Is Medicare.gov the Best Option

[carol369]

Who it's covered by depends on who is giving the injection. If the injection is done at the doctor's office, it is covered by Medicare Part B. If it's a self-injectable, it may or may not be covered by a Part D plan.

It's given by the doctor so it's covered by Part B then from what you're saying. Thanks!!

 

[G.Gordon]

I only use Medicare.gov for my own protection and a good way to cover one's ass. If it is MEDICARE making the estimate and plan suggestion then your butt is covered. Be sure to explain the donut hole, any restrictions, etc.

 

[billyg]

Of course we are not allowed to ask them if they take drugs in the first place because that is considered underwriting or cherry picking and CMS has a special place for agents and companies that violate that rule.

So in a recent certification training the trainer from a major carrier suggested something like this:

Mrs. Smith, I am not allowed to ask you for your list of prescriptions; however, if you choose to provide it voluntarily, I will use it in the Medicare.gov plan finder to help you in your decision of which plan will serve your needs.

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It's given by the doctor so it's covered by Part B then from what you're saying. Thanks!!

It is probably covered by Part B, but check with the doctor's billing clerk. I have come across 2 cases where very expensive injectables (one for cancer and the other for Hep C) were not covered under Part B. Just making the assumption whould have missled the clients and cost them lot's of money. A 5 minute phone call can save you an E&O claim later.

 

[carol369]

So in a recent certification training the trainer from a major carrier suggested something like this:

- - - - - - - - - - - - - - - - - -


It is probably covered by Part B, but check with the doctor's billing clerk. I have come across 2 cases where very expensive injectables (one for cancer and the other for Hep C) were not covered under Part B. Just making the assumption whould have missled the clients and cost them lot's of money. A 5 minute phone call can save you an E&O claim later.

ok, thanks for the info. I'll call the doctor's office & see what the billing dept says.

 

[sman]

So in a recent certification training the trainer from a major carrier suggested something like this:

- - - - - - - - - - - - - - - - - -


It is probably covered by Part B, but check with the doctor's billing clerk. I have come across 2 cases where very expensive injectables (one for cancer and the other for Hep C) were not covered under Part B. Just making the assumption whould have missled the clients and cost them lot's of money. A 5 minute phone call can save you an E&O claim later.

Great point. Guess I should have clarified that it still has to be a Medicare approved medication/procedure. My only point was in clarifying who the claim is filed with (Part B or D).

I had a client who was taking chemo and Medicare didn't cover it because the chemo he was taking wasn't normally used for the type of cancer he had. Who would have ever thought chemo wouldn't be covered by Medicare? Not me.

 

[somarco]

Scott, I am sure you know this, but CMS determines acceptable treatment protocol. They approved specific drugs for specific medical conditions.

If a provider wants to use the drug off label the Medicare beneficiary should be notified that they may be liable.