Working with Medicare

Maryanne,

I just saw this post from you concerning Medicare. Since that post is so old you may not see my reply, or you may have see a post from me on the Experiences Discussion Board yesterday.

In any event, here is a copy of what I posted yesterday pertaining to Medicare:

“One other thing someone mentioned — clinical trials. I’ve been on many clinical trials throughout the past six years. Some worked, some didn’t work. But, I’m certain the ones that did work have kept me around. As it turns out I don’t have lots of choices other than most trials because I’m on Medicare and the last time I checked they only approved three drugs for CC. Additionally some of the major medical gap insurances will only cover what Medicare approved. A chilling example is one drug was so successful that I was taken off the trial. But, not unexpectedly, the tumors came back in about three months. But I was ineligible for a trail since I’d been on one, which is normal protocol. Medicare, however, declared the drug, approved for other cancers, could not be approved for me even though it had been working. It was an “Off Label” drug in their nomenclature, so I either had to persuade my secondary insurance to pay for the treatmentsl, or negotiate with the drug company, or pay them myself — which, if I took it for a year, would have cost me $200,00!. Fortunately the insurance ran it past all their medical staff and decided to pay the cost. This experience also showed me the “retail” vs. “wholesale” price of the drug. It would have cost me $12,000 per treatment, but the hospital rate to them was $3,400. “

One of the main things we learned about Medicare is how cold-hearted they are and also it is important to get secondary insurance which covers more diseases than Medicare. Some only cover what Medicare covers but pays the additional costs beyond Medicare’s allowances. At least that is my understanding.

Good luck and keep up the faith.

Jerry D.