New Medicare Rule! Can"t Get My Fill!

[NeenBand 7]

I'm furious!! First I had to wait over 3 months before medicare would pay for a fill.

So FINALLY, I have my first fill scheduled for July 13th.

I get a call from the doctor's office saying Medicare has just put through a stipulation that in order for them to pay for it, I must get my fill at a center or hospital of "Certified Excellence". My doctor does not belong to a place "certified" with them, and in fact they told me, there are very few in the country.

SO NOW I CAN'T GET A FILL!!!

I'm sitting here with a band in me that they paid for, and that I'm also paying for and it's doing nothing, NOTHING for my health.

Out of pocket would cost me over $650, and if I needed an unfill, that would cost me extra too.

Medicare will also not pay for surgery now unless it';s at a place "Certified Excellence", so if you have Medicare and your getting this done, you better look into it.

[DrewsLou 3]

Holy moly! Your doc would charge you 650 bucks for a fill?? What a rip off!

I too despise Medicare. My hubby is disabled and it's a joke sometimes to get things paid for.

[barbara465 2]

I can't believe your doctor would charge that much. The norm seems to be around $100. I would start shopping around as the band does no good without a fill.

[NeenBand 7]

Well, the doctors are highly respected AND also work in a very affluent area. Plus, they do it under flouroscope, no exceptions.

I'm trying to get through to Medicare to complain.

[DrewsLou 3]

Good luck to you Leenerbups!

[BPM 0]

That is the highest charge for a fill that I have read and I think I have read nearly every post on this board.

I'd complain to your doctor.

[NeenBand 7]

I called Medicare and basically, I'm out of luck.

I have charity care with the hospital, but the doctor's fees are $450, I am told.

I'd really rather have it done by fluroscope, and I don't even know if getting it done by a different doctor is even an option. I don't want to

jeopardize my relationship with the current doctor.

[Stitchy 0]

Well, Leaner, if you doctor can't give you fills, you don't have much of a relationship with him.

I'd bet that he may charge Medicare $650, but that they would actually pay less. If you have a good relationship with your doc now, maybe he would be able to do it for what they will pay?

I would try that approach. And when (if) you get through to the medicare folks, ask what they charge.

Good luck.

[Alexandra 55]

Hi Leener,

Man, that is a sucky trap to be in! I know that both Morristown Memorial and St. Clare's Dover are in the process of becoming Certified Centers of Excellence, but who knows how long that will take? In the meantime, I'm sure that the docs at ALSOM will help you work out a payment plan for them. The hospital will too, I'm sure. But I hear you, you really don't want to be racking up that kind of charge for a fill.

Have you talked with Josephine or the doctors about it? You can't be the only patient in the same boat, I'm sure. See if they have any suggestions. They might actually refer you to a doctor in the city or something for the time being. You're not going to jeopardize your relationship with them because of this, I promise.

I'm sorry about this...I'm sure it's little comfort but there WILL be a Center of Excellence in our area in the near future. You can be sure of that.

[Randi 0]

Leenerbups,

It's sounds like Medicare has come up with a new ploy to reduce their costs for at time and levy it on their insured. Go out to http://www.fillcentersusa.com/. Maybe you can find a location nearby to get a fill for waaaaaaaaayyyyyyyy less than $650. I would also ask the surgeon's office why their fills are priced so high, especially if you're a current patient. I would think $200 would be the max for a flouro fill.

[NeenBand 7]

Thanks for the suggestions everyone. They help.

Alex, I'll call tomorrow, thanks!.

[Jachut 487]

I think your best option really is to call. I'm sure they wont leave you high and dry at this late stage, and will be willing to work something out with you. But if you dont ask, you probably wont get. Good luck.

[Alexandra 55]

I would also ask the surgeon's office why their fills are priced so high, especially if you're a current patient. I would think $200 would be the max for a flouro fill.

Randi, fills here are done by the surgeon himself at the hospital in the radiology suite. The surgeon's fee itself is about $300, but there is also the hospital charge over which they have no control. The surgeon makes a special trip and blocks out part of his day to do fills (though they could easily get away with letting someone else do the fills, I'm selfishly glad they don't). And we're in an NYC suburb so prices are very high anyway.

[Randi 0]

I hear ya Alexandra, but the cost of that fill leaves my mouth hanging open. :omg: I absolutely can not believe someone charges that much for a fill.

[DrewsLou 3]

I guess I'm lucky, my doc only charges me $15!