Amputee Treatment Center Forum

INSURANCE COVERAGE & ISSUES => Insurance Coverage => Topic started by: herb on June 10, 2008, 07:15:57 AM

Title: insurance
Post by: herb on June 10, 2008, 07:15:57 AM
Hi All - here is a MSNBC article about insurance and amputation  Herb
Title: Re: insurance
Post by: pegleg jack on June 10, 2008, 08:38:20 AM
Herb, it is just another company that us amputee's must fight tooth and nail to get them to reallize that we are just as good as any AB is, but no they want to put us back in to the backroom agian, like we were 15 years ago. back they we were freaks and about the only place we could get a job was the circus side shows.

Thats why i am working with the ACA  and another group down here in TEXAS to get the parity bills passed.

These insurance company dont want to spend any money that they can give to their CEO'S in bonuses and servance pay, let a lone thier base pay, most of the are being over payed any how as far as i am concerned.
Title: Re: insurance
Post by: snowbear on June 22, 2008, 11:50:45 AM
Something desperately needs to be done! this a a absolute shame for all us amputees. >:(
Title: Re: insurance
Post by: ann on July 19, 2008, 08:33:20 AM

Do most of you that's on medicare here in the US also carry a supplemental policy plus a prescription policy?Thanks, ann
Title: Re: insurance
Post by: pegleg jack on July 19, 2008, 09:43:39 AM
no ann i dont i just carry the supplemental policy and the prescriptions are included in it, right now i only by 3.00 for generic brand 30 day supply and one of my other i pay 30.00 for a 30 day supply. From what i understand it is if you are on MEDICARE and dont have the supplemental is that you need the part D. prescribtions policy. Check with your local social security office and they can tell everything that you need. I am happy with what i have now
Title: Re: insurance
Post by: ann on July 19, 2008, 08:42:29 PM
'PegLeg',  I will have to check on that.  At the present time I have Medicare and a prescription policy...I pay $5 for generic for a month.  But I didn't know that a supplemental policy covered prescriptions...I have to have drug I take several and it adds up quickly.  I always am in the donut hole for at least four months.   :) ann
Title: Re: insurance
Post by: Mitchee on July 19, 2008, 09:56:43 PM
Hi PLJ and Ann,

I used to be on Medicare.  (I just returned to having group health insurance.)  While I was on Medicare, I had a supplemental policy AND Medicare part D for Rx coverage.  If you did not enroll in the initial enrollment period for Medicare Part D coverage, most likely you do NOT have Rx coverage.  Also, if you have supplemental coverage, that does NOT guarantee that you have Rx coverage.  Most supplemental policies that covered Rx's PRIOR to medicare part D, DROPPED their Rx coverage because they required that a person enroll in Medicare Part D coverage.  This info may not be accurate if you have Medicare HMO coverage.

Does this make sense??  Any questions, please do not hesitate to ask me or send me a PM. 


Title: Re: insurance
Post by: pegleg jack on July 20, 2008, 01:21:12 AM
Mitchee, you are right i just check my card and i have both and have two differant address to send claims to: one for medical and the other for drug claims, i used to have Humana and it was costing us 140.00 month plus the medicare deduction out of our checks, know i have no premiums just what they (gov) takes out of our checks, which i believe is over 90.00 a month now.

Thanks for the update and information on this.
Title: Re: insurance
Post by: ann on July 20, 2008, 09:37:22 AM
Thanks guys...I am looking for a supplemental @ the present time to go with my prescription & medicare policies.  I just received a bill from the hospital for  over {$30 thou }that was over three years old. GRRRRRRRRRRRRR  I can't for the life of me, understand why they are just now sending it.  AND   they had the gall to ask if I  could send them the complete payment or put it on a credit card?
Title: Re: insurance
Post by: herb on July 20, 2008, 08:08:36 PM
Hi Ann - I had a similar experience a few years ago on a bill for my youngest son. The insurance company payed the bill but then on review decided that the hospital did not handle the invoicing properly so they withdrew the payment and the hospital, then sent me a bill for $26 thousand dollars. I had to fight with collection agencies, the hospital and the insurance for more than a year to resolve that.Another time the insurance company withdrew a payment that was made because they decided it was an accident and they thought somebody else might be responsible for the bill. My son had fallen off one of my horses. They eventually repayed the bill but it took hours on the phone and several letters. It seems as though the insurance put too much effort in finding ways to avoid paying legitimate bills. My little brother died a few years ago because his insurance denied coverage for a treatment he needed. He appealed the denial twice before they agreed that they would pay for the treatment.By that time they had delayed their approval for a year and he was too weak to get the treatment and he died shortly after he got the approval. I have had bills pre-authorized and then not paid. I think that many people in the insurance business are no better than criminals. Herb
Title: Re: insurance
Post by: pegleg jack on July 21, 2008, 09:55:43 AM
Ann and Herb, our family had that same thing happen to them, what happen my sister had a stroke and then after about two years one of the hospitals that she was in came up and said that she owed them if i remember something around 12000.00, and demanded full payment right now, what she did was told them that they would get x amount every month until payed off, oh they screamed and threatened her about it but after  about 3 or 4 payment they stoped.

I am right now doing the same thing on a bill that MEDICARE didnt pay on my wife ROTO CUFF surgeray, and they keep saying that  it is past due and are going to give it to a collection agency, but it hasnt happened yet because they are getting their money, not as fast as they would like to but still the same it is getting payed off,

And i know that it is going to happen agian on my operation, that there is going to be a big bunch that MEDICARE will refuse to pay and it will have to come out of my own pocket.

Dont qoute me on this but have been told as long as you are pa;ying something each month that they are limited on just what they can do to you.

I remember a nother story that happened that is similiar to this a guy owed the hospital in the town i was raised in somewhere about 12000.00, they kept bugging them and this is what he did to them and they couldnt do a darn thing about it, the first of each month he would go into the hospital and lay two quarters on the counter and ask for a reciept and that was his payment on the bill, and they the hospital tried everything in the book to get him to pay it off, (he had the money in the bank), but the hospital found out lthere was nothing that they could do at that time, now i know that you have to make a lot bigger payment to keep them a bay, but it can be done
Title: Re: insurance
Post by: ann on July 21, 2008, 11:00:39 AM

PLJ,  I feel like taking the whole three years to pay off what I owe them.  It would serve them right if I did.  I did tell them I thought their accounting system  needed a work~over.  She tried to blame it on the insurance co., but it was their mistake!!  It will be paid, but in my own time; in payments. ;D
Title: Re: insurance
Post by: stinker373 on August 06, 2008, 12:22:56 PM
Almost every amputee that is covered for 80% has to think twice before buying a limb.  the 20% is way over our heads and can be as much and $13000.00 and more.  Where ae we spose to get that money? From a hat?  I know most of us dont have that kind of  money in our bank accounts.  There has to be a way of changing the system to help us out with this expense.  If we are spose to pay for it that means that our jobs will eat up our limb expensises very fast and what to do we have left to live off of.  Maybe stay home and not work?? In that case government considers a basic limb which is literally made of wood.  Walk on that if you dare.  That is what the government pays for. If you are working guess you might be walking to work.  You wont be able to afford a car. Ok I see, take out a loan which turns into much more money after its payed back.  Then you are back to square one becsuse by the time you manage to pay it back your leg is now broke and so are you.  Insurance will not pay for repairs to limbs and we all know how expensive that an be.  Oh. lets not forget that limbs are only warenteed for 2 years.  Insurance only pays for a limb every five years.  Waht do you do inbetween this time frame?  WALK IN AGONY as you manage to go to work and your back gets really bad. 

Now how much of this realates to you as an amputee?
Title: Re: insurance
Post by: pegleg jack on August 06, 2008, 01:48:13 PM
About all you can do it start riding your wheels like i am right now cause i cannot afford to have a new pair of sockets made right now to i am stuck in my wheel chiar for awhile, dont know how long this is going to be.

There is a lot of people in this same boat, and i dont know of much we can do, for those clowns in DC dont give a hoot about our needs as long as they get thiers first, have ask both of our SENATORS down here in TEXAS about changing this and they start running the other way, they dont want to mess with medicare except when they can take or cause use to have pay out more for our needs.

Being in my chiar is because of an operation on both legs i just had but i am going to have to have both sockets replaced.
Title: Re: insurance
Post by: snowbear on October 10, 2008, 03:27:01 PM
I just ordered 2 new liners mine are shot and about 10 months old. I need more socks to make up for it, as its worn out. I have to pay $202. 63 cents for them we have 80% coverage. It nuts the liners are about  $600.00 a piece and only last 6 months or so. ::)
Title: Re: insurance
Post by: pegleg jack on October 10, 2008, 03:49:20 PM
Snowbear, i know just where you are coming from on this, i just got my last set of liners paid off today, and it take four of them for me and like you said sometimes they only last 6 to 8 months, so far as sock are concerned i have plenty of them that was given to me, so wont have to buy to many of them. And at 600.00 apiece it dose get a little pricy every time i have to get them and i too am on MEDICARE.
Title: Re: insurance
Post by: snowbear on October 10, 2008, 04:01:02 PM
We had 100% coverage and it was nice. we had blue shield. My husbands company changed and dropped Blue Shield. We have MVP and have 80% it sure beats the other choice if 50%. ;D
Title: Re: insurance
Post by: herb on October 11, 2008, 11:46:08 AM
Hi Snowbear - the liners I used in the past cost $1400. My insurance then paid the whole cost after my deductible. Now they cost a little over $600 and with my insurance I have to pay a deductible and 20% of the balance. It is hard to believe that the liners should cost so much. Herb
Title: Re: insurance
Post by: snowbear on October 11, 2008, 07:37:37 PM
yes mine cost $600.00 a piece too. The price of our needs is astronomically!
Title: Re: insurance
Post by: pegleg jack on October 12, 2008, 08:35:33 AM
I have read this somewhere, maybe steve can help me on this, i beleive i saw the cost of a iceross silcone liner in the UK was around 200.00 a piece.
if that is true then they are making thier money off of us here in the USA.

Title: Re: insurance
Post by: snowbear on October 12, 2008, 08:52:37 AM
 :o :o WOW! ???
Title: Re: insurance
Post by: Dick Stevens on October 17, 2008, 12:11:44 PM
I,too, need a pair of BK prostheses, and have just 80% coverage.  And, yes, $6000 to $8000 (20%) is a big hit.

Here in PA, the insurance industry managed to derail a parity bill.

We argued that amputees represent just 1% oe less, of the total population - so the total cost should not be burdensome to insurance companies.

BUT, that same fact (less than 1%) means that we don't have alot of clout because we don't represent alot of voters - a cruel political fact of life.

We really need a national parity act - because fighting state-by-state is a never-ending battle.  For those of you whose states DO have parity, congratulations.  Unfortunately, here in PA, the special-interest lobbyists - including Insurance Industry - rule the roost.   >:(
Title: Re: insurance
Post by: ann on October 19, 2008, 08:26:16 AM
'Dick' is that for one or two prostheses?  Makes it bad when your legs change and it's that much money out of your pocket.  Ohio doesn't have the parity act either.
Title: Re: insurance
Post by: Dick Stevens on March 10, 2010, 03:00:09 PM

That's $15K per leg, or $30K for the pair.

The 20% co-pay is $3K per leg, or $6K for the pair.

That was awhile ago, the prices may have changed since then.
Title: Re: insurance
Post by: pegleg jack on March 10, 2010, 05:23:26 PM
HERE is what my new ones cost me last year and i am taking the number right off of the bill they sent me,

lthey billed MEDICARE AND MY INSURANCE CO = 36972.86
The insurace company paid 34,283.67
my out of pocket was 2734.19

and this is for two BKA legs,
Title: Re: insurance
Post by: Dick Stevens on March 11, 2010, 12:09:59 PM
Thanks, Jack:

I guess my figures were out-of-date.  No surprise.

But, it sounds like you got a good deal, if you only had to pay $2700+ for a pair of BK's costing $36K+.

I believe I'd have to pay 20% of the total, whatever that might be.

I hope your new legs are just what you need.  Wear 'em in good health.
Title: Re: insurance
Post by: ann on May 23, 2010, 01:14:15 PM

 Jack, I just read something online that almost made me sick...when I get time I will type it out so you can read it also.  Health insurance...Uggg

Hope you are having a nice day :)
Title: Re: insurance
Post by: pegleg jack on May 23, 2010, 04:36:37 PM
the first go around with the insuance company they disapproved me getting a new set of legs, but between me and the company that is making my legs and my doc all screaming at them they come though and approved haveing them made, come to find out if you scream loud enough you can get what you need, and i am wearing my new sockets right now and man what a feeling just like a old comfortable pair of shoes, had to go though two sets of test s ockets to get it right, but my leg maker said to me if it dont fit right, that we start over and do it agian until i feel comfortable with them. and he used the digital mapping agian this time and he has gotten it down and can really make a fine set of sockets, the first pair we went though four sets of test sockets. and i almost didnot believe him when he told me that my stumps had shrunk 3/4 of an inch and that is why i was getting those nasty blisters all the time and that my legs would not tollerate the vacumm system so i am back to the old reliable pin/lock system. And if needed i can get new sockets made every year if needed, and if we yell loud enough, i can get a complete set made. Am trying out a new liner and it is made by OWW. and it is 9 mm thick and is more comfortable to wear and easier to put on. it has a differant material than the others and rolls on faster. and dosent want to wringle up in the back like the 3 and 6 mm liners and they are the ALPHA MAX.  ALL for now.