You should ask them what the cost is if paid by check/cash. When my youngest needed frequent PT therapy I got an out of pocket cost of $55 instead of $240. And I got another physical therapist a specialist to cut the rate by 65%. They don’t want to do the billing and you can get cut rate costs. Only works in small practices where the physical therapist works for themselves. This saved us tens of thousands over several years.
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Thanks - I will pass that along to her.
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We will find out from cardiologist about ‘options’. He is having another one week Holter monitor test to see about his A Fib. Hoping he can get another cardiac ablation procedure and get rid of the A Fib - I hate to see him on blood thinner at age 66. Plus the A Fib has him tired - we can just imagine how it is physically draining for someone older and not in the shape he is in.
I am ‘counting on’ him needing this blood thinner until A Fib gets cleared up.
Will be needing to make another drug plan choice on him for 2023.
I think I heard they are floating around out of pocket maximum for drugs for people on Medicare to limit out of pocket cost to $2000 - but that may only be for lower income folks, and floating around only.
They should be addressing this - and maybe they will at some future time.
@SOSConcern just wondering why xarelto being prescribed instead of Coumadin? Since Coumadin is very cheap and Xarelto is not. I don’t know anything about the differences between the 2 drugs.
Drug companies do offer assistance with expensive drugs. Unfortunately it’s only if you are on private insurance. Once you switch to Medicare or an ACA plan, they can no longer offer any assistance.
It’s very sad for those who’s health requires a medication that is prohibitively expensive. My husband will have to switch one of his prescriptions once he has to go on Medicare.
There may be some hope for some Medicare users, although implementation will be rather slow:
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Thank you for that! Most appreciated
@Htas I am a therapist. More than once I’ve been asked to provide private therapy to a Medicare recipient, and take cash payment. I can’t do this if the person has been deemed ineligible for therapy services, I can’t decide to charge them for this service if they are on Medicare.
@aunt_bea your thoughts?
This wasn’t floated…it happened. But I am not sure when this provision starts.
I’m not sure I am completely following you @thumper1 . Do you work for yourself? If so, are you saying that if you also have medicare clients you aren’t allowed to also accept payment via cash or something else? And you said you are a therapist. Do you mean a PT? I’m specifically talking about physical therapy. One PT told me about the cash discount and when I asked they all offered it ( except those who worked for a firm where they were employees).
We had a bill that was almost $750 week ( 3 times per week). It was really tough. The firm that hired people also offered a cash discount but it wasn’t nearly as good as the PT’s who worked alone (in small practices which they ran).
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I think there’s a difference between the two drugs, based on conversations I had with a doctor after my brother had a stroke. I could be wrong, though, as it was a rather tumultuous time.
Two of my friends have a condition that requires biologics to manage their symptoms. They had to switch from injections, which they could give themselves at home, to monthly infusions when they started on Medicare. It’s a pain in the rear because it limits travel … and it seems weird to me that an infusion would be more cost effective than a self administered injection. I’ve heard a number of complaints regarding medicine restrictions once people hit Medicare.
I will say one thing. If you cut yourself badly and are taking Xarelto, it can be VERY scary. Was thrilled when a family member was weaned off this drug. Took four hours in the ER to stop the bleeding from a kitchen cut.
That’s exactly the case. He’s on a biologic and will have to switch to an infusion when he starts Medicare.
Coumadin and Warfarin are two older blood thinning drugs. Often you have to monitor levels/do lab testing to keep blood thinning ‘under control’ with the older drugs. They use to run a Coumadin Clinic with pharmacy/lab for patient safety before other/better blood thinners came out.
I do think Cardiologist is avoiding problems by having him on the Xarelto but I don’t know specifics - and I really thought his A Fib would be cleared up and he would be off the blood thinner.
This is DH’s only costly medicine - that is why we were on a low end drug plan. We just got his WellCare report in the mail: 1/1/22 - 7/31/22 plan paid $3114.83 and our year to date we paid $889.68 (IDK if that includes our monthly payments, which are low).
Will see how the new legislation ‘rolls out’ with the Medicare drug plan situation.
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If they are deemed ineligible for care, then someone did an evaluation, or some type of assessment, to garner results indicating that the patient, either, wont benefit from the therapy, or that the type of therapy requested, isn’t what is needed. (Rarely: we did something wrong, on our end on the insurance, to get the denial.).
Medicare requires showing progress with therapy. The physician sends the prescription and order for therapy. The “paperwork” gets sent to Medicare. If the patient can’t “gain” anything from therapy (the results stay the same with or without therapy), then no one will benefit-not the patient and not the professional. It would be unethical to charge private pay rates to someone who will not benefit from therapeutic intervention.
When I worked as a private subcontractor, before I considered a patient, I asked the family to request medical records, and then, if comfortable, make a copy for me so that I could review the chart.
I would then review the SOAP notes and see what happened with the Medicare referrals. If the soap notes indicated several attempts at therapy with poor progress, I could see why the denials were sent.
ETA: My private pay rates were $200 per hour in 2019. People in my area were really happy to pay my rates and said I was undercharging!
With Covid, I only had 2 clients and people were “banging down my door” to get my services for them. (I did a LOT of prep work and mailing of activities/homework). Two was enough work and I didn’t really want the Zoom headaches.
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Based on the information you provided, I suspect that the family may not be ready to hear what they are hearing … that their loved one is not going to regain what she’s lost. If that’s the case, I completely understand why they would not want to give up. It’s such a sad situation, and not only will her care be difficult, but it will be very expensive. A vibrant, smiling, active woman was changed forever. Life just keeps reminding me that every day is precious.
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Exactly! We can’t regenerate those crucial brain functions after a traumatic brain injury.
The savvy physicians had us in the hospital rooms within 12 hours of the patient being admitted. Therapy has to happen immediately because we lose precious time for brain function recall.
These patients need to show us ambulation (OT/PT) and be able to communicate their needs and wants and we have to assess their abilities to swallow without harm (Speech Pathology-me and @Thumper). We have to see if VT needs to be involved for blindness studies ( I had become a specialist-not by choice- in noting toxic chemicals for local farmworkers, and blindness, which was frequently associated with a number of pesticides, or severe diabetes- because I spoke Spanish.)
Speech Therapy “prescription” orders were sent to me via computer by the neurologists. I got to the rooms to confirm videofluoroscopy orders to check swallow patterns so that I could feed the patients-with a respiratory therapist near me. The brain impacts everything.
If there is no progress, during the acute care phase, Medicare wont cover the costs of additional therapy. It’s very heartbreaking for the patient and family. We tried, HARD, to get the patient to respond, mumble, groan, use their eyes, grandkids, family members, anything, to indicate receptive and expressive changes. I always gave the patient the benefit of the doubt if the family reported something while I, or my colleagues were with other patients.
We tried.
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@shawbridge is your family still working on the insurance claim for DD’s items burned up while being transported? Is there special insurance that would have been helpful, or are the items going to be covered?
Due to H’s age and high (but controlled blood pressure), along with A Fib that may or may not be able to be resolved with another cardiac ablation procedure, he is going to be on blood thinner, and evidently the one desired by MD is Xarelto. So definitely will be looking for a better drug plan with that on his med list - but we will be paying higher premiums (for sure). Will probably be better in that more controlled deductible and spreading the premiums - so that is also ‘more controlled’. H doesn’t like going to pharmacy counter and then also having a high bill there; modest is OK.
Can’t let stuff like the drug plan situation annoy - it is what it is.
Have worked out ‘the kinks’ between various specialists and office personnel. When we see the specialist on the 31st will let him know about ‘the kink’ involving his office interacting with other medical offices and patient.
Here’s my PSA for anyone to call 911 if they have any signs of a stroke. If caught early, the effects can be greatly mitigated.
Honestly I’m so surprised how many of my senior friends miss the signs and don’t go to the hospital. I have a neighbor who I know had a undiagnosed stroke and has really slowed down. My friends begged her and her husband to go to the hospital but they said it was nothing. It wasn’t
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QUESTION (helping a friend) - If you sell stock and Computershare sends a check… can they bring the check to church for donation to avoid taxes etc? Or would they need to do the donation directly from Computershare?