[lit-ideas] Re: The flu

 
<<I'm  not sure--Virginia?--who said that Medicare does not pay for  
out-of-state
treatment, but I hope that this wasn't all that was said.  Medicare provides
coverage anywhere in the US.>> 
Medicare does not cover out of region treatment.  If a patient  lives in New 
England and decides to spend two months in Missouri (where we live)  and 
requires an oxygen concentrator and portable tanks, we, who are in "Region  D" 
of 
Medicare coverage cannot bill that person's Medicare because they do not  live 
in Region D.  Medicare simply denies payment with the code for "out of  
region".  Therefore the patient has the choice to depend on a company  long 
distance 
(which is unrealistic considering they need their portables  periodically 
refilled), pay us out of pocket (many are border-line  impoverished), expect us 
to provide services gratis, or not breathe.  One  other option is for the New 
England provider to bill Medicare as usual and for  us to send them an invoice, 
but that's a question of good-will between  providers.  If the patient wished 
to change to our Region they would need  to see a local physician (another 
expense to them), get a new prescription, call  Social Security to change 
address, with accompanying typical govt. paperwork and  wait time, and we might 
or 
might not eventually (given Medicare's hoops to jump  through) end up getting 
paid, IF the Dr. cooperated and sent us the Certificate  of Medical Necessity 
back.  I've had to wait 6 months, calling weekly, to  get a Physician's 
signature and the paper returned.  Because my husband is  good-hearted and 
can't bear 
to take an oxygen concentrator away from someone who  can't breathe from 
someone, we are providing several patients with concentrators  we pay for which 
Medicare won't cover and the patient has no means to pay  for.  Most big 
providers (Apria, Lincare, etc.) don't cut the patient that  slack and simply 
remove 
the machine and send their cumulated bill to a  collection agency.  Then the 
Dr. calls someone who is a single proprietor,  small business, like us, whom he 
knows will take care of the patient.  Jim  calls it a loss-leader and the 
physicians do typically refer patients to him who  can be paid on.  
 
 
Julie Krueger

========Original  Message========     Subj: [lit-ideas] Re: The flu  Date: 
11/23/04 9:25:02 PM Central Standard Time  From: 
_Robert.Paul@xxxxxxxxxxxxxxxxxxx (mailto:Robert.Paul@xxxxxxxxxxxxxxxxxx)   To: 
_lit-ideas@xxxxxxxxxxxxxx 
(mailto:lit-ideas@xxxxxxxxxxxxx)   Sent on:    
>Equally, medicare's not paying for  out-of-state treatment is bad.  I know 
you
have good hospitals that are  in effect national (federal?) as some of ours 
are,
but I assume only some  categories of people can be treated in your top ones.<

I'm not  sure--Virginia?--who said that Medicare does not pay for  
out-of-state
treatment, but I hope that this wasn't all that was said.  Medicare provides
coverage anywhere in the US. It does not though provide  coverage overseas. 
(So
don't jump off the Eiffel tower.)

There are no  'national hospitals.' There are just more well-known and
prestigious ones. A  regional hospital or medical center is going to provide 
more
services than  might a rural clinic. This is surely true in most countries.

With the  spread of advanced technology and the spread of specialization it is
unlikely  that anyone here would be sent to the Mayo Clinic (which seems no
longer the  almost mystical place it was in the middle of the last century)  
for
diagnosis. There would be no point in it.

The only criteria one  would have to meet to be treated in a 'top' hospital,
everything else being  equal, would be those having to do with specialization,
the unavailability of  needed services elsewhere, etc. 

Robert Paul
Reed  College
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