How does Genetically Handicapped Persons Program work?

BSJCA

New member
Well I don't really want GHPP to cover psychosocial, gyno, neurologist etc. I just want them to cover what Medicare won't cover at my CF center and to pay for drugs written by ALL my doctors. Like Cerulean said, it's hard to find doctors who accept GHPP and often they are not the best doctors. I was on GHPP about 20 years ago and hated it. Now, with my husbands job gone, so is our Aetna...
 

BSJCA

New member
Well I don't really want GHPP to cover psychosocial, gyno, neurologist etc. I just want them to cover what Medicare won't cover at my CF center and to pay for drugs written by ALL my doctors. Like Cerulean said, it's hard to find doctors who accept GHPP and often they are not the best doctors. I was on GHPP about 20 years ago and hated it. Now, with my husbands job gone, so is our Aetna...
 

BSJCA

New member
Well I don't really want GHPP to cover psychosocial, gyno, neurologist etc. I just want them to cover what Medicare won't cover at my CF center and to pay for drugs written by ALL my doctors. Like Cerulean said, it's hard to find doctors who accept GHPP and often they are not the best doctors. I was on GHPP about 20 years ago and hated it. Now, with my husbands job gone, so is our Aetna...
 

BSJCA

New member
Well I don't really want GHPP to cover psychosocial, gyno, neurologist etc. I just want them to cover what Medicare won't cover at my CF center and to pay for drugs written by ALL my doctors. Like Cerulean said, it's hard to find doctors who accept GHPP and often they are not the best doctors. I was on GHPP about 20 years ago and hated it. Now, with my husbands job gone, so is our Aetna...
 

BSJCA

New member
Well I don't really want GHPP to cover psychosocial, gyno, neurologist etc. I just want them to cover what Medicare won't cover at my CF center and to pay for drugs written by ALL my doctors. Like Cerulean said, it's hard to find doctors who accept GHPP and often they are not the best doctors. I was on GHPP about 20 years ago and hated it. Now, with my husbands job gone, so is our Aetna...
 

CaliSally

New member
If it's only your CF center items you want covered, then yes, GHPP will pick up the balance of Medicare (more so in the case that you have no other insurance). All CF appts and specialist within the system, have been 100% covered for me.

As my current authorizations from GHPP states (what it will cover):
"SCC annual team assessment and evalutions, outpatient visits, x-rays, ecg, lab works, pft's, dexa scan or other type, and ct scan as medically necesaary."
Furthermore,
"Authorization covers the following services if performed within the scc's affiliated medical center:
* picc line/central line placement for home iv infustion
* annual hearing and vision evaluation
* radiology services such as mri, ultrasound, ct scan as medically necessary
* annual women's wellness check-up to include mammogram/papsmear
* preventative care services such as flu shot and pneumonvax
* all referrals by the scc team member to any specialist within the scc's affiliated medical center. Authoriztion covers initial and follow up visits with specialist."

They don't state it, but they also pick up any balance that remains from Medicare for all hospitalizations.
I hope that helps.
 

CaliSally

New member
If it's only your CF center items you want covered, then yes, GHPP will pick up the balance of Medicare (more so in the case that you have no other insurance). All CF appts and specialist within the system, have been 100% covered for me.

As my current authorizations from GHPP states (what it will cover):
"SCC annual team assessment and evalutions, outpatient visits, x-rays, ecg, lab works, pft's, dexa scan or other type, and ct scan as medically necesaary."
Furthermore,
"Authorization covers the following services if performed within the scc's affiliated medical center:
* picc line/central line placement for home iv infustion
* annual hearing and vision evaluation
* radiology services such as mri, ultrasound, ct scan as medically necessary
* annual women's wellness check-up to include mammogram/papsmear
* preventative care services such as flu shot and pneumonvax
* all referrals by the scc team member to any specialist within the scc's affiliated medical center. Authoriztion covers initial and follow up visits with specialist."

They don't state it, but they also pick up any balance that remains from Medicare for all hospitalizations.
I hope that helps.
 

CaliSally

New member
If it's only your CF center items you want covered, then yes, GHPP will pick up the balance of Medicare (more so in the case that you have no other insurance). All CF appts and specialist within the system, have been 100% covered for me.

As my current authorizations from GHPP states (what it will cover):
"SCC annual team assessment and evalutions, outpatient visits, x-rays, ecg, lab works, pft's, dexa scan or other type, and ct scan as medically necesaary."
Furthermore,
"Authorization covers the following services if performed within the scc's affiliated medical center:
* picc line/central line placement for home iv infustion
* annual hearing and vision evaluation
* radiology services such as mri, ultrasound, ct scan as medically necessary
* annual women's wellness check-up to include mammogram/papsmear
* preventative care services such as flu shot and pneumonvax
* all referrals by the scc team member to any specialist within the scc's affiliated medical center. Authoriztion covers initial and follow up visits with specialist."

They don't state it, but they also pick up any balance that remains from Medicare for all hospitalizations.
I hope that helps.
 

CaliSally

New member
If it's only your CF center items you want covered, then yes, GHPP will pick up the balance of Medicare (more so in the case that you have no other insurance). All CF appts and specialist within the system, have been 100% covered for me.

As my current authorizations from GHPP states (what it will cover):
"SCC annual team assessment and evalutions, outpatient visits, x-rays, ecg, lab works, pft's, dexa scan or other type, and ct scan as medically necesaary."
Furthermore,
"Authorization covers the following services if performed within the scc's affiliated medical center:
* picc line/central line placement for home iv infustion
* annual hearing and vision evaluation
* radiology services such as mri, ultrasound, ct scan as medically necessary
* annual women's wellness check-up to include mammogram/papsmear
* preventative care services such as flu shot and pneumonvax
* all referrals by the scc team member to any specialist within the scc's affiliated medical center. Authoriztion covers initial and follow up visits with specialist."

They don't state it, but they also pick up any balance that remains from Medicare for all hospitalizations.
I hope that helps.
 

CaliSally

New member
If it's only your CF center items you want covered, then yes, GHPP will pick up the balance of Medicare (more so in the case that you have no other insurance). All CF appts and specialist within the system, have been 100% covered for me.
<br />
<br />As my current authorizations from GHPP states (what it will cover):
<br />"SCC annual team assessment and evalutions, outpatient visits, x-rays, ecg, lab works, pft's, dexa scan or other type, and ct scan as medically necesaary."
<br />Furthermore,
<br />"Authorization covers the following services if performed within the scc's affiliated medical center:
<br />* picc line/central line placement for home iv infustion
<br />* annual hearing and vision evaluation
<br />* radiology services such as mri, ultrasound, ct scan as medically necessary
<br />* annual women's wellness check-up to include mammogram/papsmear
<br />* preventative care services such as flu shot and pneumonvax
<br />* all referrals by the scc team member to any specialist within the scc's affiliated medical center. Authoriztion covers initial and follow up visits with specialist."
<br />
<br />They don't state it, but they also pick up any balance that remains from Medicare for all hospitalizations.
<br />I hope that helps.
 

BSJCA

New member
Thanks to all for the information. I'm going to talk to the social worker tomorrow - good idea.

CaliSali I'm nervous about what Beansmom said, basically that her first insurance paid $150 toward Tobi, but the GHPP would not pick up the rest. I mostly want GHPP for drug coverage. Have you had any experiences like this or heard of anyone who has. Beansmom doesn't say what here other insurance is. Could that make a difference?
 

BSJCA

New member
Thanks to all for the information. I'm going to talk to the social worker tomorrow - good idea.

CaliSali I'm nervous about what Beansmom said, basically that her first insurance paid $150 toward Tobi, but the GHPP would not pick up the rest. I mostly want GHPP for drug coverage. Have you had any experiences like this or heard of anyone who has. Beansmom doesn't say what here other insurance is. Could that make a difference?
 

BSJCA

New member
Thanks to all for the information. I'm going to talk to the social worker tomorrow - good idea.

CaliSali I'm nervous about what Beansmom said, basically that her first insurance paid $150 toward Tobi, but the GHPP would not pick up the rest. I mostly want GHPP for drug coverage. Have you had any experiences like this or heard of anyone who has. Beansmom doesn't say what here other insurance is. Could that make a difference?
 

BSJCA

New member
Thanks to all for the information. I'm going to talk to the social worker tomorrow - good idea.

CaliSali I'm nervous about what Beansmom said, basically that her first insurance paid $150 toward Tobi, but the GHPP would not pick up the rest. I mostly want GHPP for drug coverage. Have you had any experiences like this or heard of anyone who has. Beansmom doesn't say what here other insurance is. Could that make a difference?
 

BSJCA

New member
Thanks to all for the information. I'm going to talk to the social worker tomorrow - good idea.
<br />
<br />CaliSali I'm nervous about what Beansmom said, basically that her first insurance paid $150 toward Tobi, but the GHPP would not pick up the rest. I mostly want GHPP for drug coverage. Have you had any experiences like this or heard of anyone who has. Beansmom doesn't say what here other insurance is. Could that make a difference?
 

CaliSally

New member
I hadn't read her post until now. GHPP is a state funded program, and due to the budget crisis, has cut back on staff, causing longer delays in response time and payments; but, as far as I've experienced, there hasn't been a cut back on what's been covered. Again, I'm not dealing with any other insurances other than Medicare and GHPP, perhaps that was the reason she was having trouble? Don't know really. All I do know is that I've been fully covered, even with the cut backs.

Now the issue with Tobi: I've only been on Tobi once, a while back. I remember having to go through a separate special pharmacy to get it, but still, it was covered. Maybe her center didn't have access to that pharmacy?

And remember, GHPP doesn't pick up deductibles or co-pays, so if you have to pay $500 out of pocket before the primary insurance kicks in, GHPP won't pay that, ever. Or, if your other insurance issues a co-pay of $20 per rx, GHPP also does not pay that, ever. That is still out of your own pocket. There is no deductible with Medicare.

She is correct in that you need to use a pharm that is agreed upon by GHPP and who will accepts GHPP terms of payment; however, your CF team (Social Worker) should be able to provide you with what pharmacies they've used that are approved.

Are you in Northern or Southern CA? What center do you go to, if you don't mind me asking? If you don't want to post, you can IM me.

Again, I hope that helps. And, yes...DO talk with your center about this, that is part of their job is to help you get what you need.

Best Wishes
 

CaliSally

New member
I hadn't read her post until now. GHPP is a state funded program, and due to the budget crisis, has cut back on staff, causing longer delays in response time and payments; but, as far as I've experienced, there hasn't been a cut back on what's been covered. Again, I'm not dealing with any other insurances other than Medicare and GHPP, perhaps that was the reason she was having trouble? Don't know really. All I do know is that I've been fully covered, even with the cut backs.

Now the issue with Tobi: I've only been on Tobi once, a while back. I remember having to go through a separate special pharmacy to get it, but still, it was covered. Maybe her center didn't have access to that pharmacy?

And remember, GHPP doesn't pick up deductibles or co-pays, so if you have to pay $500 out of pocket before the primary insurance kicks in, GHPP won't pay that, ever. Or, if your other insurance issues a co-pay of $20 per rx, GHPP also does not pay that, ever. That is still out of your own pocket. There is no deductible with Medicare.

She is correct in that you need to use a pharm that is agreed upon by GHPP and who will accepts GHPP terms of payment; however, your CF team (Social Worker) should be able to provide you with what pharmacies they've used that are approved.

Are you in Northern or Southern CA? What center do you go to, if you don't mind me asking? If you don't want to post, you can IM me.

Again, I hope that helps. And, yes...DO talk with your center about this, that is part of their job is to help you get what you need.

Best Wishes
 

CaliSally

New member
I hadn't read her post until now. GHPP is a state funded program, and due to the budget crisis, has cut back on staff, causing longer delays in response time and payments; but, as far as I've experienced, there hasn't been a cut back on what's been covered. Again, I'm not dealing with any other insurances other than Medicare and GHPP, perhaps that was the reason she was having trouble? Don't know really. All I do know is that I've been fully covered, even with the cut backs.

Now the issue with Tobi: I've only been on Tobi once, a while back. I remember having to go through a separate special pharmacy to get it, but still, it was covered. Maybe her center didn't have access to that pharmacy?

And remember, GHPP doesn't pick up deductibles or co-pays, so if you have to pay $500 out of pocket before the primary insurance kicks in, GHPP won't pay that, ever. Or, if your other insurance issues a co-pay of $20 per rx, GHPP also does not pay that, ever. That is still out of your own pocket. There is no deductible with Medicare.

She is correct in that you need to use a pharm that is agreed upon by GHPP and who will accepts GHPP terms of payment; however, your CF team (Social Worker) should be able to provide you with what pharmacies they've used that are approved.

Are you in Northern or Southern CA? What center do you go to, if you don't mind me asking? If you don't want to post, you can IM me.

Again, I hope that helps. And, yes...DO talk with your center about this, that is part of their job is to help you get what you need.

Best Wishes
 

CaliSally

New member
I hadn't read her post until now. GHPP is a state funded program, and due to the budget crisis, has cut back on staff, causing longer delays in response time and payments; but, as far as I've experienced, there hasn't been a cut back on what's been covered. Again, I'm not dealing with any other insurances other than Medicare and GHPP, perhaps that was the reason she was having trouble? Don't know really. All I do know is that I've been fully covered, even with the cut backs.

Now the issue with Tobi: I've only been on Tobi once, a while back. I remember having to go through a separate special pharmacy to get it, but still, it was covered. Maybe her center didn't have access to that pharmacy?

And remember, GHPP doesn't pick up deductibles or co-pays, so if you have to pay $500 out of pocket before the primary insurance kicks in, GHPP won't pay that, ever. Or, if your other insurance issues a co-pay of $20 per rx, GHPP also does not pay that, ever. That is still out of your own pocket. There is no deductible with Medicare.

She is correct in that you need to use a pharm that is agreed upon by GHPP and who will accepts GHPP terms of payment; however, your CF team (Social Worker) should be able to provide you with what pharmacies they've used that are approved.

Are you in Northern or Southern CA? What center do you go to, if you don't mind me asking? If you don't want to post, you can IM me.

Again, I hope that helps. And, yes...DO talk with your center about this, that is part of their job is to help you get what you need.

Best Wishes
 

CaliSally

New member
I hadn't read her post until now. GHPP is a state funded program, and due to the budget crisis, has cut back on staff, causing longer delays in response time and payments; but, as far as I've experienced, there hasn't been a cut back on what's been covered. Again, I'm not dealing with any other insurances other than Medicare and GHPP, perhaps that was the reason she was having trouble? Don't know really. All I do know is that I've been fully covered, even with the cut backs.
<br />
<br />Now the issue with Tobi: I've only been on Tobi once, a while back. I remember having to go through a separate special pharmacy to get it, but still, it was covered. Maybe her center didn't have access to that pharmacy?
<br />
<br />And remember, GHPP doesn't pick up deductibles or co-pays, so if you have to pay $500 out of pocket before the primary insurance kicks in, GHPP won't pay that, ever. Or, if your other insurance issues a co-pay of $20 per rx, GHPP also does not pay that, ever. That is still out of your own pocket. There is no deductible with Medicare.
<br />
<br />She is correct in that you need to use a pharm that is agreed upon by GHPP and who will accepts GHPP terms of payment; however, your CF team (Social Worker) should be able to provide you with what pharmacies they've used that are approved.
<br />
<br />Are you in Northern or Southern CA? What center do you go to, if you don't mind me asking? If you don't want to post, you can IM me.
<br />
<br />Again, I hope that helps. And, yes...DO talk with your center about this, that is part of their job is to help you get what you need.
<br />
<br />Best Wishes
 
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