Catching Up With Myself

Well, I finished my two-week marathon of doctor's appointments and tests, and I really can't recommend that strategy to anyone--it was tough. By the end, I simply wasn't able to absorb any more information, which is why I haven't blogged about Thursday's and Friday's events yet. 

And I think I'm going to skip over most of those events here, and just say that Dr. Lee and I agreed on a new treatment plan on Friday subject to Medicare's paying for it. The new plan, I'm calling "chemo light," is only targeted therapies, no conventional chemo. 

So the drugs I will be getting:

Avastin, every three weeks, by IV

Herceptin, every three weeks, by IV

Zometa, every six weeks, by IV

And Tykerb, three 250 mg. tablets daily. 

Dr. Lee wants to do some scans, but the contrast is hard on my kidneys, which are functioning at a borderline level, so we'd like to not stress them any more than necessary. He was worried about the possibility of a pulmonary embolism, though, and was going to consult with my lung specialist to see what she thought about the risk of embolism vs. the risk to my kidneys. 

Guess I need to call and see what their advice is about that. Or I could wait three weeks till my next appointment with Dr. Lee ... 

Another disturbing bit of information came out of Friday's appointment with Dr. Lee: The "chemo light" plan assumes that I get regular PET/CT scans to keep tabs on my cancer, but Dr. Lee said that Medicare only pays for ONE PET scan a year--something I didn't know. 

So now I have to decide how to tackle that problem--because I had my last PET/CT in January, but we'd like to do another one this summer. Has anyone else run into this problem with Medicare?

I figure my options are: Fight Medicare. Hold a bake sale. Scream at the universe. 

Meanwhile, I had a great holiday weekend, which included hours spent gardening, including getting most of my vegetable starts into appropriate containers, a couple of long walks with Connie the Wonder Dog, and a cookout with Car Guy and friends on Memorial Day. 

Everyone but me ate ribs, and then we had corn on the cob cooked on the grill, grilled mushrooms (done in foil packets with soy sauce, butter, and garlic), and cheesecake. This was at Car Guy's house, since he has a grill, and I took the kitten, Wilber, along for entertainment. 

A great time was had by all. 

@ Jeanne Sather 2009. 

Comments

[carrie s]

Glad you had a good weekend.
I am fairly new at negotiating the system but wondering if you are eligible for Medicaid. Do you get Medicare because of your age or because you are disabled? You do not look 65...My family gets Medicaid because our income is virtually non existent (last year and this year), and we were approved before my husband was declared disabled. My understanding is that if you are found to be disabled you are eligible for Medicare after 2 years. But I feel silly to presume to know anything compared to you who has been dealing with all this for 10 years...Best of luck with the new regimen.

[jeanne Sather]

Hi Carrie--yes, I have Medicare because I've been legally disabled for two years. (I'm 54.)

I think I might be eligible for Medicaid now that my income has dropped so low. I keep meaning to look into it ...

[Brian]

Jeanne,

Before you start fighting, baking, or screaming...
does any of the following apply to your situation?

http://www.lungcanceralliance.org/MedicareandMedicaidPETScanCoverageExpanded.html

http://www.cancernetwork.com/display/article/10165/1407453

http://www.seniorjournal.com/NEWS/Medicare/2009/20090406-MedicareExpands.htm

If not... I'd like a German Chocolate Cake Please!

Peace
Brian

[Amorette]

I'd give Medicaid a try as a temporary measure. I've had Medicaid a couple of times temporarily, to bridge coverage gaps. Every state is different (one plan I was on required repayment in full when Medicare kicked in), but it's worth scheduling an appointment with a caseworker and looking into the options.

[Brian]

I called medicare today for a similar situation I'm having and did nothing but chase my tail.

In the next couple of weeks my doctors has scheduled me for 4 scans. Two CT scans and Two MRI's After reading your rant you got me wondering if all of my scan would be paid for by Medicare.

The answer was vague, "If it's medically necessary Medicare will pay for it."

Hum, who decides if it's medically necessary?
"MEDICARE."

So did I need to get prior approval?
"NO."

So I do I go ahead and have all 4 scans done? I don't want to end up with a big bill that I have to pay.

"IF IT'S MEDICALLY NECESSARY."

OK, so I don't need prior approval and I have the scans done that my doctor thinks are "medically necessary" and Medicare determines that they are not "medically necessary" and I get a bill for what's not covered?

"YES, YOU COULD BE BILLED."

Click!

What's a scan now a days? 4-6-8 thousands dollars??? I think we have a good case for it being medically necessary if a doctor says it's required.

I'll continue my rant on my blog. Just thought I'd chime back in...

Peace
Brian