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angry >:O

Posts: 176
Joined: Mar 2003

I just received this two days ago when I went back to my oncologist's for a second round of chemotherapy treatment. It effected me as I always was able to have them bill me when I didn't have the money. I guess nobody cares.
My oncologist also went to Washington to fight this and lost, I guess.


Last month, the Federal Government passed the Medicare Prescription Drug Bill. The primary purpose of this bill was to provide assistance to our elderly and disabled in obtaining and affording prescription drugs. While the plan is designed to help the neediest of patients in giving them the access they need to necessary medications, the method of payment chosen by this new government entitlement is less than desirable for cancer care. The "Bill" significantly decreases payments to community cancer care clinics such as The Center.

As a result of the passage of this Bill, oncologists all over the country have been scrambling to find a way to make ends meet in 2004. In many instances, the payment we receive from CMS (The Center for Medicare and Medicaid) is less than our actual cost to purchase the drugs. As a participating provider in the Medicare program, we are obligated to accept Medicare rates as payment in full. In almost all instance, failure to collect the 20% copay from you, the Medicare patient, will result in a significant loss to this practice; one which we cannot afford to continually sustain and yet remain a viable community oncology clinic.

Additionally, some of the Medicare Managed Care Programs, such as Aetna US Healthcare Medicare, have added additional financial burdens to both physician and patient alike. A new injectable program has been instituted whereby many of the drugs administered to you, such as Procrit, Aranesp, Neupogen, Neulasta, and several others, will now carry an additional $45 copay over and above the normal office visit copay. This amount will be deducted directly from our Aetna reimbursement and now becomes an additional financial burden for you, our patient.

These facts and many other distress us greatly, as we feel that we are being hampered from providing you with the many services that have become the standard of care at The Center. The environment that we created was one of going the extra mile for each and every patient, meeting the needs of all with whom we come in contact. We have genuine concerns about our ability to continue that tradition in light of the serious cuts that are being thrust upon us in the years ahead.

You will be asked for copay and deductible payments at the time of your visit. No patient will be seen without a referral if you are part of a managed care plan. All patients without a medigap or secondary insurance will be expected to remit any and all balances due. While we realise that this practice is somewhat different than what you have been accustomed to, it is, in fact, a change we find imperative in order to continue providing you with the best in care without interruption.

Please be assured that we will do everything within our power to continue to provide all of our patients with excellent care, utilizing prescription plans, pharmaceutical assistance programs, clinical trials, and state and federal programs. Realise, however, that we cannot do this without your help.

What can you do to help? Please ask at our front door for a legislative contact sheet. Your voice can and will make change happen.


What does all of this mean?

I'll break it down for you:

Basically, it's a bunch of crap that has been masqueraded as an effort to help the elderly and disabled get the medication they need. I'd really like to know who wrote this bill and why they thought it was a good idea.

To pay for the medications, this Bill has deemed it necessary to decrease payments from Medicare and Medicaid to places like the Center. Because of this decrease, places like the Center are now receiving payments from Medicare and Medicaid that are actually LESS than the money they are putting out for drugs. And because they are participating provider in Medicare, they have to accept the rates as payment in full.

Places like the Center used to allow patients to not pay their copay, if they couldn't. They were billed for it and this was frequently used in the decision making process of whether or not the patient could go on permanent disability. Now however, because of this bill, places like the Center CAN'T bill for a copay. They have to have it up front, unless they want to incur a serious financial loss. And serious financial loss will result in being unable to run their practice the way it needs to be run.

Not only all of this, but because of this bill, patients receiving specific injectable drugs are now subject to an additional payment of $45 because the Aetna reimbursement to the practice for these drugs has been taken away.

Anonymous user (not verified)

Hey Pattieb...I hear you as well as your frustration regarding the crappy bills, legislature, acts, whatever when it comes to insurance issues for many people. I too am very frustrated with Bert's HMO and the restrictions, reductions, protocols, and in many cases, lack of care yada, yada, yada, that they have forced their members to abide by. That's why I put him on my PPO...but at a price, and what a monthly price. It's sad isn't it that in a country like this one this kind of stuff goes on. It too makes my blood boil!!!

On your side! Monika ;(

P.S. If I'm reading everything correctly, at least your place of treatment gives a "kind of" gives a damn....there are many that don't and aren't even willing to work with you.

spongebob's picture
Posts: 2598
Joined: Apr 2003

Ahoy, pattieb -

Sorry to hear about the hassle the medicare reform bill has caused you and, no doubt, tens or hundreds of thousands of cancer patients around the country.

I suggest you get one of the legislative contact sheets - actually get several; one for your Congressman, and one each for your Senators. In my job I often have to review draft legislation - looking for possible problems and loopholes. I can say that it is not an easy task. There are often unintended outcomes from the most well-meaning of acts (especially when that "act" is legislation written in very long-winded and convoluted English/legalese). It's important that your representatives in DC know that they've created a serpant and they need to cut its head off.

I would also urge you to contact the ACS and let them know about this issue - they are a very strong lobby for cancer-related issues and can make an impact on remedying this problem.

- SpongeBob

Posts: 176
Joined: Mar 2003

Good morning SB
I think ACS already knows about this. The reason I'm saying this as my onc went to DC in the summer to fight this bill so I'm pretty sure ACS was there also.

Posts: 102
Joined: Nov 2003

I am so glad you posted these news, I just got back from the oncologist and the girl that does insurance asked an elderly lady for a $100 up front for the medication. The woman was dumbfounded and asked if this is something new, the girl said: no, we always had it but we just ask for it up front now.

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