotics and end up in the hospital. This is a CA insurance I'm referring to this time, not Medicare. But I need this other insurance because Medicare won't pay for these drugs in the first place!

 

[Wheezie]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>kybert</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Wheezie</b></i>The insurance wouldn't authorize the prescription IV meds to be used in the home.</end quote>



wtf? not only can they decide whether you can or cant have a drug, they also decide where you can have it? now thats odd! especially considering doing home iv's would save them money.</end quote>

It would save them money too if they'd authorize regular prescriptions when I need them filled instead of making me wait 2 weeks to get "pre-authorization", while I get sick due to lack of antibiotics and end up in the hospital. This is a CA insurance I'm referring to this time, not Medicare. But I need this other insurance because Medicare won't pay for these drugs in the first place!

 

[JustDucky]

Oooh yes Mel, I agree with you...a CF'er should never be placed in a nursing home. I learned that one the hard way. Because I have Medicare, I don't get coverage for home IV's. Yes, there is drug coverage for specialty drugs like IV's but there is a cap at least in NY there is. After the drug plan (as well as yourself with copays) has paid out something along the lines of $2,600, then you enter the "gap" phase. Some drug plans will pay for generics with a small copay and that is it (this is NY, other states have different plans that may cover through the gap phase with generics, brand names and specialty). Once you pay out of pocket about $3.400 in that stage, then you hit catastrophic coverage when they will cover all of the drugs at a low copay to you. As someone else has already mentioned, even if the drug is covered, the supplies aren't. Most home companies charge a daily fee for their services and supplies, something in the range of $80 a day. Last time I was in the hospital, the social worker tried her best to allow me to purchase the supplies alone without their fee but nope, they wouldn't budge so I had to stay in the hospital for the whole duration of my IV's.

Not too long ago, I was hospitalized in my local hospital...it was a weekend and I could not wait until the weekday when my regular doc was in, I was too sick. Unfortunately, after a week there with IV's they decided that I should be transferred to a sub acute nursing facility that would be able to handle my vent needs to finish up my IV's. It was supposed to be for 2 more weeks and then I would go home. To make a very long story short, I had complications..lots of them coupled with doctors who did not listen to me when I knew there was something going on. Needless to say, I was not there for just 2 weeks, I was there for 7 weeks, got very ill with fevers and finally transferred out of there to an ICU where I spent another two weeks. So, for a hospital stay that was supposed to be for 3 weeks total, it wound up being two months of sheer bliss. It did not have to be if the doctor had managed my complications appropriately, so now after talking to my pulmos, that will never happen again at least as far as my IV's go. They were horrified! If anything, I will do IV's as an outpatient which Medicare does cover (at about $800 a day for twice a day dosing...I know, ridiculous considering that home IV's including meds would be about $200 max a day). Not to mention, infection control is not really up to par especially since I have cepacia!! I literally had to remind people to wash their hands every day and change my neb cups daily. I actually wrote a sign to that effect.

It really is hard to find long term places that even know what care a CF patient requires...I felt that I was educating the staff in my situation. There was really no backup unless you were so sick you had to be transferred out. Things really do need to change. Jenn

 

[JustDucky]

Oooh yes Mel, I agree with you...a CF'er should never be placed in a nursing home. I learned that one the hard way. Because I have Medicare, I don't get coverage for home IV's. Yes, there is drug coverage for specialty drugs like IV's but there is a cap at least in NY there is. After the drug plan (as well as yourself with copays) has paid out something along the lines of $2,600, then you enter the "gap" phase. Some drug plans will pay for generics with a small copay and that is it (this is NY, other states have different plans that may cover through the gap phase with generics, brand names and specialty). Once you pay out of pocket about $3.400 in that stage, then you hit catastrophic coverage when they will cover all of the drugs at a low copay to you. As someone else has already mentioned, even if the drug is covered, the supplies aren't. Most home companies charge a daily fee for their services and supplies, something in the range of $80 a day. Last time I was in the hospital, the social worker tried her best to allow me to purchase the supplies alone without their fee but nope, they wouldn't budge so I had to stay in the hospital for the whole duration of my IV's.

Not too long ago, I was hospitalized in my local hospital...it was a weekend and I could not wait until the weekday when my regular doc was in, I was too sick. Unfortunately, after a week there with IV's they decided that I should be transferred to a sub acute nursing facility that would be able to handle my vent needs to finish up my IV's. It was supposed to be for 2 more weeks and then I would go home. To make a very long story short, I had complications..lots of them coupled with doctors who did not listen to me when I knew there was something going on. Needless to say, I was not there for just 2 weeks, I was there for 7 weeks, got very ill with fevers and finally transferred out of there to an ICU where I spent another two weeks. So, for a hospital stay that was supposed to be for 3 weeks total, it wound up being two months of sheer bliss. It did not have to be if the doctor had managed my complications appropriately, so now after talking to my pulmos, that will never happen again at least as far as my IV's go. They were horrified! If anything, I will do IV's as an outpatient which Medicare does cover (at about $800 a day for twice a day dosing...I know, ridiculous considering that home IV's including meds would be about $200 max a day). Not to mention, infection control is not really up to par especially since I have cepacia!! I literally had to remind people to wash their hands every day and change my neb cups daily. I actually wrote a sign to that effect.

It really is hard to find long term places that even know what care a CF patient requires...I felt that I was educating the staff in my situation. There was really no backup unless you were so sick you had to be transferred out. Things really do need to change. Jenn

 

[JustDucky]

Oooh yes Mel, I agree with you...a CF'er should never be placed in a nursing home. I learned that one the hard way. Because I have Medicare, I don't get coverage for home IV's. Yes, there is drug coverage for specialty drugs like IV's but there is a cap at least in NY there is. After the drug plan (as well as yourself with copays) has paid out something along the lines of $2,600, then you enter the "gap" phase. Some drug plans will pay for generics with a small copay and that is it (this is NY, other states have different plans that may cover through the gap phase with generics, brand names and specialty). Once you pay out of pocket about $3.400 in that stage, then you hit catastrophic coverage when they will cover all of the drugs at a low copay to you. As someone else has already mentioned, even if the drug is covered, the supplies aren't. Most home companies charge a daily fee for their services and supplies, something in the range of $80 a day. Last time I was in the hospital, the social worker tried her best to allow me to purchase the supplies alone without their fee but nope, they wouldn't budge so I had to stay in the hospital for the whole duration of my IV's.

Not too long ago, I was hospitalized in my local hospital...it was a weekend and I could not wait until the weekday when my regular doc was in, I was too sick. Unfortunately, after a week there with IV's they decided that I should be transferred to a sub acute nursing facility that would be able to handle my vent needs to finish up my IV's. It was supposed to be for 2 more weeks and then I would go home. To make a very long story short, I had complications..lots of them coupled with doctors who did not listen to me when I knew there was something going on. Needless to say, I was not there for just 2 weeks, I was there for 7 weeks, got very ill with fevers and finally transferred out of there to an ICU where I spent another two weeks. So, for a hospital stay that was supposed to be for 3 weeks total, it wound up being two months of sheer bliss. It did not have to be if the doctor had managed my complications appropriately, so now after talking to my pulmos, that will never happen again at least as far as my IV's go. They were horrified! If anything, I will do IV's as an outpatient which Medicare does cover (at about $800 a day for twice a day dosing...I know, ridiculous considering that home IV's including meds would be about $200 max a day). Not to mention, infection control is not really up to par especially since I have cepacia!! I literally had to remind people to wash their hands every day and change my neb cups daily. I actually wrote a sign to that effect.

It really is hard to find long term places that even know what care a CF patient requires...I felt that I was educating the staff in my situation. There was really no backup unless you were so sick you had to be transferred out. Things really do need to change. Jenn

 

[JustDucky]

Oooh yes Mel, I agree with you...a CF'er should never be placed in a nursing home. I learned that one the hard way. Because I have Medicare, I don't get coverage for home IV's. Yes, there is drug coverage for specialty drugs like IV's but there is a cap at least in NY there is. After the drug plan (as well as yourself with copays) has paid out something along the lines of $2,600, then you enter the "gap" phase. Some drug plans will pay for generics with a small copay and that is it (this is NY, other states have different plans that may cover through the gap phase with generics, brand names and specialty). Once you pay out of pocket about $3.400 in that stage, then you hit catastrophic coverage when they will cover all of the drugs at a low copay to you. As someone else has already mentioned, even if the drug is covered, the supplies aren't. Most home companies charge a daily fee for their services and supplies, something in the range of $80 a day. Last time I was in the hospital, the social worker tried her best to allow me to purchase the supplies alone without their fee but nope, they wouldn't budge so I had to stay in the hospital for the whole duration of my IV's.

Not too long ago, I was hospitalized in my local hospital...it was a weekend and I could not wait until the weekday when my regular doc was in, I was too sick. Unfortunately, after a week there with IV's they decided that I should be transferred to a sub acute nursing facility that would be able to handle my vent needs to finish up my IV's. It was supposed to be for 2 more weeks and then I would go home. To make a very long story short, I had complications..lots of them coupled with doctors who did not listen to me when I knew there was something going on. Needless to say, I was not there for just 2 weeks, I was there for 7 weeks, got very ill with fevers and finally transferred out of there to an ICU where I spent another two weeks. So, for a hospital stay that was supposed to be for 3 weeks total, it wound up being two months of sheer bliss. It did not have to be if the doctor had managed my complications appropriately, so now after talking to my pulmos, that will never happen again at least as far as my IV's go. They were horrified! If anything, I will do IV's as an outpatient which Medicare does cover (at about $800 a day for twice a day dosing...I know, ridiculous considering that home IV's including meds would be about $200 max a day). Not to mention, infection control is not really up to par especially since I have cepacia!! I literally had to remind people to wash their hands every day and change my neb cups daily. I actually wrote a sign to that effect.

It really is hard to find long term places that even know what care a CF patient requires...I felt that I was educating the staff in my situation. There was really no backup unless you were so sick you had to be transferred out. Things really do need to change. Jenn

 

[JustDucky]

Oooh yes Mel, I agree with you...a CF'er should never be placed in a nursing home. I learned that one the hard way. Because I have Medicare, I don't get coverage for home IV's. Yes, there is drug coverage for specialty drugs like IV's but there is a cap at least in NY there is. After the drug plan (as well as yourself with copays) has paid out something along the lines of $2,600, then you enter the "gap" phase. Some drug plans will pay for generics with a small copay and that is it (this is NY, other states have different plans that may cover through the gap phase with generics, brand names and specialty). Once you pay out of pocket about $3.400 in that stage, then you hit catastrophic coverage when they will cover all of the drugs at a low copay to you. As someone else has already mentioned, even if the drug is covered, the supplies aren't. Most home companies charge a daily fee for their services and supplies, something in the range of $80 a day. Last time I was in the hospital, the social worker tried her best to allow me to purchase the supplies alone without their fee but nope, they wouldn't budge so I had to stay in the hospital for the whole duration of my IV's.

Not too long ago, I was hospitalized in my local hospital...it was a weekend and I could not wait until the weekday when my regular doc was in, I was too sick. Unfortunately, after a week there with IV's they decided that I should be transferred to a sub acute nursing facility that would be able to handle my vent needs to finish up my IV's. It was supposed to be for 2 more weeks and then I would go home. To make a very long story short, I had complications..lots of them coupled with doctors who did not listen to me when I knew there was something going on. Needless to say, I was not there for just 2 weeks, I was there for 7 weeks, got very ill with fevers and finally transferred out of there to an ICU where I spent another two weeks. So, for a hospital stay that was supposed to be for 3 weeks total, it wound up being two months of sheer bliss. It did not have to be if the doctor had managed my complications appropriately, so now after talking to my pulmos, that will never happen again at least as far as my IV's go. They were horrified! If anything, I will do IV's as an outpatient which Medicare does cover (at about $800 a day for twice a day dosing...I know, ridiculous considering that home IV's including meds would be about $200 max a day). Not to mention, infection control is not really up to par especially since I have cepacia!! I literally had to remind people to wash their hands every day and change my neb cups daily. I actually wrote a sign to that effect.

It really is hard to find long term places that even know what care a CF patient requires...I felt that I was educating the staff in my situation. There was really no backup unless you were so sick you had to be transferred out. Things really do need to change. Jenn