#94866 05-03-2009 04:12 PM | Joined: Nov 2005 Posts: 1,128 Patient Advocate (1000+ posts) | OP  Patient Advocate (1000+ posts)
Joined: Nov 2005 Posts: 1,128 | Does anyone know how Medicare and liquid food operate? (I'm curious because there's a strong likelihood that I will need to get my prime nutrition from liquid food for the rest of my life).
I never saw a bill or invoice with prices on it during my previous bout last June nor my current bout starting last December. I do get a receipt, and have to sign for delivery of the Nutren 2.0, 'Roo bags and occasional syringes, but it doesn't show up in Medicare statements or in secondary insurance statements and I am curious. The 'Roo pump would likely be in there also if I didn't own my unit.
Likewise, I've seen nothing regarding the suction machine, ventilator and various trach supplies that I have.
Age 67 1/2
Ventral Tongue SCC T2N0M0G1 10/05
Anterior Tongue SCC T2N0M0G2 6/08
Base of Tongue SCC T2N0M0G2 12/08
Three partial glossectomy (10/05,11/05,6/08), PEG, 37 XRT 66.6 Gy 1/06
Neck dissection, trach, PEG & forearm free flap (6/08)
Total glossectomy, trach, PEG & thigh free flap (12/08)
On August 21, 2010 at 9:20 am, Pete went off to play with the ratties in the sky.
| | | | | Joined: Jun 2007 Posts: 5,260 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 5,260 | I saw a bill for VHC 1 time and that's about it. The rest must be top secret.The bill for VHC was , if I remember correctly, 48 for 3 cases.
Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
| | | | | Joined: Nov 2005 Posts: 1,128 Patient Advocate (1000+ posts) | | OP Patient Advocate (1000+ posts)
Joined: Nov 2005 Posts: 1,128 | Wow, that's not a bad price! For once the Gummint is doing good!!
I had a one-time price of $35 from Rite-Aid for one case.
One Amazon source is $26 + $11 shipping, $37/case and another is $28.50 + $8.95, $37.45, both before tax. A third Amazon source is $54.50, I didn't bother to check shipping.
Age 67 1/2
Ventral Tongue SCC T2N0M0G1 10/05
Anterior Tongue SCC T2N0M0G2 6/08
Base of Tongue SCC T2N0M0G2 12/08
Three partial glossectomy (10/05,11/05,6/08), PEG, 37 XRT 66.6 Gy 1/06
Neck dissection, trach, PEG & forearm free flap (6/08)
Total glossectomy, trach, PEG & thigh free flap (12/08)
On August 21, 2010 at 9:20 am, Pete went off to play with the ratties in the sky.
| | | | | Joined: Jun 2009 Posts: 1 Member | | Member
Joined: Jun 2009 Posts: 1 | I was on a feeding tube for two years. I didn't see much activity on my Medicare statement until recently. Then there were mistakes and wrong codes. But it did show up from the provider "Apria" then it was billed to my secondary and then I got a small co-pay. But watch out if you get a big bill and make sure it was coded correctly. Some of my nutritional supplies were coded as "home surgery" LOL go figure. Well that's not something I'm insured for and Apria wanted full payment from me because insurance rejected it. After a ton of phone calls it was discovered the coding was wrong.
It is my understanding they have up to one year to apply for payment and that the insurance company could take several months after that to make payment then several months before you ever see it on a statement.
I had 10 cases left over because as I was weaning myself off the tube I was told I HAD to keep ordering the prescribed amount even though I only needed half. And they wonder why Medicare has financial problems!!!
I have been off my tube since Dec 08 and the billing is still not finalized, mostly because of the coding issue. | | | | | Joined: Nov 2002 Posts: 3,552 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Nov 2002 Posts: 3,552 | The main issue with liquid food reimburement is that it must be ordered by a physician - by prescription. I don't believe that OTC (over the counter) foods like, Boost, Ensure or Carnation would meet that criteria (but I have been wrong before).
Last edited by Gary; 06-29-2009 01:16 PM.
Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
________________________________________________________
"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)
| | | | | Joined: Jun 2007 Posts: 10,507 Likes: 7 Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts) | | Administrator, Director of Patient Support Services Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 10,507 Likes: 7 | Prescription liquid formula is covered by some insurance companies. For others they claim that since you dont buy food this should be your expense even though its prescription. I fought with my insurance company and won but Im probably the exception. To me it was stupid to cover all the feeding extras like bags, qyringes and guaze and not cover the formula. Over the counter like ensure, boost, carnation are not covered at all.
ChristineSCC 6/15/07 L chk & by L molar both Stag I, age44 2x cispltn-35 IMRT end 9/27/07 -65 lbs in 2 mo, no caregvr Clear PET 1/08 4/4/08 recur L chk Stag I surg 4/16/08 clr marg 215 HBO dives 3/09 teeth out, trismus 7/2/09 recur, Stg IV 8/24/09 trach, ND, mandiblctmy 3wks medicly inducd coma 2 mo xtended hospital stay, ICU & burn unit PICC line IV antibx 8 mo 10/4/10, 2/14/11 reconst surg OC 3x in 3 years very happy to be alive  | | | | | Joined: Jun 2007 Posts: 5,260 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: Jun 2007 Posts: 5,260 | My Dr ordered my Carnation VHC but after a couple of months my Insurance stopped it.
Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | I always paid for mine but I never did try to get my insurance to pay. I never wanted to talk to them while they were paying out so much money to keep my sorry butt alive.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
| | | | | Joined: May 2002 Posts: 2,152 Patient Advocate (old timer, 2000 posts) | | Patient Advocate (old timer, 2000 posts)
Joined: May 2002 Posts: 2,152 | I fought with my insurance company and lost. They said it was food and I would have had to pay for food anyway.
Take care,
Eileen
----------------------
Aug 1997 unknown primary, Stage III
mets to 1 lymph node in neck; rt ND, 36 XRT rad
Aug 2001 tiny tumor on larynx, Stage I total laryngectomy; left ND
June 5, 2010 dx early stage breast cancer
June 9, 2011 SCC 1.5 cm hypo pharynx, 70% P-16 positive, no mets, Stage I
| | | | | Joined: Sep 2006 Posts: 8,311 Senior Patient Advocate Patient Advocate (old timer, 2000 posts) | | Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | I know we have had some you got their insurance company to pay for it but I don't know if they are still posting out there.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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