Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for
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Great practical advice, Marion. Even down to the detail about staying in touch with one specific person who has knowledge about the case. Some cancer centers have patient financial counselors who can help patients negotiate for coverage of procedures.
Zeekette…..given your experience it might help to contact Medicare on behalf of your friend. Prior to doing so ask the physician for explanation as to why they deem the proposed treatments to be necessary. Medicare: try to connect with one person and ask for direct e-mail and phone number for future reference. Tip: if the person you are speaking with is denying the claim, hang up, and call again to connect with another person. Await his/her response. If all fails you may need to contact a Medicare Attorney. Many offer free consults.
Good luck and please keep us posted.
Hugs,
MarionThat is the information I need-the Drs offices are recommending (oncologist and radiologist) but then their business offices are calling to say does not meet guidelines so she must pay first and then can appeal if isnt covered. As a retired nurse who worked with getting payment for patients I do not understand what guidelines they are using or how to circumvent in this case if the Physicians are not helping to get payment. Seems they dont want to deal with it but still want their money. So what are the options?
Zekette…..Medicare sets strict rules in regards to treatment options and in most instances (but not all) it sets the pace for reimbursement by Insurers as well. Take a good look at the reasons for non-reimbursement set out by Medicare; there might be a chance that it can be circumvented. Your friend needs to speak with her physician about this.
Best of luck and please keep us posted.
Hugs,
MarionHave a close friend recently diagnose and is receiving 2 chemo drugs but was told could also benefit from radiation seeding. However business office is telling her Medicare will not cover so she needs to pay up front. Why is it not covered?
Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for advanced-stage unresectable intrahepatic cholangiocarcinoma.
http://www.ro-journal.com/content/8/1/292/abstract
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