← Return to Actemra coverage on Medicare in California?

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@tuckerp

I have had 2 surgeries with hospital stay, GCA biopsy, 1 emergency room visit, and dozens of tests, scans, blood work. office visits etc and not one bill from Mayo. Medicare rules are they have to provide you with an ABN if the procedure is not covered. They did ask me to sign one ABN. I didnt sign it so they skipped that test. As long as you have Medicare original they follow the Medicare billing requirements. I did get one bill for $26. They asked me if I needed a Ibuprofen or anything for pain. I said yes. Medicare said administering of OTC medications was not covered. I appealed but lost the appeal. I just paid the $26. I have used Mayo for my urologist, cardiologist, and rheumatologist. Trying to make an appointment with Gastrologist but they wont accept new patients.

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Replies to "I have had 2 surgeries with hospital stay, GCA biopsy, 1 emergency room visit, and dozens..."

Do you go to Mayo in Phoenix for most everything? Do you have traditional Medicare or an Advantage Plan?

I have traditional Medicare with a supplement. I'm not sure if I need the coverage but I'm willing to contribute to the system.

I currently get care at the VA hospital across the street from the University hospital where I worked before I retired. The doctors I see at the VA also work for the University. I don't ever get billed for anything at the VA.

I still miss the University health insurance that was provided at no cost to the employee. I miss getting care at the University Hospital because I received excellent care there. The University hospital was "self insured" because the insurance company only processed the claims. The University hospital had an administrative board that waived many rules for employees as long as the test or procedure was done at the University Hospital.

The patient population I worked with as a nurse received a lot of their medical care funded through donations and research grants. Patient's who volunteered for research studies wouldn't be billed for tests related to research protocols.

The "usual and customary" tests and procedures were billed to the patient's insurance company. It would get complicated and sometimes it was hard to decide what was research related and therefore "experimental" and what was "the current standards for care."

I think Mayo does a lot of research too and does the same thing or something similar. Sometimes it was a source of conflict but many times I could get things paid through a research grant even if it wasn't purely research.

That is why I usually say it is just a matter of finding someone who is willing to pay the medical costs. On the other hand, I wasn't sure that all the research was "good research." There were plenty of disputes regarding these matters.