Medicare/Disability Issues

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Navigating the universe of Medicare Part D or the Social Security Administration in pursuit of disability benefits can be a challenge to new and experienced providers or advocates. How do you make your case to a Medicare Part D plan to pay for an off label use of a drug? What do you tell your clients who are in the doughnut hole? What do you need to do to give a client the best chance of making a successful disability application? Use this forum to discuss.

Patient situation and granting of LIS

Published by admin on February 25th, 2009 in Medicare/Disability Issues

I have an elderly Medicare patient who has prostrate cancer. His social security check is $375.00 per month and he is widowed. A number of years ago he bought this little house from an IRS foreclosure and did the work to make it livable. He rents it for $500.00 a month and uses that $500.00 to supplement his $375.00 monthly. Still $875. a month is not a lot to live on. Of course this house is not his residence. He was turned down on the LIS and simply can’t afford his medicines even with plan D.Read more

Experiences (positive or negative) with Disability Advocates of America

Published by admin on February 25th, 2009 in Medicare/Disability Issues

Has anyone ever heard of any experiences (positive or negative) with Disability Advocates of America? I have a patient who applied for benefits through social security, was denied and now the appeal has reached the federal level. It has sat there for months and months. No one has heard a word and we've called and no one returns calls. Any thoughts? I was wondering if it would be helpful to get a more system-savvy part involved---and if so, who that might be. The family is quite poor and could not afford legal representation on their own.

Medicare Part D and actiq, off-label

Published by admin on February 25th, 2009 in Medicare/Disability Issues

My colleague has a client who takes actiq, off-label, as she does not take it for pain related to cancer. Her Medicare Part D plan will not cover it anymore because of its off-label use. I know that Cephalon, the company that manufactures this drug, has a stated policy of not helping people eligible for or enrolled in Part D. I just want to double check to see if anyone has had any luck getting around this policy with the insurer or with this company.