Damn Medicare and Obamacare and all Healthcare!

Okay, I know some of you are big supporters of Obamacare and I'm really not here to argue about that.  But the fact remains that our healthcare system is totally screwed up!

Butch cannot receive treatment at the Cancer Treatment Centers of America in Tulsa because they just flat out do not accept any medicare patients any longer.  Neither does the CTCA in Phoenix.  The centers in Chicago, Atlanta and Philly do accept a very limited number of Medicare pts, but they won't accept a pt from Texas!  

I told the man on the phone that we would be willing to pay the difference between what Medicare would pay for a particular procedure and what it cost, and he said they were prohibited by law from doing that!  Medicare won't allow patient billing.  The hospital loses money on every Medicare pt they accept.  I understand their reasoning, but it makes me furious.

And, if we wanted to self-pay at CTCA, we would have to start by establishing an escrow account of $250K before they could begin testing and treatments.  I just had to let it go.  But it makes me so angry that we cannot seek treatment at the facility of our choice!

So we are now trying to get into MDAnderson in Houston.  Thankfully, we went there several years ago when Butch was first diagnosed with prostate cancer and I still had his pt id number!  That helped.  I went and faxed the radiologist's report to them this afternoon and have called his old doctor in Nacogdoches to have them fax all of his records to MDA and hopefully we will have an appointment there in the next two weeks.

In the meantime, we do have an appointment next week with an oncologist at University Hospital in SA.  I looked them up.  University Hospital is a cancer center of some small renown, but is ranked #12 in the state of Texas.  However MDA is ranked #1 in the nation.  There's really no comparison.  I say if we have the money to afford the stay in Houston, we go with MDA.  

Anyway, our trip to the doctor was kind of a bust this morning.  We only saw the nurse practitioner, not the doctor (what is it with this second level of care you have to go through before you can see a real doctor these days???), and she did set us up with the oncologist in SA and also a pain management doctor, but that appointment is for TWO WEEKS from now.  REALLY?  Butch cannot possibly go another 2 weeks without pain management!  I insisted that she do SOMETHING for the pain right now, so she gave him a shot of toradol, and then 2 new Rx for another pain killer (Norco) and for a nerve drug.  Maybe they will work.  The toradol helped immediately and he was able to nap all afternoon, so that was good.

Well, after all that, I had a headache.  I tried taking 3 Tylenol, and they didn't touch it, so I just gave in and took a single Advil.  I managed to fall asleep and when I woke up the headache was gone.  I feel pretty wrung out--emotionally and physically--but I'm doing okay.  So many details to work out, but I'm a determined woman.  I will get it all figured out.  

I thank you all for your prayers and encouragement.  Please keep 'em coming!  Love you all! 

I HEAR YOU!!!!!!!!!!!! HUGSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS!!!!!!!!!!!!!!!!!!!!!!!! The system sucks!!!!!!!!!!!!!!!!!!!!!!! OBAMA well you already know how I feel about him and his health care system!!!! KMA!!!!!!! Being #12 isn't THAT bad Vic...still not #1...I know...BUT I hear what you are saying!!!! Hang in there sweetie!!!!! A couple WEEKS is NOTHING!!!! I know it seems like a LONG time to you and Butch but its not that long trust me!!!! FRUSTRATING I KNOW!!!!!!!!!!!! I have been in your shoes lots of times!!!! It WILL get better it will get WORSE!!!! HANG TIGHT and TOUGH!!!! I am here for you!!!!!!   

Love you!!!! HUGSSSSSSSS

Vicki, 

Just getting to read posts. I am sorrow to hear about Butch. Also sorry to hear about CTCA. I am not surprised.  The good news is MDA is an incredible treatment center. As a case manager director we worked with them on a couple of cases we referred for treatment. 

The rules regarding Medicare reimbursement and not being able to balance bill or accept payment over what Medicare pays occurred long before Obama was in office. While it may seem ridiculous from an individual perspective, it was geared to protect the individuals without money to pay the difference from getting lesser levels of care than those who could afford to pay. 

You are in my thoughts and prayers. 

Francine

Vickie...I am so sorry...Obama can KMA too!!! 

Our country is going to hell....our health care sucks!!! Only the wealthy can afford good insurance anymore. This madness has to end soon!!!

Sorry if I offended someone....this is just my opinion.

We shouldn't have to fight for our lives!!!!

Love you sweetie...HUGS....connie d

Under original Medicare:

A physician may.   1. Decide not to treat Medicare beneficiaries

                            2. Enter into an participating provider contractual agreement with Medicare

                            3. Accept Medicare as a non participating provider

They only be one of the three.  they may change which of the 3 that they are, but they must inform Medicare

Questions? Call 1.800.medicare 24 hours/day.  they are very nice.

When they are a participating provider, they accept Medicare's approved amount as full payment contractually.  patients pay less for each service and the physician receives less for each service.

When they are not a participating provider, they are not bound contractually to Medicare's determination of the allowed fee.  the provider receives more money and the patient is free to enter into a contract for service with the provider.  the provider, who is free of the contractual agreement with Medicare, may in writing provide a service and the Medicare beneficiary may agree to pay for the service at an agreed upon rate.

The provider's contractual status, freely entered into, with Medicare legally binds them to what they can and cannot do, as far as billing and accepting payments for services, for all of their Medicare patients.