Thursday, October 13, 2005

Hopefully John's insurance will pay

Wow.  Last night I had a big scare.  John told me that Dr. Claxton, the transplant specialist, had told him that his insurances may not cover the bone marrow transplant.  I have heard of cases like this where the families have had to go fundraise before being able to schedule the transplant.  Now THAT would be a nightmare, I am already going through enough stress.

So after John tells me this at about nine o'clock last night, I got on the internet and did a google search.  I typed in "Will Medicare pay for a bone marrow transplant?"  John has Medicare Part A and B as his primary payer, and Medicaid as his secondary payer.  Where the search led me to was a page that explained what kind of bone marrow transplants would be paid for under Medicare.  John's bone marrow cancer (MDS) was not listed among those that would be paid for.  My heart sunk.  But at the bottom of the page there was a note that said that the bmt would be paid for if the local area (I think they meant state) agreed to pay for it.  

Well, needless to say I had a hard time sleeping.  I determined that as soon as morning came I would call both Medicare and Hershey Medical Center to see it he was covered.  At the stroke of 8 am, I dialed Medicare.  I asked the woman on the other end of the line whether or not the BMT would be paid for and she began to read from a book the page that I had read on the internet the night before.  I told her I had already read that page, and that John did not fall under any of the categories that were paid for, and told her about the blurb at the end.  I asked her if his kind of BMT was covered in PA.  She promptly told me she didn't know.  Sheesh, who was I supposed to ask then?  I asked her that.  She said she didn't know.  Then she told me to assume it wasn't covered, as it wasn't listed at the top of the page under the transplants covered.  I told her I wasn't going to assume anything (in my sweetest voice, of course).  Then she told me to call the hospital where he was going to get the transplant at.  

I got ready to dial Hershey Medical Center.  I wondered if this too would be fruitless.  Often I get somebody at a hospital who has no idea what they are talking about.  I hadn't had much experience with the clerical staff at Hershey, so leerily I gave it a try.  I was pleasantly surprised!  Immediately the receptionist put me in touch with a woman whose sole job is to be financial counselor to those who are going to have a BMT!

She told me that Medicare did not pay for those who got BMTs for MDS in PA.  However, she believed that John could probably still get the BMT.  The way it is going to work will be like this.  This woman Christine is the one that recommends to the hospital who gets the BMT.  She said she will recommend that John get one.  The physicians on staff will have to concur with her, but she doesn't forsee a problem, as the BMT is a medical necessity or John will die.

This means that the Hershey Medical Center will pre-approve the BMT for John.  Medicare will not pre-approve, however.  Hershey will go ahead and do the transplant.  Then Christine will submit the paperwork to Medicare asking them to reimburse the hospital.  She said that in the past Medicare has always reimbursed because MDS turns into AML (MDS leukemia - which kills you even quicker than MDS).  But even if Medicare doesn't reimburse the hospital, she said the hospital would absorb the cost, because the hospital already pre-approved the procedure.  That means John and I would "not have to pay the hundreds of thousands of dollars that would be incurred as a result of the procedure".

This presumes that the physicians agree that the hospital will take John on as a special "Medically Necessary Case" and pre-approve him.  I said all of the above to ask each of you to pray that the hospital will pre-approve John for the BMT procedure.  Otherwise, it aint happenin'.  But at least he has a good shot. 

Thanks, Krissy :) 

21 comments:

  1. Prayers being sent heavenward.
    Judith

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  2. Krissy, will pray for you. You know, this is going to be a God-thing. The only way John is going to have this surgery is because of the Lord working in his life for the Lord's glory. So we will wait on Him and will know the Lord will come through in His perfect timing and will. Try not to be too anxious and to know you are in the shadow of His wings.

    betty

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  3. Krissy, will pray for you. You know, this is going to be a God-thing. The only way John is going to have this surgery is because of the Lord working in his life for the Lord's glory. So we will wait on Him and will know the Lord will come through in His perfect timing and will. Try not to be too anxious and to know you are in the shadow of His wings.

    betty

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  4. `Praying that the doc and staff are on the same page and you guys don't have to pay:)

    Deb

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  5. Many thoughts sent John and Krissy, financial worry is horrid with everything else you both have to content with. (((( big hugs)))) Rache xx

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  6. Just awful that with everything you and John are going through right now, you have to worry about this.  I'm glad that the person at the hospital was able to put your mind at rest, at least a little.  Of course, prayers.
    ((((( Krissy and John )))))
    Sara   x

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  7. Krissy - I pray everything will go well with John and the hospital agrees to do the surgery....(Card was lovely thankyou-another on it's way to John).....Ally

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  8. Oh my dear friend. You did not need this worry on top of everything else. I am sure God will be there for you and John's treatment will be funded. I shall continue to hold you both in prayers xxxxx

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  9. Prayers for you.

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  10. We're praying. Hershey is a VERY good hospital! I know that it's the best one in this area of PA, so he's doing all he can. Prayers have been said!

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  11. Krissy I am so sorry to hear this news. You don't need any more worries, as I'm sure the hospital staff realise. I am sure they will appprove this, but Christine couldn't say that, for legal reasons, until she gets the physicians signature(s). Hugs galore for you and John.
    Sylvia xx

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  12. There should be no question whatsoever...those that cannot "afford" to live, still deserve to live...
    There has to be a way...if it comes down to fundraising, you will have lots of supporters...don't give up!  JAE

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  13. Dear Krissy,  I was going to ask you about your insurance the other day.....I pray the Hospital will absorb the bills.......I am pretty sure they will....My heart hurts for John ....If only I could make him well...I would do anything....Yes you will have your hands full but maybe you could have someone come in and help you...I know Medicare pays for that.....I just worry about you both so much and I know all the other people that comment do to...With all our prayers you will be ok

                                                  love and hugs     Myke

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  14. Dear Krissy,  I was going to ask you about your insurance the other day.....I pray the Hospital will absorb the bills.......I am pretty sure they will....My heart hurts for John ....If only I could make him well...I would do anything....Yes you will have your hands full but maybe you could have someone come in and help you...I know Medicare pays for that.....I just worry about you both so much and I know all the other people that comment do to...With all our prayers you will be ok

                                                  love and hugs     Myke

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  15. Dear Krissy, I hope now that Christine has made you both feel a little easier.  You have enough to worry about without the financial side of things. You are both in my thoughts.  Take care. :-)

    (((((hugs)))))

    Sandra xxxx

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  16. Yes he does have a good shot.  One of my biggest jobs at work is the health benefits department, and John has a really good shot.  Please if you have any problems email me and maybe I can give the two of you some ideas.  

    Terra

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  17. I could feel you anxiety in your words, but I am sure the hospital will absorb the rest of the cost...many cases they have...so think positive!!!  Hope you and John have a great weekend...relax!
    Hugs and prayers,
    Joyce

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  18. OMG Krissey i really hope they will cover it.Good Luck

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  19. Just go forward, the insurance fight can be waged later....and if you pay them $10 a month...then that is what you do... prayers coming...

    Be well,
    Dawn

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  20. How horrible that we have to fight to get needed health care.  It's amazing to me how the system works.  Keep up the good work!

    Chris

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