Medicare as primary and home IV's

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LouLou

New member
Autumn, I would get in contact with Beth Sufian. She is a lawyer with cf who specializes in disabililty but is very versed in all things cf and the law. Here is her website <A HREF="http://www.sufianpassamano.com/content/atty_beth.html">http://www.sufianpassamano.com/content/atty_beth.html</A>. From my experience from speaking with her it is better to get advice from her because you may be omitting something here online for security reasons that she would ask you that would make your situation slightly different than another person.
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<br />That being said, after you speak with her could you let us know what she tells you is the way to go. I'm very curious because I could see myself in your situation. Did you accept only the free Medicare (assuming you got it because you are on SSDI)? I think it's called Part B. I don't think my hospital knows I have it which may be illegal but I was afraid it might mess things up.
 
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LouLou

New member
Oh and she has a grant from the CFF to help cfers so there may not even be a charge for her professional advice!
 
L

LouLou

New member
Oh and she has a grant from the CFF to help cfers so there may not even be a charge for her professional advice!
 
L

LouLou

New member
Oh and she has a grant from the CFF to help cfers so there may not even be a charge for her professional advice!
 
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ltlhook

New member
Medicare changed their policy. They use to cover home IV care as long as you were "home bound," meaning that you were not driving and stuck at home. I had insurance through my employer way back when I was working in ummm 2000ish. I worked for the insurance. My ex husband was self employeed and we couldn't get insurance. I then quit work and filed for disability. I paid for the COBRA to stay on my companies insurance for the 18 months. It worked out that the last month of COBRA was the first month of Medicaid for me. Then the Medicare came into effect. Medicare is always primary when you are on it due to disability. So I had Medicare and Medicaid due to low income. As bad as the government insurance is I did have good coverage then and didn't pay for anything. It was good except the loops you had to jump through to get things done. Then I got married a year ago and my husband is in the Air Force. So I now have Medicare as primary and Tri-Care as secondary.

The reason I tell you all of that mumbo jumbo is because I have been in what seems like every insurance senerio. Medicare STILL doesn't cover my home IV's but Tri-Care does pick up the cost. I do still have some co-ins/deductable with Tri-Care. Yes Medicare is a pain in the butt, to put it nicely, but it does help in some instances. They are limited on what they cover at times and can screw with your other insurances idea of what is covered. There are many tricks to getting things covered and most coding people know how to change ICD-9 & CPT codes to get things going. I use to do insurnace billing and it was sometimes a headache trying different codes to get the thing covered.

Sorry that was long. I would say double coverage is better than just Medicare with all the "donut hole" and other hidden things with Medicare.
 
L

ltlhook

New member
Medicare changed their policy. They use to cover home IV care as long as you were "home bound," meaning that you were not driving and stuck at home. I had insurance through my employer way back when I was working in ummm 2000ish. I worked for the insurance. My ex husband was self employeed and we couldn't get insurance. I then quit work and filed for disability. I paid for the COBRA to stay on my companies insurance for the 18 months. It worked out that the last month of COBRA was the first month of Medicaid for me. Then the Medicare came into effect. Medicare is always primary when you are on it due to disability. So I had Medicare and Medicaid due to low income. As bad as the government insurance is I did have good coverage then and didn't pay for anything. It was good except the loops you had to jump through to get things done. Then I got married a year ago and my husband is in the Air Force. So I now have Medicare as primary and Tri-Care as secondary.

The reason I tell you all of that mumbo jumbo is because I have been in what seems like every insurance senerio. Medicare STILL doesn't cover my home IV's but Tri-Care does pick up the cost. I do still have some co-ins/deductable with Tri-Care. Yes Medicare is a pain in the butt, to put it nicely, but it does help in some instances. They are limited on what they cover at times and can screw with your other insurances idea of what is covered. There are many tricks to getting things covered and most coding people know how to change ICD-9 & CPT codes to get things going. I use to do insurnace billing and it was sometimes a headache trying different codes to get the thing covered.

Sorry that was long. I would say double coverage is better than just Medicare with all the "donut hole" and other hidden things with Medicare.
 
L

ltlhook

New member
Medicare changed their policy. They use to cover home IV care as long as you were "home bound," meaning that you were not driving and stuck at home. I had insurance through my employer way back when I was working in ummm 2000ish. I worked for the insurance. My ex husband was self employeed and we couldn't get insurance. I then quit work and filed for disability. I paid for the COBRA to stay on my companies insurance for the 18 months. It worked out that the last month of COBRA was the first month of Medicaid for me. Then the Medicare came into effect. Medicare is always primary when you are on it due to disability. So I had Medicare and Medicaid due to low income. As bad as the government insurance is I did have good coverage then and didn't pay for anything. It was good except the loops you had to jump through to get things done. Then I got married a year ago and my husband is in the Air Force. So I now have Medicare as primary and Tri-Care as secondary.
<br />
<br />The reason I tell you all of that mumbo jumbo is because I have been in what seems like every insurance senerio. Medicare STILL doesn't cover my home IV's but Tri-Care does pick up the cost. I do still have some co-ins/deductable with Tri-Care. Yes Medicare is a pain in the butt, to put it nicely, but it does help in some instances. They are limited on what they cover at times and can screw with your other insurances idea of what is covered. There are many tricks to getting things covered and most coding people know how to change ICD-9 & CPT codes to get things going. I use to do insurnace billing and it was sometimes a headache trying different codes to get the thing covered.
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<br />Sorry that was long. I would say double coverage is better than just Medicare with all the "donut hole" and other hidden things with Medicare.
 
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musclemania70

New member
<P>Shannon, You said that Medicare is always primary when you are </P>
<P>on it due to disability. this is not true.  </P>
<P>medicare coordination of benefits asks certain questions</P>
<P>and if the employer (who provides the private insurance) </P>
<P>has more than a certain number of emplyees, Medicare is secondary. check out this link:</P>
<P><A href="<A HREF=" 02179.pdf? pdf pubs publications <A HREF="http://www.medicare.gov">www.medicare.gov</A> http:><A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A></A>"><A href="<A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A>"><A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A></A></A></P>
<P>or you can google 'when is medicare primary' and a pdf file gives the details</P>
 
M

musclemania70

New member
<P>Shannon, You said that Medicare is always primary when you are </P>
<P>on it due to disability.this is not true. </P>
<P>medicare coordination of benefits asks certain questions</P>
<P>and if the employer (who provides the private insurance) </P>
<P>has more than a certain number of emplyees, Medicare is secondary. check out this link:</P>
<P><A href="<A HREF=" 02179.pdf? pdf pubs publications <A HREF="http://www.medicare.gov">www.medicare.gov</A> http:><A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A></A>"><A href="<A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A>"><A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A></A></A></P>
<P>or you can google 'when is medicare primary' and a pdf file gives the details</P>
 
M

musclemania70

New member
<P>Shannon, <BR>You said that Medicare is always primary when you are </P>
<P>on it due to disability.<BR><BR>this is not true. </P>
<P>medicare coordination of benefits asks certain questions</P>
<P>and if the employer (who provides the private insurance) </P>
<P>has more than a certain number of emplyees, Medicare is secondary. <BR><BR>check out this link:</P>
<P><A href="<A HREF=" 02179.pdf? pdf pubs publications <A HREF="http://www.medicare.gov">www.medicare.gov</A> http:><A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A></A>"><A href="<A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A>"><A HREF="http://www.medicare.gov/publications/pubs/pdf/02179.pdf">http://www.medicare.gov/publications/pubs/pdf/02179.pdf</A></A></A></P>
<P>or you can google 'when is medicare primary' and a pdf file gives the details</P>
 
T

triples15

Super Moderator
Thanks a bunch everybody!
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<br>I heard back from my CF Social Worker and the nurse coordinator at my clinic today. They did a little research and talked to their billing contact at the home health company I use for my IV meds. They said it has been their experience that once they bill Medicare and get an official denial, they then submit it to the secondary who will pick it up if it is a service they normally cover. They feel confident that I could do home IVs, even it took a little wrangling as far as the insurance companies go.
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<br>So for now my husband is enrolling in single coverage with his new plan and I'm going to stay on the COBRA. I spoke to the new company's benefits office today and open enrollment is in November, with coverage then starting Jan. 1 2012. I've decided I'll see how this Medicare/Cobra thing works out in the next few months, and if it's not working as I've planned I can jump onto his pretty quickly. This will at least let us avoid hitting the $3,000 deductible (and perhaps even the $6,400 out-of-pocket max) now, and then already again in January. That would be painful!! And if staying on COBRA does seem to working well over the next few months I will stay on it until open enrollment the next year, as it will coincide with my Cobra coming to an end.
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<br>Phew!! This has been a hard time trying to figure this out and I've seriously been losing sleep over it. Thanks so much to all of you for each of your responses!
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<br>Lauren, yep I'm on Medicare due to being on SSDI. I took the free Part A, plus the part B, which is about $115 per month. I didn't take part D due to having excellent prescription coverage at the time (which is now the Cobra) and I think they will still pay the same for my scripts. I was excited about getting Medicare because I thought it would be secondary and would help pick up some of what my primary didn't pay. At the time I was enrolling in Medicare my husband was still with his previous employer so I was making plans around that being primary. Now that I'm Cobra, making Medicare primary, I'm wondering if I made a mistake and would be better off without it! I still think it should come in handy when I eventually get on the husbands crappy insurance and Medicare is then the secondary. Only time will tell I guess. Sorry, I keep rambling! My mind just races with thoughts.
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<br>So my decision is made for now, and I don't have to live with it for very long if it is the wrong one! <img src="i/expressions/face-icon-small-smile.gif" border="0"> That's what I keep telling myself. Please feel free to offer any further advice tho! This has been such a confusing process and I'm sure I'll have more Medicare questions as time goes by!<br><br>P.S.  Lauren, you are right, I suppose what you are doing might be against the law, but to be honest, with the confusion I'm facing I certainly can't blame you for doing it that way!<br>
 
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