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New Medicare Rules Are Killing Us

Updated on March 5, 2015
Barbsbitsnpieces profile image

Barbara Anne Helberg is a Fiction freelancer, Internet writer, WordPress blogger, former Journalist, and a Famous Writers School graduate.

A standard nebulizer belonging to the author
A standard nebulizer belonging to the author | Source

Imagine

Imagine your nebulizer breaks, and you don't have the income to pay for a new one.

Imagine you use this equipment twice a day, sometimes three times. It's nine o'clock at night.

Imagine you were about to use the nebulizer for your evening breathing treatment.

Imagine you live in the United States of America.

Calling Medicare

Now imagine that new Medicare rules prevent you from getting a new nebulizer without a hassle that will keep you occupied for some 36 hours. That's enough time, easily, to cease breathing.

And imagine your life depends on this little machine that turns liquid into life-giving vapor that opens your airways.

Imagine not being able to get oxygen approved for installation in your home because your blood oxygen "number" isn't low enough.

Imagine suffering from Diabetes but being unable to get maintenance medicines.

It's happening, and it's going to kill people, if it already hasn't done so.

Medicare (my Dear Mr. President) needed changes, but it appears that ongoing changes represent overhauls that are hindering the health of many Americans, rather than lending a helping hand to their medical concerns.

Have you had this experience? Do you know someone who has had this experience?

Will you share your experience?

COPD and Exposure

I use a nebulizer twice to three times a day to maintain my airways; in other words, to help keep them open enough for air to pass through them. COPD (chronic obstructive pulmonary disease) is an incurable lung disease that requires constant maintenance.

There are two types of this lung ailment: COPD emphysema and COPD chronic bronchitis.

Generally, heavy smokers can contract emphysema, while exposure to secondhand smoke and other irritants causes chronic bronchitis.

I have COPD chronic bronchitis. Although I never have smoked other than briefly and experimentally as a teen, I spent the last 13 years before my retirement in industry being part of atmospheres that included cigarette smoke, oily welder smoke, fine steel shavings, sawdust, and the stinking smoky residue from plastic product extruders.

What have you been exposed to?

The Search for A New Nebulizer and A Medicare Adventure

One evening, my nebulizer broke. The machine's stem to which breathing tubing is attached broke off completely inside the end of the new tubing I had been installing. What to do? Trying not to panic, I used my rescue inhaler, then at midnight, as usual, I inhaled my Symbicort.

The next morning, after using my Symbicort again, I called a local medical supply company to find out what I needed to do to get a new nebulizer through Medicare. Here's what I needed:

A. = A new face-to-face interview with my doctor, explaining the nebulizer problem. The conversation needed to include information on how often I use the neb, and how often I will continue to use it (both of which, of course, she already knew, since she's been treating me for COPD.)
B. = A sheet of notes from the conversation with my doctor, written, signed, dated, and initialed by her.
C. = Proof of my current prescription medicines (Albuterol and Ipratropium) that are used with the nebulizer, and others.
D. = A standard written prescription for the nebulizer.
E. = A standard written prescription for the neb's tubing and mouthpiece.

All this was required even though I'd been a COPD patient on a nebulizer for five years and my neb meds had been covered all that time by Medicare and Medicaid.

I had to make a special doctor's appointment to another town to obtain these paper requirements. As I haven't owned a car since 2009, my transport anywhere is always a first concern. Fortunately, we have a cheap bus transport system available to Seniors in our county.

Acquiring a nebulizer from the medical supply company:

Did you know that anyone can purchase a nebulizer from a medical supply company, or off the Internet, but you cannot do this if you are a patient who needs Medicare to pay for your medical equipment because you can't afford it yourself?

I'm not anyone; I'm a patient.

So, when I took my doctor's notes and my pulmonologist's notes and personal ID and insurance papers and prescriptions and whatnot to the medical supply company, I still needed to sign, or receive, twelve pages of regulations, agreements, and instructions concerning the neb purchase.

Because I have Medicaid as a secondary insurance, Medicare covers all the cost of my new neb. It cost $25 a month for 13 months, as much as three times the amount, in some cases, that an "anyone" would pay. After the 13th payment, the neb officially is mine. I won't own it until then, plus I'm liable for any breakage, or misuse, of the unit that might occur before the payments end.

An "anyone" pays anywhere from $80 to $200 for a standard desk nebulizer like mine (pictured above.) But Medicare charges more for a patient's like nebulizer. Who is being served?

Does this story sound reasonable to you? Is it something, do you think, that a regular patient should have to go through?

I was outraged at Medicare's demands. Are you?

Every Breath I Take

With every breath I manage to take, I worry about the next one and how difficult it some day will be, once again, to draw an additional one.

In 2009, I collapsed several times, unable to breathe, in need of a rescue squad, before the diagnosis came in: COPD chronic bronchitis and asthma. I had no idea what the COPD part meant, but it didn't take me long to find answers. The asthma had nearly killed me as a pre-schooler but had gone dormant in my adulthood until my retirement in 2008 and my subsequent collapses in 2009.

In January of 2010, it was determined I also had a lung infection. My neb and I have been pals ever since then, along with Symbicort and Prednisone and a rescue inhaler.

I have no idea how long I will keep breathing, and those New Medicare Rules haven't made it any easier.

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    • Barbsbitsnpieces profile imageAUTHOR

      Barbara Anne Helberg 

      3 years ago from Napoleon, Henry County, Ohio, USA

      @Austinstar... Thanks for stopping by to comment!

      Your remarks are so true, and very much describe my own like dilemma. I especially applaud your thought: "Why cover Rx drugs at all if you(')r(e) not going to cover them sometimes?".

      What was once accepted as necessary for one's health is now unaccepted with the new filing system of refuting what was once true. And if that statement confuses, welcome to the new Medicare language!

    • Austinstar profile image

      Lela 

      3 years ago from Somewhere near the center of Texas

      Any medical insurance company today in the USA needs to be overhauled. My stupid Medicare insurance plan refuses to pay if the paperwork isn't perfect, they keep sending me snail mail paperwork even though I've repeatedly asked for emails instead. They even send BLANK pages in the envelopes! They send 10 pages of paper every time I get a Rx filled, (one email would be sufficient). They always deny payment before making me get MORE paperwork. It's insane.

      The Medicare doughnut hole is HORRIBLE. Why cover Rx drugs at all if your not going to cover them sometimes?

      You really have to plan ahead and keep on top of the freaking paperwork in order to survive healthcare in the Medicare world.

    • Barbsbitsnpieces profile imageAUTHOR

      Barbara Anne Helberg 

      3 years ago from Napoleon, Henry County, Ohio, USA

      @aviannovice...Your comment is sadly true. Thanks for participating on this Hub.

      Yes, I've thought of moving to Canada!

    • aviannovice profile image

      Deb Hirt 

      3 years ago from Stillwater, OK

      This country does nothing for its citizens medically. Granted with socialized medicine, it has its problems, too, but everyone gets what they need--FREE.

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