I am a prostate cancer patient. I am getting Degarelix and Xgeva injections. The doctor's office sent me a bill amounting $2600 which is the deductible from Anthem blue cross. I am covered at the same time by Medicare. It seems I have to pay only 20 per cent of the $2600. But they insists I am responsible for the amount. Any one can help to explain that?
Medical bill for hormone treatment - Advanced Prostate...
Since you have Anthem, you can go online to see the EOB. Take a look at it to make sure it’s correct and you should be able to see what Anthem pays, what Medicare pays and what you owe. If you have questions call Anthem so they can walk you through it line by line so you understand what your responsibility is.
This may be a possibility. These medicines may be covered by Medicare part D, but the doctor's office does not bill Medicare part D. Drs working in Institutions (Cancer center, University etc), get around this problem by ordering the medication from the local pharmacy, the pharmacy bills medicare part D, and send the medicine to the infusion center or the doctor's office. Then the infusion clinic bills medicare part B for the administration of the drug.
Doctors' offices bill Medicare part B, and many medications administered (vaccines etc) in a medical office are not covered by part B. It is safer (in terms of payments) to get the vaccines given at CVS than in a doctor's office. I had this problem with a shingrix vaccine and I had to pay.
Medicare part B covers some medicines. These are some of medicines covered by part B.
If you get one of them in the doctor's office you pay 20%, if the drug is not covered by part B even when is covered by Medicare part D, you pay 100%. Doctors do not bill Medicare part D.
Well I just got my lupron shot at the Urologist’s office at the hospital. The hospital orders the lupron for inventory not a retail supplier. I was assured the Lupron will be billed to Plan A and I should have no problems. In fact they have not heard of past Medicare patients having problems with Lupron. Time will tell.
Good luck with any kind of Medicare Advantage plan. You might get lucky and do OK or you could end up with a huge problem of not being able to see the physician you need to see or not getting approval for drugs your physician wants you to have. Medicare Advantage IS NOT the same as Medicare and don't let anyone convince you otherwise. Like I said, you could get lucky and avoid their limitations and problems or you could be unlucky and end up with care that is not the best for your situation. It is a crap shoot and you have to decide how lucky you feel. And that's all it is. The Medicare Advantage plans are commercially managed and those guys are all about profits, period. And they are making a lot off of Medicare....that's why they market them like crazy.
I’m a licensed Insurance agent. I live in a big city and because many like the free part they want me to put them in it. I tell them basically what you said . I said Medicare supplement is the Cadillac version. I actually make a tad more in the advantage care but I always do what’s best for the client and the best fit.
If you want an objective article about this, the NYT just published one this past weekend: