Medicare and Liver Transplants

We need to lean heavily on the Secretary of HEW to change this insane policy, if in fact, Medicare still disallows coverage.

Medicare used to require a 'study' for a cardiac patient to get an AICD (pacemaker/defibrillator).  The 'study'  included inducing an arrhythmia in the patient, with potentially fatal results.  Medicare has since reversed itself on this crazy policy.  The apparent genesis of this policy came about when some genius in the Social Security Administration realized that as many as 250,000 per year could benefit from the technology ... then came the realization, "How are we going to pay for this?"  Thus came the gatekeeper policy of a 'study'.  At the time I had to go through this nonsense, I wrote to my US Senators, Congressman and the Secretary of HEW.  Only one Senator even had the courtesy to reply, but it was clear his aide who replied didn't even understand the policy in question.

There are clearly some circumstances where transplantation for cc patients makes medical sense, and this needs to be forcefully presented to the appropriate administration officials.  This is another case of the government denying effective and needed care.

Have you tried calling your carrier to find out where your planned treatment is at in their decision process?  Most carriers have a doctor on staff who's is the final authority on approval matters.

Margaret, I appreciate your insights.  I, personally, have never needed to deal with any of the insurance ropa dopa, which is inherent in HMO plans.  I had conventional non HMO when I had a major cardiac surgery in 2001.  In 2009 I had a resection, covered by Medicare, and last May a lung surgery, again covered by Medicare.  I never have had to deal with any approval process at all, although the hospital may have on my behalf, but that was totally transparent to me and there's never been a case of any procedure delayed.  My take on medical insurance is for most people, PPO plans are probably best.  HMO's are OK for healthy people, but are not too great if you get a serious medical issue.  Unfortunately, it's not always possible to predict illness.  I know people with cc and HMO's and they must get approval for almost everything.

Lisacraine
My mother is waiting for insurance approval for radiation treatment at CCF. We recently had appt with Dr. Stephans and Dr Estfan. They are planning for the IMRT radiation about 6 weeks they said along with Gemzar chemo.  I just called the office friday to check if insurance approval was obtained, they're still waiting.