Medicare Lupron authorization

[Still_in_shock]

Im going to be on Medicare 01 Jan 2025.

My Lupron shot is due 17 Jan 2025

Earliest appointment is 15 Jan 2025 at UCLA

Will my new Onc be able to give me a Lupron shot on the 15th, or will I need Medicare preauth??

[fireandice123]

The hospital I use gets any needed authorizations in advance of my appointment so I get whatever treatment was planned the day of my appointment.

[MJCA]

Hi,

I’m in the same boat as you; I start Medicare January 1. Since Lupron is administered by an RN in a medical facility, this is covered under part B. I know Part B has a deductible, just don’t know it off the top of my head.

[Still_in_shock in reply to MJCA]

$240 deductible. I also have a Plan G which will pay the 20% copay after deductible met.

But its the pre auth that worries me.

Im only on Lupron, cant chance going without after the 6 month.

[MJCA in reply to Still_in_shock]

Since you said plan G, I am assuming you have a supplement and not an Advantage plan. Two things I would recommend:

1. Contact the Finance Office at UCLA, they should be able to help.

2. If you purchased your plan from an agent, call that individual - that’s they are there for.

[Still_in_shock in reply to MJCA]

Im asking if a pre-authorization by the Doctor will be needed from Medicare, even though Ive been on Lupron the last 2 1/2 years.

Some things need preauthorization from Medicare.

I dont need any help with ny plan!! Yes Plan G IS a supplement.

[Tommyj2 in reply to Still_in_shock]

As long as your Medicare card shows active part B prior to the date of service you don’t need pre authorization from Medicare to my knowledge unless you have an advantage plan……check with the finance folks where you will be getting the injection if you want extra asssurance.

[dhccpa in reply to Still_in_shock]

I made the transition to Medicare after being on Lupron for 2.5 years. No issues; Medicare has always paid in full with no issues, particularly if you're not with a Medicare Advantage plan.

[leebeth]

Since you have traditional Medicare with a supplement, and not an Advantage Plan, you will find that very few things need prior authorization. Durable Medical Equipment generally does, but that’s about it. Services covered under Part B, like Lupron, do not need prior auth and it should be no problem at all for your Lupron.

I have no experience with Advantage Plans.

[Ingress]

just out of curiosity, why aren’t you asking Medicare directly?

[Still_in_shock in reply to Ingress]

Because IM asking members of my club their experience.

[Vangogh1961]

Medicare doesn't do pre auth. Only Medicare advantage plans.

[Still_in_shock]

Ironically, Dr Rettig's nurse at UCLA called to delay my appointment a few days with the Doctor to correlate with my 24 weeks from the last shot. They seem to be able to see my Kaiser records. She didn't want me to make 2 trips, see below!!

I asked about preauth, she said, oh, dont you worry about that!!

New patients get the 4 PM slot. Anyone in LA knows what it's like to leave Westwood at 5 PM back over the hill on the 405.

Tall Allen, you know!!

[j-o-h-n]

"Anyone in LA knows what it's like to leave Westwood at 5 PM back over the hill on the 405."

Got any relatives or friends who own a two seater motorcycle?

Good Luck, Good Health and Good Humor.

j-o-h-n

[Still_in_shock in reply to j-o-h-n]

I have too much metal on me from a murdercycle

[j-o-h-n]

Murdercycle (writing that one down, thanks)...

Good Luck, Good Health and Good Humor.

j-o-h-n

[Still_in_shock in reply to j-o-h-n]

What's another name for a motorcycle rider?

Statistic.

[j-o-h-n in reply to Still_in_shock]

ha ha ha Thanks (joke book filling up)...

Good Luck, Good Health and Good Humor.

j-o-h-n

[carlsbadjack]

Hey Still in Shock,

Yeah, I have experience with Lupron. As far as cost goes, I just pay a co-pay and Mecicare pays some, but the majority of it I don't know who pays it. I just know it isn't me. I live in California if that makes any difference, but I doubt it.

I got significant hot flashes from the Lupron, so I bought a USB neck fan on Amazon that helped. At my second injection I complained of them and a Dr. prescribed Venlafaxine Hydrochloride 75MG. It is a lightweight Anti Anxiety med as I understand it. It totally stopped my hot flashes except for an occasion warm flush of the skin for a few seconds. It has been a Godsend. But, as I understand it, others have tried and it did not help. Good luck with your treatment and your costs. The amound shown on my reports from medicare are stunning. But they just go away.

Carlsbadjack

[Still_in_shock in reply to carlsbadjack]

Im going on 3 years of Lupron.

Medicare pays 80% of negotiated fees, which is accepted by the doctor, you pay 20% of that.

You can buy a Medicare Supplement that pays your 20% copays, I did.

Gabapentin stops hot flashes, and is a safe drug.