NH woman with MD fights for Medicare coverage

From the Nashua Telegraph:

NASHUA, N.H. – Arthur Pare (pictured) isn't sure which is worse: that Medicare won't pay for medical supplies his daughter badly needs, or that it would pay in full for many of those things if she took a more costly route and opted to be hospitalized rather than be treated at home.

Even her doctor is frustrated, said Lisa Pare (pictured), 44, who has muscular dystrophy.

Her doctor at St. Joseph Hospital said, "I'm going to hospitalize you until they pay," Arthur Pare related.

However, the Pares didn't want that. To them, it makes no sense that Medicare won't pay for care to be administered at her home for a third of the cost of hospitalization.

Medicare is an insurance program that provides coverage to people older than age 65 or who meet other criteria. The program is administered by the federal government.

As debate over health care reform continues, Arthur Pare believes Medicare itself isn't working. Pare favors health care reform but worries about the details.

"I'm all for it, but my pharmacist seems to think it's going to cause all these other problems," he said.

Meanwhile, Lisa Pare's bills keep piling up.

The trouble began a year ago this October. Lisa, who had long before been diagnosed with muscular dystrophy, had a coughing fit that landed her in St. Joseph Hospital.

Her weakened chest muscles caused her lungs to collapse. She needed a tracheotomy to breathe and spent 4-1/2 months in the hospital.

"After that, it was one thing after another," Arthur Pare said.

Lisa came down with pneumonia, and then a virus invaded her lungs that doctors can't get rid of. She has to go to the hospital daily for treatment and requires special equipment and medicine.

Her doctor wrote a prescription for a lift chair and equipment for the bathroom.

The Pares bought the $1,250 chair at a local medical supply company. They were told they had to pay up front and then submit a claim to Medicare for reimbursement. Medicare rejected the claim.

Medicare also rejected claims for other equipment, such as a $99 walker, or limited the amount of equipment it would fund. For example, she constantly needs to replace plastic suctioning tubes she needs because of the tracheotomy. Medicare approved paying for 60, which Lisa said she'll go through in no time.

"Sometimes we'll suction her eight times in one day," Arthur Pare said.

Each time requires a new tube, he said.

Same with plastic gloves at $3.75 a box. Because of her lung infection, each time Arthur or someone else suctions Lisa's tracheotomy, he has to wear plastic gloves, and the family whips through those, Arthur Pare said.

Tubes run $50 a month. Sponges cost $11.

Lisa receives a monthly disability check of $708. She never added up her monthly medical expenses, but they're steep.

Worse is medicine that Lisa says Medicare declined to pay for.

"I told them it's a life and death situation here, and they still wouldn't pay for it," she said.

Exasperated, Arthur Pare is seeking help from elected officials. He said he waiting for a call to be returned from the office of U.S Sen. Jeanne Shaheen.

Lisa is tired of fighting her Medicare case manager from the state.

Meanwhile, her doctor keeps hoping Medicare will pay the claims.

"St. Joseph Hospital keeps submitting them, and they keep rejecting them," she said