So a medicare representative on the phone tells me I can't pay for rejected benefits for my parents?

[Progressive_In_NC]

My dad is 64 years old, has epilepsy and neuropathy in his legs and fell a few months ago. We asked for outpatient therapy for strength or for at home therapy.

Medicare told us he could have a wheel chair. I told them I would pay for the therapy out of my own pocket and the nice lady told me that once care had been rejected under medicare it was illegal to pay for it yourself out of pocket.

I'm still trying to get my head around that one.

[sharesunited]

1. It is rules like this which play right into the hands of HCR opponents.

WTF?

Don't interfere with care! Stick to financing issues. Not going to pay? Fine, then butt out!

[Progressive_In_NC]

4. I've called back and am on hold

I'm livid and am going to find out what part of the medicare law actually states this. If we don't file with them and seek outside care, then how can they possible have a say in what care I pay for?

Live and Learn.

[havocmom]

9. Is there any sort of advocacy for the elderly or individuals with epilepsy in your area?

If so, call them too, and ask them if they have any source of advice or help for such a question. Sometimes, a seasoned advocate knows a shortcut through red tape and maze of the system. A bit of support and information may be just the ticket.

Good luck, and bless you for trying to help rather than just walking away from the situation. We need more like you.

[sharesunited]

10. When Rachel was debating Dick Armey on MTP the other day, they touched on this.

She mentioned, and he acknowledged, that he is the plaintiff in a pending lawsuit to opt out of Medicare.

I thought he is suing just because he is a RW curmudgeon making some kind of symbolic point.

But if there are real world restrictions like this, it is a problem which should be objectionable to anyone with common sense!

[mnhtnbb]

2. How does he qualify for Medicare if he's not yet 65?

[Hepburn]

5. Medicare is available to those who qualify for SS Disability regardless...

...of their age.

I am guessing from the medical problems, the Dad is disabled and on SS and receiving Medicare because of this.

[Progressive_In_NC]

7. You are correct, he had a tumor in his ear cavity the size of a raquetball at 52

He has been disabled every since. The tumor cause the seizures, the balance issues and the crushed vocal chords (yes it was that big).

But he is still here alive and kicking and getting around as best he can.

[Hepburn]

14. Wow....

...he is a survivor. Please give him this for me: :hug:

:hi:

[katmondoo]

3. If you do it but do not tell Medicare

would that work? They cannot control every aspect of one's life.

[Name removed]

6. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[Progressive_In_NC]

8. So the answer is that I can take him to a clinic for therapy where a Medicare claim has not been

filed and I can pay for the 8 week program myself. I called another therapy group and they can take him tomorrow. If I pay cash it will cost me $65.00 a visit for 24 visits.

But FYI for anybody else who has to tackle this.

[sammytko]

13. maybe they thought you wanted to be reimbursed afterwards

cuz what she said makes no sense at all. if you have the money, you can do whatever you want.

[jsamuel]

19. .

[Hepburn]

24. Your parents raised a wonderful child....

....:hug:

[deminks]

11. Something similar happened to my mother a few years ago

Tried to take her to an outpatient clinic for cold symptoms. When we got there, we saw a big sign that they did not take Medicare patients. When I said we would pay for the visit, they said that would be illegal. We had to go home and call the doctor and wait 2 days for an office visit.

There are some issues with Medicare, but it still paid for a great deal of her care.

[Progressive_In_NC]

15. No doubt Medicare has saved my dad's life, this is just a new wrinkle in the process

Right after the surgery happened, his insurance dropped him. He spent 4 months in in-patient therapy and Neural Intensive Care.

The bill was $600,000 and insurance paid that but didn't want to pay anymore.

We had to fight to get him on disability even though he went to his hearing in a wheelchair with a charge nurse with him.

I was so mad, the lady in front of him was granted disability for social anxiety disorder, and my dad was denied that time and three more times at hearing. One of the ladies was convinced there was a desk job he could do even though he had been a laborer his whole life.

It finally took two letters from Jesse Helms (our Senator at the time) to get my dad into the disability program.

After that he has been on Medicare, and has had several surgeries to remove more benign tumors from his head and lymph nodes.

Medicare and his supplement have paid for each of those surgeries.

[Orangepeel]

12. The medicare website doesn't say any such thing

"You can always choose to get services not covered under Medicare and pay for these services yourself. In this case, you do not have to sign a private contract, and your doctor does not have to stop giving services through Medicare."

http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=31&p_created=993580100&p_sid=XEkpUHFj&p_accessibility=0&p_redirect=&p_lva=&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PSZwX2dyaWRzb3J0PSZwX3Jvd19jbnQ9NTEsNTEmcF9wcm9kcz0mcF9jYXRzPTQmcF9wdj0mcF9jdj0xLjQmcF9wYWdlPTE*&p_li=&p_topview=1


"ALWAYS choose"

[asjr]

16. This just does not sound kosher. The "nice lady"

must be new or a Republican. If your father pays the A and B premiums he can surely contest it.

[haele]

17. Because of the politics that have been involved with Medicare -

The basics are covered by Medicare, and things like therapy or in-home care are covered by the government Medicaid, a means-tested supplemental insurance, a state provided supplemental like Medi-Cal, or by whatever government regulated/approved Medicare supplemental your father is supposed to be on (Pacificare, Secure Horizons, et all). In fact, my over-65 parents and my in-laws have one primary insurer - either Medicare or Tri-Care, and two to three low cost non-profit or even for-profit supplemental insurers to cover the gaps, as it were. My mother gets free regular therapy at a Medicare/Medicaid-approved program at the local "Y" for her knee surgery and arthritis. My father had 2 months in-home therapy for a broken hip eight years ago through his "TriCare for Life" supplemental.
See, everyone in power has been sooo scared of "socialized" medicine that while they could just barely accept single payer basically for just the emergencies and initial treatments (to keep the elderly and the other un-insurable somewhat covered and from dying in the streets like in some third world country), the program has been set up to force everyone to purchase some sort of private insurance - even if it's under government regulated.
And then those same "anti-socialists" bitch that they won't get their "fair share" of the mythical free goodies those "nogood, lazy, low income elderly or disabled are scamming off the taxpayer", because the rules have been made so strict that it really has become a burden for the average person to navigate through the system and get the help they need.
Hey, everyone knows the poor, unlucky, elderly, and disabled are all lazy scammers.
Rant off*********

As for the in-home therapy, it's possible that your father has supplemental insurance to cover it, you or he just isn't aware that Medicare doesn't pay for the therapy on it's own. Check with his doctor - all his providers should be on file somewhere. Medicare can't advise you as to what you need for the supplemental.

If he doesn't have supplemental insurance, check with some elderly assistance groups; they'll be able to walk you both through the maze of procedures he will need to prove he needs and "deserves" for coverage.
'Cause it doesn't look like we're going to get any real public health coverage anytime soon. :(

Haele

[enough]

18. Let's hope this OP doesn't give anyone the wrong impression.

You do have the option of self-pay for anything that Medicare rejects.

[madfloridian]

20. Of course you can get services if you pay for them.

Please don't try to say false things about Medicare at this time.

[madfloridian]

21. I unrecommended this because it is not true.

I don't know who the lady was but she should be fired.

[Lex]

22. They can't keep you from paying for whatever services you want.

How could they as a practical matter?

[hedgehog]

23. I'd e-mail Sebelius about this.

[unapatriciated]

25. don't believe her. I doubt medicare has any such laws. Ask to speak with her supervisor.

and always follow-up in writing.
Get your doctor involved on why it is necessary. I fought denials for physical therapy (for my son) for years.
During the active stages of my son's illness (dermatomyositis) and the denials and many reviews by my Insurance company, I paid out of pocket for his physical therapy. My son's doctors also took the time to train me and my son in some simple exercises that would help while waiting on approval of care. They also challenged the denials of services and wrote letters detailing the reasons for physical therapy