Medicare Part D The Hidden Evils When one becomes sixty-five years of age a whole new world opens up to them. The elderly people of the US are offered discounts at a wide range of different places which include: salons, movie theaters, and drug stores. The reason behind the discounts offered for seniors unfortunately has nothing to do with people appreciating their elderly but it is because many people over the age of sixty-five are on a fixed income. Men and women over the age of sixty-five in the US are also enrolled in Medicare programs. Medicare can be very beneficial however it can also be very sneaky and costly. In theory, Medicare is a good idea. The goal of Medicare is simple: provide reasonably priced medical coverage to seniors. …show more content…
He had been wheezing and found it difficult to breathe. The man went to see his primary care physician who then wrote out a prescription for a nebulizer and for inhalation solution to go along with it. That same afternoon, the pharmacy received the doctor’s fax and they billed Medicare for the device and its solution. In a perfect world, Medicare would have covered the medications and the patient could pick them up from the pharmacy a few hours later. Unfortunately, this was not the case. Medicare originally denied the (expensive) prescriptions for the suffering patient. The pharmacist then called the insurance to get authorization and was told to wait for a call back. Days later, an adjuster from Medicare called the pharmacy and told them to rerun the prescription. The adjustor also said that the nebulizer the pharmacy had in stock would not be covered and that they had to order a different one for the following day(Lee). What should have been a simple pick up for the patient led to a week's worth of aggravation and suffering as he was at home coughing and going without his much needed medicine. Medicare claims to be efficient but it took over a week of back and forth faxing and calling between three parties to get one man’s medication
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A Bordentown family physician’s license was temporarily suspended for prescribing up to 720 opioid pain pills a month without any physical exams or documentation of a legitimate need for the drugs, according to the Division of Consumer Affairs. The physician, Dr. Moishe Starkman, allegedly prescribed large amounts of Fentanyl, Oxycodone, and similar drugs to five patients over the course of five years. From 2012 to 2017, he wrote them prescriptions without legitimate reasons until he agreed to a suspension of his license until a hearing on the allegations with the state Board of Medical Examiners, according to the New Jersey Attorney General’s press release. “We allege that instead of providing legitimate medical care to his patients, Dr. Starkman simply wrote them prescription after prescription for highly addictive drugs without so much as taking their temperature,” Attorney General Porrino said.
MHP took the member home once his prescription was filed. The member states he forget to make follow up appointment with the doctor for next month. MHP told the member she will schedule follow up appointment and will let him know the date and time. The member report that he still want to find a senior citizen apartment. MHP told the member that he will be responsible for paying for the first month rent and security deposit.
These days’ patients can either opt out of treatment or health care options in general because the healthcare system has undergone so much scrutiny for many incidents that still go on, because there’s not a day that goes by without see these drug compensation commercials. Compensation for patients whom have suffered the side effects of drugs that were tested on them with vague explanations of how it would work, and we see human beings die off of such careless inhumane acts. Patients should be constantly reminded of their rights, like how the police read one’s Miranda before they arrested it should be the first thing a care giver makes sure his or her patient knows before they agree to any type of treatment that just
Lastly, I will discuss if Medicare Part D being passed corresponds with my understanding of the policy and politics. Medicare Part D is a prescription drug benefit program that was designed to subsidize the cots of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. Medicare Part D offers prescription drug coverage to everyone with Medicare coverage. Medicare Part D was passed in 2003 in a political climate that used it as a tool to ensure the re-election of a President facing huge deficit (Medicare Part D Policy: The Cost to the Republican Party. (2015).
The parties have not shifted responsibility of medical treatment, or payment thereof, to Medicare in contravention of 42 U.S.C. Sec. 1395y (b). The parties resolved this matter in compliance with both state and federal law. The parties made every effort to adequately protect Medicare’s interest and incorporate such into the settlement terms. Plaintiff and Releasors represent and warrant that all bills, costs or liens resulting from or arising out of Plaintiff’ and/or Releasors’ alleged injuries, claims or lawsuit are Plaintiff’ and Releasors’ responsibility to pay and Plaintiff and Releasors agree to fully satisfy any such bills, costs or liens, including but not limited to any Medicare and Medicaid liens out of the proceeds received from this settlement.
The Affordable Health Care Act was signed into effect on March 23, 2010 signed by Barack Obama. The Affordable Healthcare Act is to make sure that everyone has medical insurance either from your job or just your family insurance then you are safe from getting fined. Although if you don’t have medical insurance and you get caught you get a fine. This fine can range anywhere from 1 to 2 percent at your yearly household income in 2015 if you don’t have coverage, you’ll pay the higher amount of 2% of your yearly household income and the maximum penalty is the national average premium for a bronze plan. The 2% only takes affect if the amount of income is above the tax filing threshold, which is about $10,150 for an individual.
Medicare is a tightly regulated US health insurance program that provides coverage to those who are 65 years or older, certain younger individuals with disabilities and those with end staged renal disease or amyotrophic lateral sclerosis. Medicare has four parts associated with it, one of which is Part B. Part B is also known as supplementary medical insurance and provides coverage to beneficiaries for outpatient care, preventive services, ambulance services, and durable medical equipment. Outpatient physical therapy services falls into this category of coverage for Medicare Part B (Jannenga, 2014). However, there are several rules and regulations that health care providers, including physical therapists, must follow in order to receive proper
At the time of the event, a bar coding system for all medication had been in effect for a duration of two weeks, however, Thao had been gone one of those crucial weeks. Because of her absence, she did not receive the adequate training, instead, she received a sped
Medicare Part D plans may require that you get documentation from a physician in order to cover an expensive medication. Supplemental Help For Prescription Medications One of the drawbacks of having a Medicare prescription plan is that it has a coverage gap. This means that once the cost of your medications have reached a certain limit, you will have to pay 100 percent of the cost up until a certain point. In 2009, the average coverage cap begins when the plan has covered $2,700 worth of drugs.
I enjoyed reading your discussion post and I find it very informative. Medicare is an insurance plan provided by federal government for persons who are age 65 and older, totally disabled, and someone with end-stage renal disease (Touhy & Jett 2012). Your patient interestingly brought up some great points about medicare. It is sad to know that retired people have to deal with the financial hurdle of medicare. It can be very disappointing, because of the added premiums and uncovered medical bills.
The benefits of Medicare Part B include physician and nursing services, diagnostic tests, radiology and pathology services, blood transfusions, medical equipment, physical, speech, and occupational therapy, and outpatient mental health services (Esdin 5). The third part of Medicare is Part C, which was established
The Affordable Care Act “provides Americans with better health security putting in place comprehensive health insurance reforms that will; expand coverage, hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans” states in the Affordable Care Act article. The base of the Affordable Care Act is to help the middle class or financially unstable people get cost effective insurance. This is a major benefit for millions of people especially that don’t have a stable job, young adults and many with families to support, and people who retire and can’t afford paying so much money for medical problems. So with that being said, it will be a long-term benefit for millions to
Their insurance is covered even if they have good income. Everything Is not for free the do have to be able to pay stuff and they are required to pay monthly premiums health care service. Due to Medicare being a Federal run program the regulations are pretty much the
Health Care Law: Tort Case Study Carolann Stanek University of Mary Health Care Law: Tort Case Study A sample case study reviewed substandard care that was delivered to Ms. Gardner after having sustained an accident and brought to Bay Hospital for treatment. Dr. Dick, a second-year pediatric resident, was on that day in the ED and provided care for Ms. Gadner. Dr. Moon, is the chief of staff and oversees the credentialing of all physicians at Bay Hospital.