The Med Diva

An insider's guide to Medicare Part D and more

Archive for the tag “Obamacare”

Medicare No Longer Pays for Vitamin B-12 Injections — and it’s All Obama’s Fault

Medicare True or False
Is the headline of this post true or false?

If you are a person who believes everything you read on the Internet, then you may be inclined to say it’s true. If, on the other hand, you question everything that sounds too good to be true or simply too unbelievable, then you probably think it’s false—but you’re going to do more research to double-check.

A recent State Farm commercial features a man and a woman discussing mobile apps. During the conversation, the man asks the woman why she believes something he said, and she tells him it’s because she read it on the Internet. “They can’t put anything on the Internet that isn’t true,” she tells him. Right then, an unattractive man walks into view. The woman tells her friend that the boorish man said he was a French male model on the Internet.

The point is, there are a lot of lies out there on the World Wide Web. And many of them have to do with horrible changes to Medicare coverage under the Patient Protection and Affordable Care Act (ACA). Many of the lies are ludicrous and primarily designed to instill fear in people.

The other day, my mom sent me an e-mail that she had received from a former coworker. She told me she was concerned about some of the things the letter said about Medicare coverage under the ACA, aka, Obamacare. Here’s just one excerpt from the e-mail:

Today I went to the doctor for my monthly B-12 shot that I have been getting for a number of years. The nurse came and got me, got out the needle filled and ready to go and then looked at the computer and got very quiet and asked if I was prepared to pay for it. She said that Medicare had turned it down and went to talk to my doctor about it. Fifteen minutes later she came back and said she was sorry, but they had tried everything they could but Medicare is beginning to turn many things away for seniors because of the projected Obamacare coming in.

I did some quick research on and and found out that this letter was one of many that began circulating when Congress was considering a healthcare bill called America’s Affordable Health Choices of 2009 (H.R. 3200). This bill was never passed by Congress. However, the letters continue to circulate, even though most of the points made in these letters are completely irrelevant, outdated, and have nothing to do with Obama’s Affordable Care Act (H.R. 3590).

Yes, Medicare does pay for B-12 injections – if deemed reasonable and necessary
Under Section 1862 (a) (1) (A) of the Social Security Act, Medicare covers services that are deemed reasonable and necessary “for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” For example, vitamin B-12 injections are covered, but only for diagnoses such as pernicious anemia, gastrectomy, and dementias secondary to vitamin B-12 deficiency. In addition, the frequency and duration of the administration of the medication must be within accepted standards of medical practice, or there must be a valid explanation regarding the extenuating circumstances to justify the need for the additional injections.

You should also make sure your doctor’s office uses the correct codes when billing Medicare for B-12 injections. According to what I read on the American Academy of Professional Coders website, some Medicare Advantage Plans will not pay for the injection if the doctor also bills Medicare for an Evaluation and Management service. Other plans require a diagnosis code in addition to the codes for the administration and drug code. So if you get your coverage from a Medicare Advantage Plan or Medigap supplemental plan, you should ask what documentation the plan requires for coverage before getting your first injection.


This Medicare article is not about Paul Ryan or Obamacare. It’s about a new Medicare rule for power wheelchairs.

Seven states will require a prior authorization process to get Medicare coverage for power wheelchairs and scooters.

For the past few days, my inbox has been bombarded with news about the Paul Ryan budget and its projected impact—good and bad—on Medicare. I’m not a political pundit and I don’t pretend to be one, so I have no intentions of joining the Ryan-Romney-Medicare bandwagon. What I do want to talk about are the real (i.e., known) issues that are going to affect Medicare beneficiaries now or in the very near future.

Although it was like trying to find a needle in a haystack, I found such a real topic yesterday, in an article from American Medical News.  It turns out that while everyone has been worrying about Mr. Ryan and his proposed budget plans, Medicare beneficiaries in seven states are actually going to have to wait longer than beneficiaries in other states to get Medicare coverage for their power wheelchairs or scooters. This news is for real.

Beginning September 1, 2012, and continuing thereafter for the next three years, the Centers for Medicare & Medicaid Services (CMS) will require prior authorization for power mobility devices prescribed in seven states: California, Florida, Illinois, Michigan, New York, North Carolina, and Texas. CMS is calling this a “demonstration project,” which they said will allow them to collect data that will be used to combat fraudulent claims for power motility devices.
Under the three-year project, providers in the seven states will need to send authorization requests and supporting documentation to a Medicare contractor when ordering power wheelchairs for patients. The contractor will review the request to ensure that it meets national and local coverage requirements. Contractor approval will be necessary before patients can receive the items.  

According to CMS, the prior authorization review process will take about 10 business days. Expedited reviews will be available when a patient’s health would be harmed without access to the power wheelchair or scooter.

Medicare power wheelchair fraud has been rampant in recent years. According to CMS, federal law enforcement agencies have prosecuted more than 600 cases representing almost $3 billion in fraudulent claims since 2009. The seven states chosen for this demonstration project represent more than 40 percent of power mobility device orders through Medicare.

I’m not totally sure that a prior authorization process is the right tactic to take here, although I do give CMS credit for trying new ways to control Medicare fraud. And hey, maybe if CMS saves enough money by reducing fraud, we won’t have to talk about a Paul Ryan budget plan anymore…I’ll leave it at that.

Granny, Get Your Gun — And No, Medicare Won’t Make You Tell Your Doctor!

Lately, there have been a lot of crazy rumors about Medicare spreading like wildfire on the Internet. Like the rumor that Medicare premiums are going to jump to $247 in 2014 thanks to the Affordable Care Act, or that Medicare is going to refuse procedures for seniors over 75 unless an ethics panel (aka, death panel) reviews them—again, thanks to Obamacare.

But this rumor that I came across today on the Huffington Post Politics blog isMedicare Does not Ask About Guns by far the most absurd falsehood I have heard yet: Apparently, a Vietnam Vet and/or retired police officer started spreading a rumor via e-mail that Medicare regulations require doctors to ask you if you own a gun. “Be forewarned and aware,” the e-mails state. “The Obama administration has gone on record as considering veterans and gun owners potential terrorists.”

There’s a long and convoluted story behind this rumor, which you can read for yourself on Snopes, but just know that this rumor is wrong and belongs way out in left field (or maybe that should be right field in this case). Although doctors (particularly pediatricians) in most states can ask patients if they own guns if the question is relevant to the person’s medical care or safety, this question is most definitely not required by Medicare. 

So as I stated in my last post, don’t believe everything you read or hear. If you want to sort through the rumors and get to the truth, do some searches on Google to find reputable sources, or check out these fact-finding sites: or or

Coming soon to a theater near you: Son of the Medicare Donut Hole

Like the Blob, the Medicare Donut Hole can consume you.

The dreaded Medicare Coverage Gap will return if Obamacare goes away

Remember the movie Beware! The Blog (also called Son of Blog), the 1972 sequel to the horror science-fiction film The Blob? In this film, a rapidly-growing mass of red ooze returns to prey upon a small town, consuming everything and everyone in its path.  

I hate to say it, but sometime in the near future the Blob may return again, this time to consume all those new Medicare benefits made possible by the Affordable Care Act, aka, Obamacare. Like all those low-budget horror films of the 1970s, a sequel to Obamacare—be it by way of Republican repeal or Supreme Court decision—could be pretty scary and rotten for many people.

For the past few months, Mitt Romney has been going around the country telling supporters that he vows to repeal healthcare reform on Day One of his presidency. I’m not going to get into the irony of this promise or bring up any other political views here, but suffice it to say that most Republicans are in favor of doing away with both Obama and his administration’s Affordable Care Act. Mind you, repealing the law entirely would be a very difficult and lengthy process, but let’s assume it could happen.

We also have to watch out for those nine men and women in black. Starting today, the Supreme Court will begin hearing three days of arguments over the constitutionality of the healthcare reform law. There are three ways the Supreme Court could rule: It could uphold the law, strike down parts of the law, or strike down the whole law.

If there’s a sequel to Obamacare, the Blob may very well return – albeit, in the shape of a donut hole.

Under the Affordable Care Act, the donut hole is shrinking each year until it closes in 2020. Right now, 3.5 million seniors and disabled citizens with Medicare Part D coverage pay less for prescription drugs when they reach the Coverage Gap. Thanks to the ACA’s Coverage Gap Discount Program, Medicare beneficiaries have already saved an estimated $3.2 billion on prescription drugs. In addition, every senior now receives free preventive-care visits under Medicare Part B.

As Vice President Joe Biden recently told a group of seniors in Florida, if the law is appealed or struck down in its entirety, the donut hole will return and you can say good-bye to free preventive care visits. 

If you would like more information about all the benefits you are entitled to with Medicare under the Affordable Care Act, check out this short video from the Patients Aware campaign.

This campaign was created by the National Committee to Preserve Social Security and Medicare Foundation, the Herndon Alliance, and the National Physicians Alliance to help seniors understand the new Medicare benefits available to them through the Affordable Care Act.

It’s not as exciting as Son of Blob, but it helps show why Obamacare is not the horror show some people want us all to believe.

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