Cost Sharing Defined: Who Gets Left Behind

Cost sharing and medicare

Medicare Patients & the catch 22 if you have a chronic illness
Define Cost Sharing: Because BIOLOGICS (blood products) are NOT generics

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Update on #Cures: Patients Lose

Something about #Cures is earily related to the current crisis with health-care in America. There may be, yet again, a false sense of security if your on Medicare.

21st Century #Cures Impact- continues to impact infusion patients. Does not look like an appeal will occur (realizing AHCA is now at forefront, my concerns, fears, shock, and personal turmoil looms). I began a mission because of #cures, to inform patients to be knowledgeable and proactive based on fact . To the best of my abilities, took risk others refused, lost my own community, because I tried to help. I am a patient too. I’m struggling, afraid, and depressed. The update on Cures: http://newyork.cbslocal.com/2017/03/27/heart-patient-infusion-costs/
Full Text of CURES: HERE
Something about #Cures is earily related to the current crisis with health-care in America.  There may be, yet again, a false sense of security if your on Medicare. Those on Medicare and receive any type of immunoglobulin replacement therapy, #Cures is still law, and patients have not dodged the AHCA reform act.


As I went to check on my child, and say good night. He read the following to me:

The tongue of the wise uses knowledge wisely, but the mouth of the fools pours forth foolishness. –Proverbs 15:2

This scripture certainly nails the entire situation that has evolved, beginning with my awakening to the truth.  As I read a few verses further:

A wholesome tongue is a spirit of life.  But perseverance in it breaks the spirit. –Proverbs 15:4

In other words, A gentle tounge with its healing power is a tree of life, but willful contrariness in it breaks down the spirit. The Amplified Bible

Having spent hours researching, reviewing, and reflecting; my perseverance is walking a thin, invisible line that is either leading somewhere or nowhere. The loss of #Cures, was the beginning of many losses that the chronically ill will witness. I cannot begin to explain, how millions will be affected. To be honest, since Thursday, our house has been utterly quiet, a sadness and sense of helplessness and dispair. I hear  and read to often:

Or similar but…

Upon first read, yes. Seems simple enough. Then, I ponder. If one gives into whats happening and does nothing. What will the outcome be? Thats the difference, you challenge yourself not to accept what is out of your control, and idly shrug it off. Instead, what are the other options to circumvent, or change the direction in your destiny that we are powerless to?

The absolute truth is not what I want to believe, not what anyone wants to believe. And, like #Cures, what everyone refused to believe, and its happening.

Attribution: The 700 Groups That Supported the 21st Century Act: https://energycommerce.house.gov/news/press-release/over-700-groups-stand-behind-cures2015/

“Reduce the value of coverage for consumers, which WILL significantly increase out-of-pocket expenses. Increasing financial risks associated with high medical costs”(quoted from Trumpcare) Respond NOW: Deadline 3/7

Healthcare coverage cuts for consumers, increases in out-of-pocket expenses, thus increasing their exposure to financial risks associated with high medical costs and Pre existing conditions exclusions contact http://www.regulations.gov BEFORE 3/7/17 and say NO

Direct link to CMS-9929-P https://www.regulations.gov/document?D=CMS-2017-0021-0002

TELL THEM NO.  Updated 2/18/17, Directing correct link to tell CMS/PAUL RYAN/GOP/DEPARTMENT  OF HEALTH THAT WE DO NOT ACCEPT THE PROPOSAL TO REDUCE HEALTH CARE, RAISE COSTS,  AND ELIMINATE PRE EXISTING & MORE.

The Administration has provided only a 21-day comment period, on the proposed “Trumpcare” an extreme shortened timeframe for public comment,  from standard periods for rules of this significance. Below you will find the document, embedded within the document, there are many changes that will adversely affect all American Citizens and their Healthcare. The proposal titled, “Patient Protection and Affordable Care Act; Market Stabilization”, however known as “CMS-9929-P” (aka TRUMPCARE).

Of Note: Shift of Healthcare to Insurers (Health Plans), adversely affecting ALL patient populations, do NOT be fooled by the “Exchange Speak”. As ALL Insurers uniformly follow CMS, notably, this document does not exclude any other type of plans. The Authors of this plan have–AND WILL–institute this as Law, unless the Public voices concerns prior to MARCH 7, 2017. There are multiple false statements, and studies reported within this plan, and links are provided for the reader to arrive at their own decision. Many areas of concerns, the two that I am focusing on are the admitted rise in costs while decrease in coverage, pg. 7 & 74. Additionally, Pre-Existing Conditions are ON THE TABLE for denial of coverage, delay of coverage, underwriting, additional costs, and more, page 41. The file is the complete proposal.

Trump Administration intends to reduce the value of OF coverage for consumers, and increasing Out OF Pocket Expenses, and other essential limits
Of extreme significance, denial of Pre Existing Conditions by insurers are addressed, the Pre Existing Clause is multifaceted, and will negatively affect millions of people.

Linked here: https://docs.google.com/document/d/1LsgaqcVLxaErUqfZGShvB57tpg2bSztVmcN3OQcaaqw/edit?usp=sharing

FORMAL PROPOSAL (PDF): https://www.regulations.gov/contentStreamer?documentId=CMS-2017-0021-0002&contentType=pdf

ADDRESSES: In commenting, please refer to file code CMS-9929-P

You may submit comments in one of four ways:

Electronically:  (NOTE: CMS CHANGED THE SITE ALLOWING COMMENTS TO: https://www.regulations.gov/document?D=CMS-2017-0021-0002

  1. You may submit electronic comments on this regulation to http://www.regulations.gov

Follow the “Submit a comment” instructions.

2. By regular mail. You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services,

Department of Health and Human Services,

Attention:  CMS-9929-P,

P.O. Box 8016,

Baltimore, MD 21244-8016

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9929-P,

Mail Stop C4-26-05,

7500 Security Boulevard, Baltimore, MD 21244-1850.

4.By express or overnight mail. You may send written comments to the following address ONLY:Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9929-P,

Mail Stop C4-26-05,

7500 Security Boulevard, Baltimore, MD 21244-1850.

  • 1.By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:
  • 2.For delivery in Washington, DC– Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201
  • 3.For delivery in Baltimore, MD– Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850.   
  • If you intend to deliver your comments to the Baltimore address, call telephone number; 410 786-7195 in advance to schedule your arrival with one of our staff members.Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

Complete Proposal:

Update on CMS re: DME (Infusion Pumps, supplies) per #cures

I Published the information, about Policy Article A52507 in reference to CMS billing, codes, payment criteria, and general information of Infusion related DMEs and medication on 12/28/16. Since, Policy Article A52507, has been superseded with Revised Policy Article L33794, revisions begin implementation 01/01/17.

Since last posting , CMS reports that the External INFUSION PUMPS – Policy Article (A52507) has been superseded. Reviewing the policy article from A52507, may give the reader a comparison to the implementation of the revised Policy Article L33794.

Policy Article “Local Coverage Determination (LCD) External Infusion Pumps”(L33794) Revisions seem to supersede Policy Article A52507. Of note, Revisions;  JW Modifier instructions, Denial verbiage for JW Modifiers when coverage criteria is not met, and more.

I would encourage any patient, or any person, to check the changes and decide if the changes will affect your current medical situation.

My perspective, the #cures has moved forward. How this will affect DME needed for SCIG infusions, is not yet clear. However, as educated and concerned patients we certainly need to keep aware of what is occurring with the DME exclusions. As well, continue to check any strategic movement that may, or may not, affect the PID community.

Link To .pdf:

Local Coverage Determination (LCD): External Infusion Pumps (L33794)

Link to docs.com with Both CMS Coverage Articles available:

CMS ARTICLES

 

Sources and Attribution:
http://docs.house.gov/billsthisweek/20150706/CPRT-114-HPRT-RU00-HR6.pdf

Over 700 Groups Stand Behind #Cures2015: https://energycommerce.house.gov/news/press-release/over-700-groups-stand-behind-cures2015/

Travesty in the USA. Are you on Medicare? If your not, can you help? We, CVID  & PI patients, plan to action: Gather our resources and help our peers.

We say, there is a “way”, “there is a possibility” there are “other options”.  Am I right?  You would  not be a zebra, if you thought otherwise. We are strong, fierce, fighters, and above all we have to keep our  loyalties to our”herd”.

 

It’s  the end of October. Always a stressful time of the year, Halloween, then Thanksgiving and the holidays. It’s also time to make sure you have all of your end of the year doctor appointments, all of those specialized tests, and make sure your medications are in order before the first of the year hits.

And the dreaded OOPs has to be met again.

Few concerns I have, the presidential election.  Seems as of this date, Trump has a lot of fans. Have to admit I’m not a fan of Hillary either, she was one of the politicians behind the CMS scandal last spring.

Im wondering and pretty concerned, If trump gets office, he plans on eliminating Obamacare (ACA). A lot of people are for that  idea, not me. If you have a chronic illness, and understand the repercussions, you should be worried.

Will he bring back the non insurable because of existing illness–my guess is yes.

Will he bring back maximum lifetime health insurance limits-yes, again.

As I type this, a fellow CVID’er is now on hospice, because she was unable to afford her Medicare co pays for her IGg. She reached out to every organization and agency that could help. Please say a prayer  for her comfort and peace.

if you haven’t been heard, or are unaware, if one is  on Medicare, and make to much for Medicaid—they are unable To get ANY financial assistance to pay for their 20%co pay—that’s right, they are left to sink or swim. At this point, due to federal restrictions, organization oversites, lack of funding from private agencies….this is a gap that is ALMOST unbearable, and the consequences are a complete break down of medically necessity in the USA. The PiPUnited hopes to alleviate this gap, by knowledge of immediate needs, and resources formpatients that are in this dire situation.

You, as I, have asked what about supplemental? If you are not at retirement age, you do not qualify for supplemental insurance. If you decide you prefer to purchase private insurance, and your on Medicare, private insurance (anthem) won’t take you. I tried.

I reached out To so many agencies to inquire, how can this happen in the USA? Well, blame was either placed on the patient, the government, or funds are no longer available. This is a travesty.

its more of a travesty my friends, when maybe, we, as fellow CVID or pi patients can, will, and want to help. However if your bound by an organization or a group that installs such ridiculous rules. I may have answer. I will need help to make this work. It is our moral duty as human beings to help save a life if we can.