MEDICARE OR MEDICAL PAIN MANAGMENT - Pain Management Message Board

cathy pierce · 06-05-2002, 02:57 PM

Hi I live in California does anyone know if medicare or medical. Cover pain management . Thank Cathy

[This message has been edited by cathy pierce (edited 06-05-2002).]

davidc66 · 06-06-2002, 06:29 AM

Hey Kathy, If you signed up for Part B of medicare it will cover your office visits and treatment at whatever percentage your type of medicare you have.

I have basic medicare part A and B along with my primary ins through my wifes work. Medicare is my secondary ins put picks up my copays. Some states offer an HMO option for medicare so you would have to look at your benefits guide or get some scoop from someone else in Cali. Basic medicare doesn't have prescription coverage where some medicare HMO's do.

I've met a couple people at my PM's office that opted to have the pump implanted because they didn't have a way to pay for the expensive long acting oral meds. This is covered by medicare and the pump refills are also covered as an offfice visit. I'm sure ther is a web site for mediCal, you might want to look for that to see what type of prescription beni's you would have.

The state version of medicare in VA is called medicaid. This program pays for 100% of office visits and all scripts have a 1 dollar copay.Medicaid is based on income. It really is different from state to state. Good luck, David

cathy pierce · 06-20-2002, 03:00 PM

Hi Looked could not find out from the internet if medicare covered pain managment. Called around to different pain managment. In California medicare will not pay for pain managment. If call around you will find some pain managment that except medical. Cathy

davidc66 · 06-20-2002, 03:58 PM

Hey Cathy, I'm getting ready to do the pump trial because medicare will pay for the office visits and refills. My prescription plan changes 7-1 and the copays and prices of the long acting meds are just not afordable, I would have to choose between my home or refilling a script for any long acting med. So I do know for sure that pain management is covered by medicare, If you have both it probably gets confusing as to who pays what and first. I would call you local mediCal office and ask if they cover PM and if they are considered your primary or is medicare your primary ins.

I'm really not clear on the whole Primary secondary thing. My wifes co's medical is my primary and medicare is my secondary. Medicare does cover my copays when I see the PM doc now. So they should pick up whatever my primary doesn't cover once the pump is implanted.
My wifes foot has continued to detoriate and Rite aid is trying to squeeze her out now. She was out 6 months for a total ankle reconstruction, since returning 2 months ago she has suffered 2 fractures in the foot they worked on. So medicare will likely become my only ins, My PM doc knows this and said not to worry, Medicare is great at covering the pump costs. Good luck, David

nonanita · 07-08-2002, 04:39 PM

Hi, Cathy, I see we are almost neighbors! Don't know if you qualify, but if you have Medicare B and Medi-Cal as second payor, it is my understanding that you pay -0-. I worked in a doc's office almost 16 years, until 1/02 and thats the way it worked there.

Do you have a referral to a pain management clinic? I wonder if some arrangement might be worked out for you with them, if, for example, you only have Medicare and you say Medicare won't pay for pain management? Do you mean Medicare won't pay for injections/and/oral medications given in a physician's office? In some cases Medicare will pay for injections given in a physician's office, but not oral meds. Maybe your PM doc could hospitalize you as an out-patient for the treatments? I would check out with the PM doc about in-office injections and Medicare. In my former job, Medicare paid for them (up to the 80% allowed). Good luck.

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nonanita