Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Uhm....my father in law was just denied life saving heart surgery by Medicare today (aortic stenosis and 2 non working valves).....Medicare felt that it was a high probability he would not survive the heart surgery so therefore they said they will not cover the surgery. Heart surgeon tried to fight it today...said he is for sure going to die without the surgery but there is chance he will survive if he has surgery.....Medicare stood by their decision and will not pay for it! So yes, it happens.....the heart surgeon had to come in and tell my mother in law that her husband is going to die! Don't fool yourselves!
If this is true, you should post the name of the hospital and doctor so others can rally behind you in support, otherwise, this sounds like another 1 post stir the pot post about some so called denial of services by Medicare. I don’t want to sound insensitive to your troubles, but my 92 years old great grandmother, her 97 year old husband both had recent multiple heart surgeries paid for by Medicare even though the risk of death was greater during the surgery than not doing anything. So, I am a bit skeptical about this so called denial.
If this is true, you should post the name of the hospital and doctor so others can rally behind you in support, otherwise, this sounds like another 1 post stir the pot post about some so called denial of services by Medicare. I don’t want to sound insensitive to your troubles, but my 92 years old great grandmother, her 97 year old husband both had recent multiple heart surgeries paid for by Medicare even though the risk of death was greater during the surgery than not doing anything. So, I am a bit skeptical about this so called denial.
So, this sounds like it could be an Advantage plan issue. Which wouldn't surprise me in the least - as others on here besides Suzy have posted their in-laws in the 90's have had heart surgery and joint replacements in their 90s paid by Medicare.
So, mitenz, what kind of insurance are you talking about, here - Medicare or Medicare Advantage? Name the insurance company - or, is your regional CMS office denying the coverage?
Regions do differ in what they will approve.
We had one younger person die in WI because she moved into a different county, different CMS region which wouldn't approve the anti-cancer meds she'd been on for years previously approved in her old CMS region. Doc used a substitute, cancer immediately began growing again, by the time old meds were approved six-eight months later, it was too late.
Last edited by Ariadne22; 02-06-2014 at 09:30 PM..
There are age restrictions for very expensive and risky procedures, such as a stem cell transplant for someone 75 or over. In fact, I know in this case, it was not actually medicare that would not pay for the procedure, but the hospitals who refused to do it. Most hospitals establish a cut off age at 70. The patient I know of finally found one who would take him, and he was 75. Hospitals known for performing certain types of specialty procedures don't like to add to their fatality statistics. Similar to drug trials. Don't want the patients who might not give a favorable outcome.
It's not only age but whether or not there are comorbidities .To say he is going to die...well, yes, older people with that condition are but the mortality rate may be no or little different than the rate of people that have the surgery, with all the other factors being the same.
I do agree with Suzy that it should be a medical decision but on the other hand, there are surgeons that will perform surgery regardless of ...well...putting it in a very blunt way...for 'fun and profit'.
There's an old quip.. "The surgery was successful but, unfortunately the patient died"
Just from the bare facts that have been posted here, none of us can tell what the actual situation is.
I just had my first experience with medicare and I love it,I've never been without coverage since my mid 20's but this is the best.
Part A is free while Part B is $104.90. Still working so I just got a check for $314.70 out in the mail yesterday.
Each of us is different, having different medical conditions and needs, but the best supplement plan I could find for me was Aetna's Plan F which I am learning to love and pay $141/month for. I developed spinal stenosis and over the past six weeks I've seen my primary doctor twice, had an x-ray followed by an MRI which was followed by two epidural injections and then four sessions of physical therapy. It was wonderful, first time in my life I walked in and out of hospitals and doctors office without having my wallet leave my pocket even one time.
With my plan D I might pay out a little more than average, $276/month, but my medical costs are fixed and that is all I pay out except a little co-pay for drugs.
To be clear I am not saying the Plan F is the best way to go but for me it is.
I just had my first experience with medicare and I love it,I've never been without coverage since my mid 20's but this is the best.
Part A is free while Part B is $104.90. Still working so I just got a check for $314.70 out in the mail yesterday.
Each of us is different, having different medical conditions and needs, but the best supplement plan I could find for me was Aetna's Plan F which I am learning to love and pay $141/month for. I developed spinal stenosis and over the past six weeks I've seen my primary doctor twice, had an x-ray followed by an MRI which was followed by two epidural injections and then four sessions of physical therapy. It was wonderful, first time in my life I walked in and out of hospitals and doctors office without having my wallet leave my pocket even one time.
With my plan D I might pay out a little more than average, $276/month, but my medical costs are fixed and that is all I pay out except a little co-pay for drugs.
To be clear I am not saying the Plan F is the best way to go but for me it is.
A little more???
Are you sure this your correct premium??
May I ask what plan this is with what company and what are they offering that would induce anybody to pay that much?
A little more???
Are you sure this your correct premium??
May I ask what plan this is with what company and what are they offering that would induce anybody to pay that much?
I think he means his total expense, including ALL insurance premiums:
105.00 - Part B (actually $104.90)
141.00 - Medigap F 030.00 - Part D 276.00 - Total Insurance Cost
will be $276 - plus a little more for Part D copays.
Last edited by Ariadne22; 02-09-2014 at 02:24 PM..
I think he means his total expense, including ALL insurance premiums:
105.00 - Part B (actually $104.90)
141.00 - Medigap F 030.00 - Part D 276.00 - Total Insurance Cost
will be $276 - plus a little more for Part D co-pays.
This is correct.
I haven't been on it for long but so far Medicare is the best insurance I've ever had.
My wife and I have never been without medical insurance since we were married coming up on 40 years now but to be honest the premiums have been getting a little high once we hit our early 60's. Together our total premium was $1,400 and that was for a plan with a $1,500 deductible, $20 doctor co-pay and maximum out of pocket of $3,000 for each of us. In 2012 we were both hospitalized and we spent over $20,000 just that year so yes, that sure sucked. I had $2,000 in the budget every month just to cover medical insurance and co-pays. Biggest single living expense we had by far. Not paying it now I feel like I am wealthy.
I went with the Plan F which runs a little higher than average but it is great for someone who has some medical issues.
What I really like about that Plan F is the foreign travel coverage. Yeah, it's $50,000 lifetime coverage but I figure if we're on a cruise vacation in the Bahamas at least it's enough to get us back state side.
I have a deteriorating back issue which took two doctor visits, an x-ray, an MRI and two epidurals along with four physical therapy sessions and I discovered what it must be like to be a Congressman getting all this done for "free" with my wallet never leaving my pocket! I still have to pinch myself.
The only money that comes out of my pocket is for the Part D pharmacy deductible. Got all my drugs filled on 90 day prescription last month and had to shell out $485 but I think that is all for the rest of the year. I know Cigna has a $310 drug co-pay so at worst case I might have to pay $175 every three months which isn't bad at all.
One of the drugs I am taking is JENTADUETO and it isn't cheap. Pharmacy told me it would be $480 per month so I made darn sure I had Part D coverage.
Your MIL's family should contact her congressman. Someone who has never seen the patient in person should not get to determine treatment, and I doubt that anyone can determine with any degree of certainty that there is a "high probability" he will not survive.
Also, the surgeon should proceed with the surgery and fight it out with the insurance company afterward.
Payment should not get in the way of good patient care.
A little publicity might help, too, in this situation.
Is the plan traditional Medicare or an Advantage plan? If it's an Advantage plan, I suspect us Medicare aged folks would like to know which company to avoid.
I don't agree. Medicare will pay for some things - not others. For example - my late FIL's doctor told him he should get an ICD. Well Medicare in this region would pay for an ICD if the patient had A/B/C - but not X/Y/Z. Regardless of whether or not a doctor would be willing to implant an ICD for X/Y/Z. (As it turns out - my FIL had A/B/C and got his ICD courtesy of Medicare).
As it should be. Medicare isn't in the business of - and shouldn't be paying for "Hail Mary passes". It's already going broke fast enough .
FWIW - when it comes to advanced aortic stenosis (especially when combined with other valve problems) - traditional surgery is often a "Hail Mary pass" option - and many doctors won't perform the surgery.*
OTOH - there's now a new procedure/technology for patients with a terrible surgical prognosis: TAVR (Transcatheter Aortic Valve Replacement). I assume it's very expensive - and profitable too (because I see local hospital ads for it in our local newspapers). Medicare has approved its use under very limited circumstances in certain medical institutions that meet very specific criteria:
Perhaps what we're looking at here is an institution that wants to do a very risky traditional surgery on this patient because it isn't qualified to do a TAVR? Impossible to say. But I wouldn't rule it out.
Note that I'm not sure this new technology is a swell way to use limited Medicare funds - but TPTB in Medicare have spoken. Also - I doubt that age has anything to do with this (except insofar as an older patient may be a worse surgery candidate - especially if that older person has other medical issues). Also - I suspect most MA plans will follow Medicare guidelines in terms of covering certain surgeries/procedures for certain conditions. Robyn
*My late mother had bad aortic stenosis and her doctors wouldn't operate on her at age 80 or so due to the risks of death in the OR. It was a death sentence more or less. But she died 4 years later from colon cancer (not a pretty death) - not heart problems. In retrospect - had she been able to choose her manner of death - I don't know which she would have chosen (probably "none of the above"). In addition to my mother - my husband has a bum heart valve (but no aortic stenosis). So I tend to follow this stuff. And - even though I know more about medicine than most average people - it's very difficult to understand the medical stuff in general IMO - and especially difficult when it comes to a particular patient.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
.
