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  #51  
Old October 16th, 2009, 07:51 AM
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Default Re: Medicare

Barry...I had one of those scrapings done too. I was doing an internship at the Waipahu Mental Health Clinic back in the 70s and we took a bunch of our clients (all kids) out to Electric Beach on the Leeward Coast for the afternoon. I wasn't wave savvy, being a mainlander from the Chicago area at the time....so I did a HUGE "no no" and had my back to the waves. Needless to say, one of the waves knocked me down and smashed me around the coral rocks a few times and I ended up being pulled out of the water by my practicum instructor with quite a few coral cuts and scrapes that needed to be cleaned up (along with a bruised ego). The closest place for me to go for medical care (I happened to be a military dependent back then) was the Barbers Point dispensary, where they scraped me with a brush that hurt WAY more than the coral scraping and near drowning did! LOL Luckily those kids never gave me a hard time but they probably had a few laughs on the way back to the clinic! (dat lolo haole wahine!) LMAO
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  #52  
Old October 16th, 2009, 10:07 AM
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Originally Posted by tutusue View Post
I don't see that they offer an Advantage plan, tho'. Maybe I overlooked it?
Secure Horizons offers Senior Advantage in my area, I interviewed them. They had no stop loss benefit.

Quote:
I'm nearing the end of tendonitis of the shoulder. It's been a 1 1/2 year battle 'cuz I can't take cortisone.
I forgot to tell the rest of the story. My regular Kaiser primary care physician was out with the flu! So I had a backup up Kaiser doctor I had never seen before. Fortunately his specialty was sports medicine and he fixed me up liki liki. I lucked out!
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  #53  
Old October 16th, 2009, 10:15 AM
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Quote:
Originally Posted by alohacandy View Post
Amati...Just be very careful when choosing your plan. If you travel a lot, make sure your plan will cover you in other parts of the country.
That's what I like about my Kaiser plan, it will cover me anywhere in the world for emergencies.

Quote:
My Kaiser Senior Advantage plan patients seem to be pretty happy with what they have because most of them have been with Kaiser forever and don't want to leave Kaiser. Their main problems seem to be when they get into the donut hole with their drugs
I don't have a "donut hole" with Kaiser Senior Advantage.

Quote:
....which happens to many people with Part D who don't qualify for the State's SPAP program (State Pharmacy Assistance Program) that helps with copays on certain Part D plans.
The Federal government has a program for low income people for parts A, B, & D.
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  #54  
Old October 16th, 2009, 10:28 AM
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Originally Posted by Amati View Post
If a decent retirement medical/dental plan is offered by the employer, then would taking Plans A+B be the right coverage, and not bothering with Plan C?
You will have to analyze both plans and decide which gives you the most coverge for the least cost.

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Originally Posted by alohacandy View Post
But that all depends on who they worked for....and so each situation is different. I've had some patients that ONLY kept their retiree plan and didn't bother to even apply for Medicare.
My father is a good example of someone who kept his retiree plan through his employer and had a great deal. Except.........his plan expired at age 90! Nobody lives past 90 right? Well my Dad is now 91 and he is paying through the nose for his Medicare coverage! His medications alone cost almost $3000 per month. Be careful when you analyze the details.

Quote:
If you're retirement income is super high, you may end up paying alot more than $96.40/mo for your Part B...it's not a set rate any more.
That is correct, a member may pay more or less for Medicare depending on their income level. I pay 96.40 so that tells you my income level is pretty average for a retiree, as are something like 80% of members. I don't recall what the income level is for higher Medicare payments, but it is high, something like $75K per individual.

Quote:
Very low income people are lucky to have the state of Hawaii pay their Medicare Part B premiums for them (these are people that are also eligible for Medicaid/MedQuest
I don't understand why the State is paying, since it is a Federal program.
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Last edited by matapule; October 16th, 2009 at 10:31 AM.
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  #55  
Old October 16th, 2009, 10:38 AM
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Quote:
Originally Posted by matapule View Post
That's what I like about my Kaiser plan, it will cover me anywhere in the world for emergencies.

Most plans WILL cover for emergency care out of state. Some people, however, who travel regularly and know that they will need to see a doctor for non-emergent care or get some kind of treatment that is non-emergent, want to know that they are going to be covered out of state if they are gone for a few weeks at a time on a regular basis.



Quote:
I don't have a "donut hole" with Kaiser Senior Advantage.
Lucky!



Quote:
The Federal government has a program for low income people for parts A, B, & D.

They have one called the LIS or Low Income Subsidy that helps with the premiums, the deductibles, and lowers the copayments. The SPAP program through the State helps with the copayments so that for some people who also have LIS, they may then have absolutely NO copayment on covered meds. Only certain Part D plans, however, are part of the SPAP program
.
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  #56  
Old October 16th, 2009, 10:47 AM
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Quote:
Some people, however, who travel regularly and know that they will need to see a doctor for non-emergent care or get some kind of treatment that is non-emergent, want to know that they are going to be covered out of state if they are gone for a few weeks at a time on a regular basis.
Well yes and no. I can only speak to the Kaiser plan. I can go to any Kaiser facility - anywhere, any State - and receive non-emergency or emergency care. However, if I am traveling or living in a foreign country (like Mexico), I can only receive emergency care in that country reimbursed by Kaiser. Therefore it is necessary for me to return to the US to receive non-emergency care through Kaiser.
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  #57  
Old October 16th, 2009, 03:47 PM
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Default Re: Medicare

Quote:
Originally Posted by Amati View Post
[...]But I'm more confused than ever.[...]
And therein lies the problem for the majority of people researching Medicare! Speaking for myself, the more research I did, the more confused I got!
Quote:
Originally Posted by alohacandy View Post
[...]and so each situation is different.[...] More confused now??
Bingo! Each person's situation is different which is why none of us can recommend a plan to another. It's just all so confusing!
Quote:
Originally Posted by matapule View Post
Secure Horizons offers Senior Advantage in my area, I interviewed them. They had no stop loss benefit.
Perusing medicare.gov, I don't see that SH offers an Advantage plan in Hawaii.
Quote:
Originally Posted by matapule View Post
I forgot to tell the rest of the story. My regular Kaiser primary care physician was out with the flu! So I had a backup up Kaiser doctor I had never seen before. Fortunately his specialty was sports medicine and he fixed me up liki liki. I lucked out!
My ex-husband had a couple of bouts with bursitis in the shoulder. Both times I had to take him to the ER; 2 different ERs in 2 different states. Both times he was given an injection of cortisone in his shoulder which gave him relief. Happy it worked for you, too! Sounds like your doc didn't get his flu shot in time!
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  #58  
Old October 16th, 2009, 03:54 PM
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Default Re: Medicare

On a sidenote: Medicaid: If you're planning on preserving your assets by setting up a trust and doing the 5-year wait period to qualify, beware that Medicaid also considers Annuities and Whole Life Insurance policy cash values as assets so long as the trust remains "Irrevocable". My mom found out the hard way after waiting 5-years to qualify and to suddenly not on the fifth year when my dad passed away.
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  #59  
Old October 16th, 2009, 10:48 PM
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And therein lies the problem for the majority of people researching Medicare! Speaking for myself, the more research I did, the more confused I got![...]
I learned something today that really proved to me how confused I got, and still am, with the subject of Medicare!

Today I was filing some papers in my SH folder when a brochure fell out on the floor. The brochure's title..."Medicare Advantage Explained" from Secure Horizons!!! I know I had not seen that brochure before. I received a very large package of info when I joined SH and this was probably part of it. So, I perused it. Guess what, Matapule? I have the Secure Horizon's Advantage Plan C... I even called SH to confirm that! Turns out in Hawaii SH offers both HMO and PPO in their plan C and I elected to go with PPO. And, as I mentioned in a previous post, my annual out-of-pocket expenses do have a cap but with some limitations.

Ya coulda knocked me over with a feather! And, yes, I'm still confused!
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  #60  
Old October 17th, 2009, 11:05 AM
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Guess what, Matapule? I have the Secure Horizon's Advantage Plan C. I even called SH to confirm that!!
Okay, now your explanations make sense! Your description seemed to be an Advantage plan, but I am not completely familiar with Secure Horizons. If you had Secure Horizons Medicare Supplemental plan there would have been a monthly charge, in addition to the 96.40. In SoCal SH Senior Advantage is also a "no fee" plan, it just didn't offer as many benefits and conveniences as Kaiser. I really like the fact that I can communicate with all my doctors (primary and specialists) via email. I can also access all my medical records and doctor's notes on my password protected page(s). Also, I don't have a "donut hole" for my prescriptions.
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  #61  
Old October 21st, 2009, 09:37 AM
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I received my Kaiser Senior Advantage benefits book for 2010 in the mail yesterday. Many preventive procedures like mamagrams, pap smears, prostate screening, colonoscopys, etc, had a co-pay of $20 to $100. They are now all free in 2010. I guess free preventitive medicine is cheaper than on-going cancer treatment.

My annual maximum out-of-pocket expense is going to be increased from $3350 to $3400. I can live with that.

Also, Tutu, I was looking at their drug formulary. A note said that if your drug is not on the formulary, contact them with an explanation why you need that particular drug. They said they look at each request on a case by case basis.
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  #62  
Old October 21st, 2009, 11:33 AM
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Originally Posted by matapule View Post
Many preventive procedures like mamagrams, pap smears, prostate screening, colonoscopys, etc, had a co-pay of $20 to $100. They are now all free in 2010.
I just learned my HMSA plan does not cover colonoscopy. The out of pocket cost would be about $3,000. I've undergone it twice in the past, so that means this is something new.

But Medicare covers it, I was told. Unfortunately, I'm about four years away from that. My doctor still scheduled me for the procedure, pending approval from HMSA. If it's not approved, I won't get it. Isn't that ridiculous?

By the way, I've been skimming this thread. I really should study this more closely, but every time I look at it, I get dizzy. Why does health care have to be so complicated? I have the same gripe about taxes.
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  #63  
Old October 21st, 2009, 02:22 PM
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I just learned my HMSA plan does not cover colonoscopy. The out of pocket cost would be about $3,000. I've undergone it twice in the past, so that means this is something new.

But Medicare covers it, I was told. Unfortunately, I'm about four years away from that.
Holy Shit! Pardon dee expresion. I betta go check my HMSA Policy. It's about dat time foa me to get onnada colonscopy done. They found three polyps. I'm glad I got it done. I recently received a letter from Medicare informing me I will no longer be having coverage anymore. It's fine with me. When I retire or am disabled again, I can reapply.

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  #64  
Old October 21st, 2009, 03:45 PM
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Originally Posted by Honoruru View Post
If it's not approved, I won't get it. Isn't that ridiculous?
Be careful Honoruru! You really rolling the dice on this one.

Kaiser Senior Advantage pays for the colonoscopy once ever 2 years if at high risk (I am since my Dad had colo-rectal cancer) otherwise it is once every 4 years.

Quote:
I really should study this more closely, but every time I look at it, I get dizzy. .
Let me simplify it. Medicare part C (Senior Advantage) is the least expensive and most comprehensive coverage for 95% of seniors. Several companies offer Senior Advantage in your area. In general the top three companies (most dependable) are Kaiser, Secure Horizons (AARP), and Aetna. Compare the price and coverage of these three.
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  #65  
Old October 21st, 2009, 05:23 PM
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Originally Posted by Honoruru View Post
[...]
But Medicare covers it, I was told. Unfortunately, I'm about four years away from that. My doctor still scheduled me for the procedure, pending approval from HMSA. If it's not approved, I won't get it. Isn't that ridiculous?
Do you receive HMSA's annual Health Pass...a health screening around your birthday? If so, they usually offer a discount on several tests, incl. colonoscopy.
Quote:
Originally Posted by Honoruru View Post
By the way, I've been skimming this thread. I really should study this more closely, but every time I look at it, I get dizzy. Why does health care have to be so complicated?[...]
Can you imagine how complicated Medicare is when you try to sift thru it completely clueless?!!! That's why I started this thread.
Quote:
Originally Posted by matapule View Post
[...]In general the top three companies (most dependable) are Kaiser, Secure Horizons (AARP), and Aetna. Compare the price and coverage of these three.
Matapule, I didn't find Aetna on the list based on my zip code. In Hawaii, HMSA also offers a Medicare plan...65C. However, it's quite a bit more expensive than the ones Matapule mentioned. Still, you might want to add that one to your comparison.

Honoruru, plan offerings and rates will probably change in 4 years but it's really smart that you're trying to grasp the subject now. It will make it a lot easier for you when the time comes!
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  #66  
Old October 21st, 2009, 05:37 PM
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Finally I'm back in. Been trying to post looong time.

You don't have to be 65 to get Medicare. The Disabled also receives Medicare. Disabled Widows at the age of 50 recieves Medicare and those who are not receive it at the age of 60.

If you are a widow or widower, please contact Social Security at 1-800-772-1213 for further assistance.

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  #67  
Old October 21st, 2009, 11:21 PM
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Originally Posted by matapule View Post
Be careful Honoruru! You really rolling the dice on this one.
Itís not that Iím negligent on this issue. Iíve already had two colonoscopy (both negative) and this was supposed to be my regular scheduled followup. If my doctor had not informed me about the change in policy, I would not never questioned it. I would have gone through with it, expecting it to cost the same as it did the last two times. And I would have been blindsided with a $3,000 bill.

As I see it now, I have three choices. Go ahead as scheduled and pay the $3,000; wait four more years till I qualify for Medicare; or postpone the procedure and see if there is another solution. Iím leaning towards the later if my claim is rejected. Of course, HMSA could still approve the claim, in which case I would want to know the definite out-of-pocket cost for me, and other relevant information. In the meantime, I want to find out exactly what the hell is going on. Because itís not very clear.

Quote:
Originally Posted by tutusue View Post
Do you receive HMSA's annual Health Pass...a health screening around your birthday? If so, they usually offer a discount on several tests, incl. colonoscopy.
Not sure about that. Iím afraid I have a bad habit of throwing away those informational mailers from HMSA.

Quote:
Originally Posted by tutusue View Post
Can you imagine how complicated Medicare is when you try to sift thru it completely clueless?!!! That's why I started this thread.
Iím still totally clueless about HMSA. Is Medicare going to be worse?
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  #68  
Old October 22nd, 2009, 01:23 AM
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Quote:
Originally Posted by Honoruru View Post
[...]
As I see it now, I have three choices. Go ahead as scheduled and pay the $3,000; wait four more years till I qualify for Medicare; or postpone the procedure and see if there is another solution. Iím leaning towards the later if my claim is rejected. Of course, HMSA could still approve the claim, in which case I would want to know the definite out-of-pocket cost for me, and other relevant information. In the meantime, I want to find out exactly what the hell is going on. Because itís not very clear.[...]
Prior to my very recent Medicare coverage I had HMSA. Plans differ and I had the small business plan. Approx. 12 years ago my doctor recommended a colonoscopy and told me immediately that HMSA didn't cover it unless they found something. A small, benign polyp would do! After some research I ended up (pun intended!) getting a much less expensive colonography at Holistica. Same prep but no anesthesia needed. The Holistica doctor mentioned that should they find something then I would need to follow-up with a colonoscopy. That was fine with me because then I'd know it would be covered. Nothing was found so I was out-of-pocket a much lesser amount of money.
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Iím still totally clueless about HMSA. Is Medicare going to be worse?
Medicare was much worse for me. When I got HMSA there weren't many choices. Come to think of it, there was only one plan I could afford!!! I owned a small business (just me!) and needed a group policy so I opted for the small business plan. It was pretty simple!

With Medicare there are several choices and each has different coverage, many with the same monthly cost. That means there's a lot of comparing to do. You may have a friend or family member in another state, as I do, who has a plan s/he loves but that doesn't mean the same plan is offered in Hawaii. Chances are it won't be! I've spoken directly with Medicare, my doctors, various plan reps, friends and family and all have used the same word...CONFUSING!!! Now, the good news is that once you choose a plan you're not stuck with it forever. There's open enrollment every year from mid Nov. 'til the end of Dec. During that time you may switch to another plan.
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  #69  
Old October 22nd, 2009, 05:59 PM
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Quote:
Originally Posted by matapule View Post
[...]
Also, Tutu, I was looking at their drug formulary. A note said that if your drug is not on the formulary, contact them with an explanation why you need that particular drug. They said they look at each request on a case by case basis.
Sorry I missed this earlier. I've already talked with Medicare about the possibility of my doctor submitting a request and the drug in question is totally excluded with or without an explanation.
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Old October 22nd, 2009, 10:25 PM
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I've already talked with Medicare about the possibility of my doctor submitting a request and the drug in question is totally excluded with or without an explanation.
Tutu, I'm totally confused. If you have Secure Horizons Senior Advantage, Medicare part D has nothing to do with it. Secure Horizons is the one that provides your prescription coverage. Kaiser provides my prescription coverage, that's why Kaiser said to contact Kaiser if a medication I needed wasn't in Kaiser's formulary.

I think maybe you have SH supplemental medicare coverage not part C coverage.
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  #71  
Old October 23rd, 2009, 02:02 AM
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Tutu, I'm totally confused. If you have Secure Horizons Senior Advantage, Medicare part D has nothing to do with it. Secure Horizons is the one that provides your prescription coverage. Kaiser provides my prescription coverage, that's why Kaiser said to contact Kaiser if a medication I needed wasn't in Kaiser's formulary.

I think maybe you have SH supplemental medicare coverage not part C coverage.
SH said I have Advantage part C. When I called SH about the prescription in question, "Patricia" said she also checked with the Centers for Medicare and Medicaid Services (CMS). The drug is excluded there so is not and will not be on SH's formulary.

Patricia also mentioned that submitting a request for coverage of a drug not on their formulary is generally done for brand name drugs.

I do have an inexpensive workaround for the excluded drug but, again, it's time consuming and cumbersome. But at least I have an option.
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  #72  
Old November 15th, 2009, 03:33 AM
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Matapule...I was checking something at Walgreens.com and remembered this thread! I found the following info interesting...
Quote:
Originally Posted by tutusue View Post
I mentioned in a previous post that Walgreen's does not allow Medicare recipients to join the discount club. [...]
Quote:
Originally Posted by matapule View Post
I am suspicious of the information you were given.[...]
From Walgreen's web site:
Quote:
Eligibility and Enrollment
If you live in the United States or Puerto Rico and are not enrolled in a publicly funded health care program, such as Medicare, Medicaid or TRICARE, you are eligible for the Prescription Savings Club.
Walmart - I don't find this subject addressed.

CVS:
Quote:
Q Can I use my Health Savings Pass with my current prescription or medical coverage?
A You must either use your Health Savings Pass or other insurance. The CVS/pharmacy Health Savings Pass cannot be used in conjunction with other insurance on the same prescription or medical service.
So, it appears that Walgreen's has made a corporate decision.

And...still...none of my drugs are on any of the lists!

ETA: I have an appointment with the Humana rep next week. Secure Horizon's premiums didn't increase but the co-pays and a few other things did. Plus, most of the extra benefits were eliminated. Yippee! I get to add to my confusion!

Last edited by tutusue; November 15th, 2009 at 03:37 AM.
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  #73  
Old November 15th, 2009, 07:40 AM
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Matapule...I was checking something at Walgreens.com and remembered this thread! I found the following info interesting...From Walgreen's web site:
Tutu, I'm not sure what this means. I think it means that Walgreen's does not participate in any Medicare drug programs by giving you the prescription at no charge and then Walgreens will seek reimbursement from Medicare. I am sure if you want to join Walgreens private pay discount club, and you pay for your drugs directly to them, they would be happy to have you as a member.


Quote:
I have an appointment with the Humana rep next week. Secure Horizon's premiums didn't increase but the co-pays and a few other things did.
Go to this site http://www.medicare.gov/MPPF/Include...lQuestions.asp and all the plans in your zip code are compared. Kaiser comes out number one, SH number two (along with others) and it says that Humana is too new to rate. Consequently, I would be very careful with Humana! Buyer beware.
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  #74  
Old November 15th, 2009, 10:32 AM
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Boy, if you two old pros are having a difficult time understanding all of this, how can us young whippersnappers (relatively speaking, of course) make sense of it all?

By the way, regarding my past posts:

Quote:
Originally Posted by Honoruru View Post
As I see it now, I have three choices. Go ahead as scheduled and pay the $3,000; wait four more years till I qualify for Medicare; or postpone the procedure and see if there is another solution. ... Of course, HMSA could still approve the claim ...
HMSA did approve the above procedure and I had it done last week. One benign polyp and allís well with the world. I donít have to worry about this round of silliness for another five years, at which time Iíll probably be on Medicare, or one of the hybrids mentioned above, or something new altogether depending on how health reform goes.
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Old November 15th, 2009, 10:49 AM
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matapule matapule is offline
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Default Re: Medicare

Quote:
Originally Posted by Honoruru View Post
HMSA did approve the above procedure and I had it done last week. One benign polyp and allís well with the world. .
EXCELLENT! The best medical care is preventive care, even if it had cost $3000 it would have been worth it.


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