Medicare – Medical Tourism – Medicare Cancer Patients
There’s a shell-game being played by many U.S. doctors, insurance companies and government that hurts all seniors. It’s called cost-shifting. The euphemistic buzz-phrase “Cost-Sharing” is in fact “Cost-Shifting”; it’s a shell game.
I wonder at the gullibility of seniors when it comes to thinking Medicare is their best bet for managing their health care costs. And stories, like the following, make me sad.
Medical Tourism has been my field of expertise for several years, which led to an educated opinion on all health care options globally and a deepening awareness of Medicare as the “Emperor Has No Clothes”. Medicare Cancer Patients may be some of the most obvious victims of Medicare Cost-Shifting.
And I suspect the following story is an example of cost-shifting.
I was prompted to make the call to the official U.S. Government Office for Medicare to corroborate a recent article about a Medicare patient taking a prescription for a new kind of chemotherapy pill to her local drugstore only to find that the monthly cost to her would be $2,400. [source: USA Today article “Seniors face Medicare Cost Barrier for Cancer Meds”]
The article piqued my interest, because I wondered if some doctors or clinics were cost-shifting. It goes something like this: “If Medicare will only reimburse us X-amount for chemotherapy administered intravenously at a clinic or doctor’s office, let’s prescribe a pill instead and shift the expense back on the Medicare patient”.
So, I called 1-800-Medicare to get clarification. And I could not get a straight answer.
Here’s how the call went:
Customer Representative, Gloria Rodriguez, told me that Medicare pays 80% of all chemotherapy administrated intravenously or orally after only a $162.00 deductible. That’s a far cry from what Medicare patient Rita Moore experienced when she was told by her pharmacist it was going to cost her $2,400 a month to fill her prescription for a cancer medication.
Upon asking more detailed questions, I was informed by Rodriguez that “We only answer general Medicare questions here. For more information you’ll have to call your doctor.” That is an obvious pass-the-buck move being played by the government.
The “Call your doctor maneuver” wouldn’t be nearly so alarming if it was made clear up front that the Medicare government line was there to give you only “general” Medicare coverage information. It’s alarming because that limitation is not disclosed and therefore misleading. You call to get an answer from the ultimate authority, and what you get instead is a “party line” answer and a disclaimer.
The problem with “Call your doctor” is that a patient can get caught in the middle of a cost-shifting game played by far too many doctors, hospitals and insurance companies.
In the article, Dr. Lowell Schnipper, who chairs the American Society of Clinical Oncology‘s task force on the cost of cancer care is quoted as saying the task force “advises doctors to discuss costs with patients up front, to avoid surprises.”
So, now it’s the doctor’s responsibility to be the front-line against cost-shifting. At best that’s like asking a doctor to become the expert on Medicare in addition to being a physician. At worst, it’s like asking the fox to guard the chickens.
According to the article, “The study last month in the Journal of Oncology Practice found that nearly 16% of Medicare beneficiaries did not fill an initial prescription for pills to treat cancer, a significantly higher proportion than the 9% of people with private insurance who did not follow through.
Forty-six% of Medicare beneficiaries faced copayments of more than $500, as compared to only 11% of patients with private insurance. Among people of all ages, 1 in 4 who faced a copayment over $500 did not fill their prescriptions. Cancer is more prevalent among older people.”
What’s so sad about this story is that it takes a personal experience of suffering for an individual to realize the absurdity of Medicare while the majority still share in the collective ignorance of an obvious fact; that Medicare is never going to be the same again. Read: The New Medicare .
I’m a big believer in the concept that when one door closes, another door opens. The solution, I believe, is to be found globally, not locally, both in terms of prices of pharmaceuticals and procedures.
Perhaps rather than trying to hold on to the idea of Medicare as your sole plan for managing your health care, you should be looking for ways to avoid the pitfalls of Medicare.