1 Topic by mlepp0416 (edited by mlepp0416 Mon, 16 Jan 2012 20:02:42)

  • Registered: Fri, 08 Jan 2010
  • Posts: 832

Topic: Medicare and Transplants.

Marions asked me to post this under Insurance:

I just found out recently that if a person is over age 65 generally transplants are NOT an option.  My brother in law was diagnosed with failing kidneys and they refused to put him on the transplant list because he was over age 65.  His wife had a liver transplant when she was 60 (pre Medicare).  Even a live donor was out of the question.  Apparently if you are over 65 Medicare feels a transplant is a waste of money?

Marions posted that in Texas Medicare would not pay for a transplant.  I live in Wisconsin and so does my brother in law.  So my reply to Marions was:

Since Medicare is a 'Federal' program I'm pretty certain that what is the norm in one state would be the norm in any other state in the U.S. as we are all under one Federal Government.  Right?

In Tom's case (my husband who had CC), my son was willing to be a live donor and so was Tom's son for a liver transplant as they can use only a small section of the liver.  As to whether or not a persons medical insurance would cover that type of transplant, it would depend upon the policy.  Most medical insurance's do have some type of 'transplant protocol' written into their policies.  I know for certain that all Fully Insured policies do, and for ASO (Self Funded) policies, it is up to the individual company that is paying the claims for the ASO plan.

Medicare ?  I don't work for Medicare so I don't know what rules they have or what they will or will not cover.  I do have a Medicare booklet here as we were just in the process of getting Tom signed up for Medicare when he passed.  I'll have to take a look and see what it states regarding transplants!  Not right now though as it is 3:32 am (I can't sleep)  Imagine that eh?

I do know that when Tom first presented with CC we did discuss the transplant option.  Given his other medical conditions, they really played down a transplant, even with a live donor option BECAUSE CC can come back even with a new liver and stats show that a transplant may not change the outcome.  Even Mayo clinic Stats show that.  I was amazed when I read that one!

Margaret

  • Registered: Thu, 09 Sep 2010
  • Posts: 535

Re: Medicare and Transplants.

I am proof that stats are not accurate!! I will be 3 years cancer free May 24, 2012 due to "2" transplants!!! (Hopre I didn't jinx myself I have scans next week!)I have BCBS insurance and it payed for both trial and transplants with no problems. I had 2.5 million dollars of medical treatments and I was responsible for my dedutctables which was about $6,000 a calendar year. My expense could have been lower if opted for higher premium/lower dedution. I basically spent $18,000 for 2.5 million dollars of medical treatment sounds like a great GROUPON!! LOL!!
I am now at the point where I am eligable for medicare, but private insurance is less!! I do know that thanks to cancer we are a lot more educated in things that never seemed so important. Once again cancer has taught me until "You walk a mile in there shoes..."
Transplants are an option and they do save lives!! Thank you God, 2 strangers and Dr. Chapman for believing in them.
Lots and lots of prayers-Cathy

  • From: Phoenix AZ
  • Registered: Fri, 13 Jan 2006
  • Posts: 8,227

Re: Medicare and Transplants.

Hi MS Groupon! I thought my daughter had that title!!! You are too funny. I will be impressed even more if you join a CC Frequent Flyer Club for mileage to Dr. Chapman!! I am also issuing you a Jewish POO, POO! It means you poo poo the bad so it doesn't come through when you think you jinx yourself. So a hearty POO, POO! And you really are the Million Dollar Girl!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.
  • From: Iowa
  • Registered: Mon, 15 Feb 2010
  • Posts: 373

Re: Medicare and Transplants.

Cathy,

Always great to hear your story.  You are right, statistics are not always correct.  I am 2 1/2 years out with inoperable stage 4 and still feeling good. Did not qualify for a transplant because my tumor grew too large, but looking back I would have been a great candidate.  I understand how they have to have and follow protocols though.

I, too, recently qualified for medicare because I have been on ss disability for 2 years.  I'm sure you know all this, but a full insurance policy is better than a supplemental policy with medicare.  Supplemental policies only cover medicare approved procedures. 

Medicare does not cover transplants for cc, but a full policy may.  I am fortunate to be on medicare and then pay over $500 a month for my BCBS policy.  For me, it's a bargain.  There may be procedures in the future which medicare will not pay, but my full policy will.

My 3rd coverage with United Health Care just refused my referral to Mayo and said they will not cover me for routine care because I am on a trial.  That happens to be against our state law, but because it's a self-funded ERISA insurance (which I've learned that 1/2 of all large businesses and now many smaller businesses have - to save money) this full insurance policy is not subject to state insurance laws or regulations. 

Provisions in the Affordable Health Care Act (Obama HealthCare as some call it) requires: # Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial.  Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.

It really irks me that an insurance company will use anything they can to disqualify you from routine care.  They were not asked to pay anything in connection with the trial.  The National Cancer Institute pays for my trial drugs.  How can effective treatments ever be discovered if clinical trials are not conducted?  We need more clinical trials and more people to participate in them.

  • From: Phoenix AZ
  • Registered: Fri, 13 Jan 2006
  • Posts: 8,227

Re: Medicare and Transplants.

Kathy, a BIG AMEN to your post!!! It's an upside down world sometimes.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

6 Reply by jathy1125 (edited by jathy1125 Tue, 24 Jan 2012 17:10:15)

  • Registered: Thu, 09 Sep 2010
  • Posts: 535

Re: Medicare and Transplants.

Kathy-Are you just amazed at what knowledge you have on something you just always complained about!! Everyday I thank God for health insurance, I just know that was never on my prayer list before.
I qualified for medicare for the same reason as you, 2 years on disability. I opted for hospitilization part only because by the time I payed for supplement , part B and drug coverage, I was paying $100.00 plus a month more, and more out of  pocket expense (I pay $3,000 a month for my prograf!).!!  I also know I was diagnosed with terminal cancer and my insurance company gave me no grief, just boxes of EOB's!!In order for my family, (which is one spouse and a child) to have health insurance and me afford my ant-rejection drugs I need $20,000 a year!! If Jeff or Cates were to get sick and need to meet deductalbes to be payed at 100%, we would need another $12,000!! I always love to add to this ridiculous scenario by reminding who ever is listenning is we just mow grass for a living!!! I have to add we  are blessed to have my husband own his own business.
Keep posting all your positive notes, we need to keep the HOPE going!
Lots of prayers-Cathy