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I will NOT mention the fact that I spent a huge sack full of cash ($4375 to be exact) during January and February for drugs through Medicare Part D, which basically made me feel like I had no insurance what so ever. Finally my drug costs were reduced to a reasonable amount ($156 for a month of meds) which is around the amount I was paying with private insurance...oh wait, I just did?!...
This is a great time to talk about Medicare Part A & B and the mysterious Part F, with a lot of HIVers' losing medical coverage because of unemployment. Once COBRA runs out Medicare/Medicaid is the only option for people with HIV, unless a partner/spouse has private medical insurance. Being HIV+ is textbook for a preexisting condition, sorry! In my case, I found myself on disability and in the process of ended my relationship with my boyfriend. We had co-habited and qualified for domestic partner benefits. Adieu, adieu...privy medical coverage, thoughts of me going to an HMO, even worse a clinic, or paying astronomical amounts of money to my own PCP doc and what exactly is a "referral"? A lot of worry for nothing, I'm now more in control of my health coverage than ever. Already having Social Security Disability (SSD, not SSDI) after COBRA ended, I was automatically cover under Medicare Part A (inpatient/hospital) and Part B (medical: doctors, outpatient services, etc.) Add on magical and mystifying Part F (not sure what happen to C and E?) and for $270 odd dollars a month, you can see doctors every day of the week!
Empire Blue Cross Blue Shield is my Part F provider, and as much as I detest Scott Serota, CEO of the Blues, Part F is actually a bargain for me. It's a great example of a private company (Empire) working alone with Medicare (The Federation Government). I'm no accountant, and I'm not sure if Empire is making a profit on my $270, or if Medicare is hemorrhaging money, but it look good for my house! Let's take the last eight month as an example. Having a great infectious disease HIV/AIDS primary care physician, who is continually in New York Magazine's "Bests Doctors of New York" for over ten years running, isn't enough for me. Luckily my PCP does accept Medicare; BTW if the provider does participate in Medicare Part B as the primary insurance, Part F is routinely the secondary. Now for the magical portion, Part B cover the 80% of the office visit, Part F covered the additional 20%. And the cryptic referrals, which I thought were literally when your PCP called a specialist to have a chat, are actually just numbers for insurance proposes. Part F doesn't require referrals EVER. It's basically free (not literally) and no referral red tape. In late September 2008 after suffering from extreme allergies, I checked myself into the ER late on a Friday night, complaining of severe pain in my right lung every time I took a breath. Scare it might be PCP rearing its ugly head again (already had full-blown PCP in '96,) I didn't want to take any chances. After a chest x-ray and several tests I was diagnosed with only good old regular pneumonic...phew! The pain I felt was a bruised rib bone...who knew? My three and a half hour visit to the ER costs close to $5000, I owed nothing thanks to Medicare Part F!
This was blog is turning into a novella so I try to wrap it up and discuss my clever subtitle. Fortunately, my gastroenterologist also takes Medicare, I've been seeing him for years, and I still here after living throw liver disease! Sadly I had to say goodbye my neurologist/psycho-pharmacologist because she was opposed to taking Medicare and took NO insurance. I had to pay $250, submit a bill and wait patiently by the mailbox every time I say her...ugh. After my private insurance ran out, I saw her less and less which wasn't good for me in the end. After meeting a few doctors and taking the advice of one neurologist I decided to "localize" my docs to ONE hospital - New York University Medical Center. My AIDS PCP is also a professor at NYUMC, maybe that why he doesn't wait time with drug reps and only has office hours twice a week. Using NYUMC has my home base I search for docs practicing or affiliated with the hospital AND Medicare participants. I now have a neurologist AND a psychologist who concentrate on epilepsy (I suffered from seizures following my stroke.) The neurologist has in coming handy dealing with my neuropathy over the last several months (read "Spring Hibernating...?") The physical therapist, which the neurologist sent me to, also takes Medicare. With AIDS wasting comes bone loss; in addition I'm seeing a rheumatologist (see future blogs.) When I need a new prescription for contacts or a CMV checkup, I've got a Medicare ophthalmologist on hand as well. Just to reiterate: When I see a doctors/specialists there is no exchange of cash, check or credit card, I only need to speak to the receptionist to make another appointment or say "Cheerio!" For me the $270 is peanuts compared to the expenses and hassles I would rack up over the curse of month. Now if we could only do something with Medicare Part D...?
Dplus
Hi David,
Thanks for another thought provoking and uplifting post. I have to admire the way HIVers in the States cope with all the rigmarole and financial stress surrounding medical costs, as well as HIV itself. Here, in the UK we have completely free HIV care from consultations to meds and everything in between. For this I am grateful. HIV is stressful enough and not worrying about costs is very beneficial.
Keep the posts coming, and good luck with your health.....and money.
Michael.
Wow! Your story sounds so familiar. I went through much of the same living in NYC and in LA. Today, i've relocated to NM. Aside from being beautiful and slow, I have managed to have my hospital stays, my doctor visits, my meds all paid for.
Am I just lucky or is NM that good in support of the HIV community. Keep at it, my friend. You are not alone and do have support. At least from a distance.
Take Care.