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Thread: Baclofen pump refill @home and Medicare ONLY?

  1. #1

    Baclofen pump refill @home and Medicare ONLY?

    Well, here's the deal. I used to be on Medicare and Medicaid many years ago. I was dirt poor, so everything was covered. Then, I got a job and had private insurance and Medicare. I have enough assets that I am NO longer eligible for Medicaid. When I was working, my refills were covered at home. I had to quit due to a decube. and I really can't go back to work. I do not have Medigap.

    So, I negotiated a private pay cost of $325 for refills (all inclusive), at home, every 4 months. Lot of money, but I'm good. I should note that the "company" I use for refills had changed names/hands a few times. Well, I start getting invoices for the nurses' visit and supplies a few months ago. I'm up to like $600. I always just write a check and give it to the nurse and she turns it in. Trust me, she does. So I call the accounting dept. and tell them how I negotiated with the CEO of the old company for the $325 rate for refills. The rep. tells me the deal of supplies, skilled nursing charges, and drug charges. I understood all that and she was like "I see you've done your homework." She told me she really couldn't do anything else, but was used to hearing these predicaments. SHe cautions against going to the neuro. office for refills because I could get billed a GRIP if the MD doesn't accept assignment. That's why I do it at home--1.) Convenience 2.) Cost 3.) the wait at the MD 4.) Neuros. need to see other people more than myself. I hear the office bills Medicare like $1500 for an office refill. I know Medicare won't pay all that. She said to call Medicare, and that's where the fun begins...

    I wait for 10 minutes and get the general questions guy. He has absolutely NO idea what I'm talking about, so I explain it in detail. He says that there is no way Medicare will give a pre approval for something like that and I need to speak with billing. I wait about 15 minutes and talk with billing. She says that since this is something INSIDE my body, I have the wrong dept.!!! I was surprised by none of this, even with my descriptions and detail. She says I need to talk with MD services about this. I ask her what the holdtime is and she says 30 minutes. I said later to that. She gave me instructions on how to get to MD services through the hoops that is their call menu. I could call my neuro., but I bet it would be the same runaround there.

    Does anyone know if Medicare will pay for any of the services (drug, skilled care, supplies) involved with an at home Baclofen pump refill? The only coverage I have is Medicare A and B. The lady at the nurse service said that MC might fund PART of it, but definitely not all of the refill. I cringe at the thought of calling Medicare again. ANY help is appreciated on this one. Hopefully, I covered all the info...

    I should add my MD will only go 90 days between refills now, not 120 days like a few years ago.

  2. #2
    Have you contacted Medtronics? Their customer assistance program should be able to help you with these issues. Many specialty SCI clinics have a nurse who does the refills in clinic so you can get it done cheaper than with a physician, or with a home visit.

    (KLD)

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