An elderly lady who is a client of this insurance agency visited our office on May 11, 2010. She showed to me documents that she had received from the prescription company that she uses for her Medicare prescription needs. The client is from Dyer, Indiana.
The prescription fulfillment company asked her to sign an ADVANCE BENEFICIARY NOTICE OF NONCOVERAGE. If she signs the document and Medicare refuses to pay for her prescribed need, the company will bill her $1,944.53 for every monthly treatment.
The reason stated on the document reads, “DIAGNOSIS MAY NOT MEET CRITERIA.” Federal Medicare officials approve only some reasons for the use of the prescribed treatment. If a doctor prescribes the treatment for a reason that is not approved, the patient will not get any financial help from Medicare for the treatment.
If Medicare will not help to pay for a treatment or medicine, usually the private insurance company will not help to pay for it either. The private insurance company relies on the soundness of the review by federal Medicare officials. Whether Medicare approves or does not approve a treatment or medicine makes a big difference to senior citizens. In the case of our client who was asked to sign the document, the difference is almost two thousand dollars per month. If she does not get the treatment, she will die.
Obama and his allies in Congress who pushed for the new health care law complained that health care was being “rationed”. They forgot to mention that much of the “rationing” was being caused by rules and policies of the federal health care systems that already exist.
Note: Woodrow Wilcox is the senior medical bill problem solver at Senior Care Insurance Services in Merrillville, Indiana. That is one of the largest senior citizen oriented insurance agencies in the Midwest.
© 2010 Woodrow Wilcox