| Medicare and radiation therapy (RT) coverage |
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09/20/2011 02:41
flojo 
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09/20/2011 02:41
flojo
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Re: Medicare and radiation therapy (RT) coverage
Linda,
Quote:
I also have summary notices from Medicare for:
$455.00 - radiation tx management (code 77427)
$178.00 - set radiation therapy field (77290-26 professional charge
$440.00 - radiation therapy planning (77263)
$145.00 - radiation treatment aid (77334-26 professional charge
$184.00 - Teletx isodose plan complex (77315-26 professional charge
$74.00 - radiation therapy dose plan (77300-26 professional charge
Are any of these Dr. T's charges?
It also looks like these were not paid by medicare. There are notes on the summaries saying "the information provided does not support the need for this service or item" and that I "should not be billed for this service". Never noticed that before.
Yes, those are Dr. T's charges. So, Medicare didn't pay for those for you either. Did Scripps have you sign a statement saying that if Medicare didn't pay that you would? That's what happened when I had RT there the 2nd time and that's when Scripps/Dr. T billed me. Certainly the greatest cost of RT is the radiation that Medicare did pay for you and for me. It just makes no sense that they pay the big $ item, the radiation, but not for the radiologist/oncologist. I do think that Scripps didn't/doesn't follow through effectively with appealing to Medicare. We are going to have to get Medicare to recognize that RT is the only game in town to stop the progression of Dupuytren's at this point.
URGENT: Learn from my mistake and read those Summary of Benefits thoroughly when they come, be prepared with documentation, and start the appeal right away. I and others on this site can help you build an appeal case.
Flora
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09/20/2011 02:54
flojo
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09/20/2011 02:54
flojo
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Re: Medicare and radiation therapy (RT) coverage
Quote:
Medicare RT coverage - The Fees in Germany
Very interesting discussion in the Forum . THX to all who contributed; I was just curious and pulled out the two bills which I had to pay for RT with Linear Accelerator in Germany at the Strahlenzentrum Hamburg
1 Hand
GOÄ #34 Set-Uo of the RT Treatment Concept for 1 Target Volume 61,22 Euro
GOÄ # 3 Consultations (E-mail, oral, other contact) 4x 30,60 Euro 121,40 Euro
GOÄ # 8 Physical Examination (per each extremity) 4 x 34,85 Euro 139,38 Euro
GOÄ 5810 Physics Treatment Plan (2D) for 1 Target Volume 26,82 Euro
GOÄ 5812 10 Treatment Sessions with a Linear Accelerator 10 x 11,07 Euro 110,70 Euro
GOÄ # 75 1 Medical Report 26,52 Euro
Individual Manufactured Lead Absorbing Material for each irradiated extremity 160,00 Euro
Material, Photographs, Documentation 10,00 Euro
Total Sum: 656,04 Euro
Thank you for sharing. Not meaning to be political, but this clearly paints the picture of what's wrong with our "for profit" medical system. When there is a national, or socialized medicine, wellness and curing people is a priority. In our system, there is no profit in patients getting well.
Just curious, are there TV advertisements for prescription drugs?
My left hand is showing signs of Dups, but not yet clear symptoms of being "active". I will go first to Loma Linda University Medical Center and followup with Dr. K there. They seem to be more actively involved in describing why a treatment is a recognized "standard of treatment" and more knowledgeable about how to deal with it when the need for an appeal comes up.
Or, I may just go to Germany and get the world-renown doctor at a fraction of the cost of RT in the USA. It really makes me sad to see how our medical care has been taken over with the $ as priority over patient care.
Am I wrong in this? I'd wonder how others see it.
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09/20/2011 04:36
annmaiden 
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09/20/2011 04:36
annmaiden
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Re: tx with RT
I have an appointment to see a radiation oncologist in October. I live in TN. and so far no one in TN. does this treatment for dupuytrens. This Dr. is willing to see me (thank God) as I was feeling really hopeless. If he does the tx. I hope he will be willing to treat others here in the US. as surgery is still the option for most. Have medicare as primary and will see if they pay for the tx. If not I will do what it takes to get my hands and feet treated.
I just hope it isn't to late. Thanks for all the wonderful information shared on this forum. It has been a life saver.
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09/20/2011 16:05
moondanc
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09/20/2011 16:05
moondanc
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Re: Medicare and radiation therapy (RT) coverage
flojo:
Thank you for sharing. Not meaning to be political, but this clearly paints the picture of what's wrong with our "for profit" medical system. When there is a national, or socialized medicine, wellness and curing people is a priority. In our system, there is no profit in patients getting well.
I totally agree with you--single payer is the way to go as it cuts out the middleman (insurance companies) and eliminates the 15% or more of administrative costs that are part of what patients are charged for all the paperwork docs and hospitals have to do. Costs are way, way lower under the Medicare single payer system. 2) why doesn't the law allow Medicare to negotiate drug prices the way the VA can?
In regards to Medicare paying for RT--below is a link to my original post about it. In my case, despite the aggressive billing and appeals by my provider Medicare did not pay anything for my RT not even for code 77416 which is the delivery of the radiation. I do see that others had a different code used for delivery, 77414 and others. Medicare did pay for my very first initial consult with the Dr. but that's it. I had it done on both hands and the charges for just one hand were more than $10K-- much more expensive than others have posted but then I live in CA. Luckily I did not have to pay anything. I do think Medicare coverage does has some regional differences as the billing and payment is handled by different CMS regional offices across the US.
http://www.dupuytren-online.info/Forum_E...eded-0_747.html
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09/20/2011 17:21
Larry
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09/20/2011 17:21
Larry
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Re: Medicare and radiation therapy (RT) coverage
....
Quote:
: flojo
My left hand is showing signs of Dups, but not yet clear symptoms of being "active". I will go first to Loma Linda University Medical Center and followup with Dr. K there. They seem to be more actively involved in describing why a treatment is a recognized "standard of treatment" and more knowledgeable about how to deal with it when the need for an appeal comes up.
Or, I may just go to Germany and get the world-renown doctor at a fraction of the cost of RT in the USA. It really makes me sad to see how our medical care has been taken over with the $ as priority over patient care.
Am I wrong in this? I'd wonder how others see it.
I think,this is the advantage of the GERMAN DOCTORS - they are seeing many more patients for MANY YEARS and they might just be more experienced examiners, better knowlegable about possible developments and the potential best time to intervene with radiotherapy ...
How could someone LEARN this from published papers ?? Daily PRACTICE makes alot of difference ! Thus, my personal recommendation would always be to see the MOST EXPERIENCED PERSON and look for the BEST DOCUMENTED DATA,
Larry
Edited 09/20/11 20:25
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09/21/2011 02:22
flojo
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09/21/2011 02:22
flojo
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Re: Medicare and radiation therapy (RT) coverage
Larry,
If all factors were equal, I wouldn't hesitate to go to Dr. S. I do have to consider his location - 6000 miles away. When I got my RT, I didn't have the information about how to do the trip and make it work that has now been posted by those who have shared how they did it.
I do have insurance that covers most of my treatments and I have to consider that. I feel confident in other radiologists knowing how to do my RT. I figure that if radiologists can effectively radiate cancer precisely in one part of the brain, prostate gland, etc., they can radiate my hand for Dupuytren's.
Again, all things being equal, I would go to Dr. S. He has contributed so much to the knowledge base and shares his knowledge very unselfishly. He epitomizes the Hippocratic Oath, as does Dr. Eaton and Dr. Denkler whos share about NA. I respect them all for what they have done to promote treatment options that were essentially not an option 5 years ago and barely available even 3 years ago when Dupuytren's decided to set up in my hand.
The RT I got was successful in slowing the progression in my hand. It stopped the nodules and slowed the cords progression. I'm very thankful that I found out about it and was able to have it done while mine was still active.
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09/23/2011 19:22
LindaGail
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09/23/2011 19:22
LindaGail
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Re: Medicare and radiation therapy (RT) coverage
I don't recall if Scripps had me sign a statement saying if Medicare didn't pay that I would. I'm surprised to learn that Dr. T was not paid. I never received any bills from him or Scripps. Linda
flojo:
Linda,
Quote:
I also have summary notices from Medicare for:
$455.00 - radiation tx management (code 77427)
$178.00 - set radiation therapy field (77290-26 professional charge
$440.00 - radiation therapy planning (77263)
$145.00 - radiation treatment aid (77334-26 professional charge
$184.00 - Teletx isodose plan complex (77315-26 professional charge
$74.00 - radiation therapy dose plan (77300-26 professional charge
Are any of these Dr. T's charges?
It also looks like these were not paid by medicare. There are notes on the summaries saying "the information provided does not support the need for this service or item" and that I "should not be billed for this service". Never noticed that before.
Yes, those are Dr. T's charges. So, Medicare didn't pay for those for you either. Did Scripps have you sign a statement saying that if Medicare didn't pay that you would? That's what happened when I had RT there the 2nd time and that's when Scripps/Dr. T billed me. Certainly the greatest cost of RT is the radiation that Medicare did pay for you and for me. It just makes no sense that they pay the big $ item, the radiation, but not for the radiologist/oncologist. I do think that Scripps didn't/doesn't follow through effectively with appealing to Medicare. We are going to have to get Medicare to recognize that RT is the only game in town to stop the progression of Dupuytren's at this point.
URGENT: Learn from my mistake and read those Summary of Benefits thoroughly when they come, be prepared with documentation, and start the appeal right away. I and others on this site can help you build an appeal case.
Flora
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