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Discussion on all insurance topics. Medicare, Medicaid, HMO's, Work insurance, Health Reform, and so on.

Please post comments, issues, ask questions, whatever pleases or irks you.

Website: http://www.transplantfriends.com/group/insurance
Members: 80
Latest Activity: Feb 2

Discussion Forum

Losing Medicare after transplant?

Started by Jay Lackritz. Last reply by Orly Jan 2. 20 Replies

Is Medicare alone enough coverage?

Started by Lori. Last reply by livecam Oct 16, 2013. 5 Replies

First Health / Coventry Health Care

Started by Jay Lackritz Sep 26, 2013. 0 Replies

Medicare 2014 Booklets

Started by Jay Lackritz. Last reply by Mark Sep 24, 2013. 1 Reply

Congress must buy health insurance?

Started by Jay Lackritz. Last reply by Jay Lackritz Jul 30, 2013. 3 Replies

Warning about Walgreens

Started by Jay Lackritz. Last reply by Mark Feb 9, 2013. 1 Reply

A Health Insurance Detective Story

Started by Jay Lackritz. Last reply by Rachel Dec 10, 2012. 2 Replies

Insurance Exchanges

Started by Jay Lackritz. Last reply by Jay Lackritz Sep 24, 2012. 1 Reply

Point of Confusion

Started by Dennis. Last reply by Dennis Sep 9, 2012. 4 Replies

Insurers buying out their competition.

Started by Jay Lackritz. Last reply by Jay Lackritz Aug 20, 2012. 4 Replies

Low Cost Medicare Advantage Plan in Florida?

Started by Jay Lackritz. Last reply by Jay Lackritz Jul 15, 2012. 2 Replies

30 day limit on drug supply

Started by Carolyn. Last reply by Carolyn Dec 3, 2011. 8 Replies

Part D plan confusion

Started by Jay Lackritz. Last reply by Jay Lackritz Dec 2, 2011. 1 Reply

Comment Wall

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Comment by Rachel on December 3, 2013 at 10:57am

Last year I received my letter telling me about the increase back in Sept. and  since I hadn't heard anything this year......thought I was going to get a break :(  Wrong, I received my letter yesterday.   

Comment by Susan D Fairbank on October 25, 2013 at 7:20am

Thank you so much for the post with links.  I will review and see how to proceed.  Short Term Disability is a program my employer offers.  It is part of the FMLA program but for yourself not a family member.  I have up to 12 weeks in a rolling calendar available to use.  I use sick time or vacation time for the first 5 days and then will receive compensation at a prorated rate weekly but most importantly will keep my benefits and job until I return.  I do  not know what will happen with me next, but at least I can have some time to make a clear, educated decision based on the way my health is without the stress of having to go to work everyday and adding more stress. 

Comment by Jay Lackritz on October 24, 2013 at 7:11pm

to apply for social security disability (SSD):

http://www.ssa.gov/dibplan/index.htm

Supplemental Social Security Income (SSI)

http://www.ssa.gov/pubs/EN-05-11000.pdf

Benefits for people with disabilities:

http://www.ssa.gov/disability/

Information on mental claims for disability:

http://www.disabilitysecrets.com/dnewsblog/2008/09/mental-illness-a...

Comment by Jay Lackritz on October 24, 2013 at 6:46pm

Susan, I don't know what short term disability is, but you can apply for social security disability, and if you get accepted, you automatically get Medicare two years later. They don't only accept physical reasons, but mental as well. This is one of the reasons the application is so long. There are other poverty programs like SSI, Medicaid, food stamps, etc. Personally, I went on SSD a few years before my transplant, and I am still on it. I am now 64, and have Medicare health insurance and a monthly Social Security check, which isn't enough to live on, but it sure helps. I love the $104 medical insurance. When I went on disability I just called Social Security and they sent me all the forms.

Comment by Susan D Fairbank on October 24, 2013 at 5:09pm

My question is what to do now?  I went back to work after kidney transplant 3/29/2010.  I was out for 3 weeks to rehab and went back.  Now 3 1/2+ years later I am struggling at work.  I am a customer service rep at a bank so my job is not physical, but mental.  I am longer to do this job between my apathy and the stress of the job itself and the environment.  I am 53 years old.  I went on short term disability yesterday.  I don't know how to proceed.  Has anyone gone back to work after transplant to find out later they just don't have the strength to do the job anymore?  I would appreciate any information. I carry all the benefits for the family.  What will happen to me?  Can I get SS?  Can I get some government insurance?  Thanks!  Sue

Comment by Lola on October 20, 2013 at 4:49pm
Jay, I am not on prednisone either. My pulmonary MD has not helped with the weight situation either. He just tells me stories of other pts who have succeeded with more weight loss than what I require. I weigh about 195 and Duke wants me to be below 163. I wonder if all transplant facilities have the same requirements?
Comment by Lola on October 20, 2013 at 4:44pm
Hi Jay, no I do not retain CO2. Yes, I use 2 liquid tanks at PR, each on 15 liters. 1 with oximizer, and the other tank hooked to. Non-rebreather mask which I wear on top of the other cannula. If I did not have the liquid, then I wouldn't be able to leave my home for any reason. Medicare does not seem to care whether a person leaves their home or not. I spoke to Medicare last week but the employee did not offer any suggestions. I plan to file a complaint.
Comment by Jay Lackritz on October 20, 2013 at 3:03pm

Hi, Lola,

Very sorry to hear about your troubles with Lincare. With all the political pressure from the conservatives in congress, there have been many changes in Medicare's DME program. Most areas of the country must use the Competitive Bidding Program, which limits who you can go to for your O2 and supplies, but they must service your needs. Medicare says that if you are having any issues getting your oxygen, you are supposed to call 1800Medicare, and they will do something to get you help.

Since you are now near the end of the 5 years, you should be able to switch oxygen providers, and it also sounds like your current provider is not able to fill your needs anyway, so you need to report them to Medicare. Have you tried calling Medicare, or has your doctor come up with any recommendations? If they are not able to help, you should look for another doctor,

More and more companies are converting people away from LOX, since it is so expensive, which is unfortunate, but there's really nothing we can do about it. However, if you really need a very high oxygen flow, your supplier is supposed to help you. I know a couple of people who use over 15 liters when exercising, and they 'T' (or 'Y') tanks together and put them in a rolling cart so they can exercise. I have to admit that I've never heard of anyone needing 30 liters of oxygen. That doesn't sound right. Are you retaining CO2? It sounds like there may be other issues if you require that high a flow.

You should discuss this with your pulmonologist and he should be able to prescribe the needed flow for you, and your supplier is required to fill those needs.

If they won't put you into a transplant program due to your weight, you should also discuss this with your doctor to see how he can help. If the main reason you are not able to lose weight is prednisone, maybe he can take you off all steroids to help you.

http://www.medicare.gov/coverage/oxygen-therapy.html

If you are not familiar with using a "Y" connector to combine oxygen sources, I put an article on my server with links to photos which should help:

http://www.lackritz.net/WyeConn.html

Jay Lackritz   -  Double Lung Transplant, NYC, May, 2007

Comment by Lola on October 19, 2013 at 10:54pm
Ok I've been on O2 for 18 yrs and I understand that Lincare or any O2 company accepting Medicare gets paid the first 36 mos. and must continue to provide maintenance and supplies for up to 5 yrs. per contract. There is a "cap" on payment after 36 mos. After the 5 yr. "contract" is fulfilled a patient may change providers. My 5 yrs are up in 01/2014. I am on 8 l/24 hrs and up to 30 with exercise. I have a high-flow concentrator, 3 liquid reservoirs, and 3 portable units- companion T. My tanks suck! The reservoirs are sub-standard, as well as my portable units. I have been told that Lincare does not have any more tanks or liquid units because they are expensive. The units freeze up and cannot be re-filled- one after the other because the tanks and reservoirs freeze up. That's why I need 3. Now my reservoirs gauges are broken and I cannot tell how much I have left and they leak out the pressure almost immediately after Lincare fills them. They do not care that I am left with no "back-up" and that I cannot leave my home. I am supposed to go to pulmonary rehab 3X/wk. I am in desperate need of a lung tx. I need to lose 30 lbs. my thoughts are that most people on O2 are dead by the time they require so much O2 and I am a rare case,and they are not willing to accommodate my needs.....any thoughts? I have sent the company a letter but have received no response. Lola
Comment by Jay Lackritz on April 2, 2013 at 8:40pm

U.S. to Raise Medicare Advantage Payment Rate

In a reversal that followed intense lobbying from the health insurance industry and members of Congress, the U.S. government said it will increase the payment rate for health insurers that offer coverage through the popular Medicare Advantage program.

The Centers for Medicare & Medicaid Services said on Monday it will increase the rate by 3.3% in 2014, reversing a 2.3% cut announced in February.

The turnaround boosted shares of major health insurance companies such as Humana Inc in after-hours trading.

Medicare Advantage provides care for seniors who select to receive their Medicare benefits through private insurance plans. About 14 million Americans are enrolled in the program.

The program has long ensured industry participation by paying more than the cost of the traditional Medicare program for the elderly and disabled. The proposed reduction had followed efforts by the Obama administration to reduce how much money it pays private insurers as an incentive to participate.

In announcing its final rates for 2014 on Monday, CMS said the changes came "after careful consideration of public comments."

"The policies announced today further the agency's goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice," Jonathan Blum, acting principal deputy administrator for the CMS, said in a statement.

Since the initial rate announcement in February the agency, part of the U.S. Department of Health and Human Services (DHHS), has encountered weeks of heavy lobbying by health insurers, whose share prices dropped sharply on the planned rate cut.

Some insurers hinted they would drop their Medicare Advantage business for 2014 if the government did not back down.

Lawmakers on both sides of the aisle took those concerns on board. More than 160 of them joined an effort to reverse the previously announced rate cut, according to America's Health Insurance Plans (AHIP), which launded Monday's decision.

AHIP has released several lawmaker letters expressing worry about the proposed Medicare Advantage payment cuts, including three last week from bipartisan members of the New York House delegation; the entire Massachusetts House delegation, all Democrats; and six other House Democrats.

"We have concerns that if CMS does not make this adjustment, many Medicare Advantage enrollees in Massachusetts, and across the country, will face higher premiums and fewer benefits," said the Massachusetts delegation's letter, which was addressed to Marilyn Tavenner, acting CMS administrator, and dated March 27.

Earlier in March, a large bipartisan group of senators highlighted the threat of plans potentially exiting the Medicare Advantage market altogether.

Meanwhile "The Coalition for Medicare Choice," which is funded by AHIP and other private insurers, launched a full-throated attack on the proposed cuts through television advertising and social media.

 

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