Medicare & Medicaid Cancer Patients Can’t Get Easy Treatment for Anemia

The Center for Medicare and Medicaid Services (CMS) released information yesterday that has oncologists (cancer specialists) across the country up in arms. The CMS has said that Medicare cancer patients can’t get treatment for anemia unless they want to pay for it out of their own pocket.

“CMS has reversed over 15 years of clinical experience in the treatment of Medicare patients with ESAs without offering appropriate scientific evidence to support such a drastic change. This action ignores the substantial scientific evidence submitted during the course of the CMS review, and dramatically alters the standard of care for Medicare cancer patients,” said Dan Cohen, US Oncology Senior Vice President of Government Relations & Public Policy.

Anyone can become anemic. Anemia happens when your cells don’t get enough oxygen, and they can die. All of our cells need oxygen to survive. Red blood cells carry oxygen to the cells in our body. When we don’t have enough oxygen in our cells, we are considered anemic.

It’s common for cancer patients who are receiving chemotherapy or radiation treatment to become anemic. Cancer treatment is designed to kill the cancer cells, to stop them from growing and multiplying.

Before this decision, cancer patients who developed anemia were given a pretty simple treatment – they were given the drug ESA. Why are ESAs important? ESAs are important in treating cancer patients who are getting chemotherapy or radiation treatment because of how they work.

ESAs are drugs that are injected into the body. They stimulate the body to make more red blood cells. This helps treat, and ultimately recover from, anemia. This has been the standard treatment for cancer induced anemia for years.

The ruling by the CMS will change this treatment. Under this ruling, Medicare and Medicaid cancer patients who develop anemia won’t be able to get this injection. Instead, anemic patients will be forced into a more expensive and riskier treatment – they’ll have to get blood transfusions to treat their anemia.

According to the oncologists, blood transfusions are more expensive than ESA treatment. Blood transfusions also carry more risks. You can die if you get the wrong type of blood, cancer patients might refuse blood because they’re afraid of receiving blood from strangers,

People who have private insurance won’t be subject to this decision. If their insurance covers it, they’ll still be able to get ESA treatment. We’ll end up with a two-tiered system for medical care. Those with private insurance will get the better treatment.

Cohen said, “Medicare beneficiaries who are battling cancer are already fighting for their lives. They should not have to also be battling Medicare coverage policy for treatments that their personal oncologists regard as necessary.”

Long Term Disability Insurance Essential to Patients with Fibromyalgia

Long term disability insurance is a type of insurance coverage that many adults fail to carry, often believing they will not need such coverage in the immediate future. For many adults, the complications of health that lead to a need for LTD coverage often come well before LTD coverage is secured, ultimately leading to a financially devastating loss when uninsured. If you are at-risk for developing long term complications associated with fibromyalgia, it is important to consider how you may need long term disability insurance coverage and what roadblocks you may encounter when attempting to use such coverage. Read about long term care facility.

Fibromyalgia is a complex health condition that adversely affects the lives of millions of adults worldwide. As a condition that leads to chronic fatigue, depression, and an overall feeling of muscle fatigue and pain, many adults with fibromyalgia become unable to work due to symptoms that can not be well controlled. When gainful employment becomes difficult to acquire and retain, long term disability insurance coverage is a necessity to ensure health and living expenses can be paid.

When living with fibromyalgia, if you plan to purchase LTD coverage, or if you already have LTD coverage, you can expect the insurance company will initially deny your claim for benefits with the most often basis for decline as “no evidence of disability”. For many LTD companies, there is a strong belief that fibromyalgia is a mental health condition for which a total disability is not commonly present and therefore it is commonplace to deny such a claim.

In addition to the denial basis for disability, many LTD carriers attempt to deny fibromyalgia claims for disability under the basis that long term disability insurance coverage has not been in effect long enough to secure such benefits. Because fibromyalgia is classified as a mental health complication, and most LTD policies carry a two year waiting limit, your insurance adjuster will usually classify your claim for disability and deny it under the mental health exclusion.

If you find that you suffer from fibromyalgia, and you want to secure or utilize long term disability coverage, be prepared for the initial denial and possible subsequent denials of your claims. Using lack of disability documentation, along with mental health policy exclusion, many LTD insurance carriers are finding ways to deny these benefits to policyholders who are in desperate need of such coverage when living with fibromyalgia. The key to obtaining benefits lies in your persistence and diligence in fighting the denials with proper documentation.

Sources: Journal of Immunosuppressive Disease, May 2008, pp. 7-16.

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