I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: pdpatty on May 16, 2009, 01:22:19 PM
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Boy,am I miffed! Back in 2005 I went thru a battery of tests at the Cleveland Clinic to be placed on the transplant list. Made it to transplant nurse who said they would notsee me(transplant docs) unless I could get the drugs needed after transplant. Basicly told not to come back.
NOW,I find out I was covered for these drugs all along thru Medicare BECAUSE I had qualified for Medicre(10 yrs prior to being diagnosed with ESRD). The rule is if you were already on Medicare for a disability ,they would furnish the needed drugs for a lifetime.
Gheesh!
http://cjasn.asnjournals.org/cgi/content/full/3/3/899
(http://cjasn.asnjournals.org/cgi/content/full/3/3/899)
The last improvement to coverage for immunosuppression came in 1999, when Congress authorized the "lifetime benefit." CMS's handbook Medicare Coverage of Kidney Dialysis and Kidney Transplant Services (21) explains, "Medicare will continue to pay for your immunosuppressive drugs with no time limit if you already had Medicare because of age or disability before you got ESRD, or became eligible for Medicare because of age or disability after getting a transplant that was paid for by Medicare, or paid for by private insurance that paid primary to your Medicare Part A coverage, in a Medicare-certified facility." The handbook also takes pains to point out twice that "if you have Medicare only because of kidney failure, your Medicare coverage will end 36 mo after the month of the (successful) transplant," so the patient must first be eligible for, then enrolled in, and paying the monthly premiums for Part B to have coverage for immunosuppression. In some programs, patients postpone active listing or living-donor surgery until the month of their 62nd birthday to be assured of uninterrupted lifetime help with the high cost of immunosuppression.
I am wondering,is this knowledge to little and to late for me?
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I'm sorry. I wish I had something to say. But I agree with you that is Bull Crap! :cuddle;
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Patty,
The whole insurance/medicare bureaucracy is a nightmare. It took us a year to get listed because of a similar misunderstanding. I understand your frustration.
:Kit n Stik;
Aleta
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I did not know of the improvement of 1999. Thank you for sharing.
You need to talk to your transplant coordinator and tell them you want your time back dated due to misinformation/misaction.
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You have been treated unfairly. Seems to me the transplant coordinator should have been able to figure this out at the time. You should contact the transplant center again and pursue this. I like Rerun's suggestion of demanding your time backdated. Good luck.
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:banghead; I agree, ask that they make your status active and see what rights you have for time served - don't give up.
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They said that??? Thats insane! It really is nuts the way the insurance/medicare system works. I hope you get on that list right away.
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Patty: Get on the transplant list with whomever is close to you and has a better staff. Then appeal
your starting date with the transplant unit and with UNOS.