Help! Financial "Catch 22"

Posted By
POW
12/18/2012 11:50pm
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POW
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Replies: 2

My brother is being treated for Stage IV melanoma at the Tampa VA Medical Center. In addition to his Veteran's health benefits, he is also covered by Medicare and by Medicaid. In June, when he was first diagnosed at the VA, the oncologist there suggested that my brother look into clinical trials at Moffitt. He did that, but he was not elegible for any trials because of brain mets. So he started Zelboraf at the VA.

The Zelboraf plus some SRS surgery to the brain worked great. All of his mets were shrinking, dead, or gone. But then one met in his lung started growing. Darn! The VA oncologist said that we could check into clinical trials at Moffitt again (now that the brain mets are gone) or my brother could get ipi at the VA. My brother decided to check into clinical trials again. The appointment is next week.

Meanwhile, my brother got a letter from Medicaid saying that they would not pay for the June Moffitt consultation because it had not been arranged through the proper referral process. We didn't even know that Medicaid was involved in this. I assume that Moffitt does not take Medicare (?) so they billed Medicaid(?). My brother discussed this with his VA oncologist who said that he can not officially refer my brother to Moffitt if any type of appropriate treatment is available at the VA, which it is (ipi). 

So now we have a Catch-22 situation. The VA won't pay for these consultations at Moffitt (the clinical trials may be free, but the consultations are not). Apparently, Moffitt doesn't accept Medicare. Since an "acceptable" (perhaps not the best) treatment is available at the VA, the VA oncologist can't refer my brother to Moffitt. But without an official referral, Medicaid won't pay, either. And my brother lives on his Social Security and has no assets. 

Does anyone have any suggestions? Is there any way to get the VA to either pay for or refer my brother to Moffitt? I suspect we will have to talk to someone at Moffitt about this. But who should we talk to? The Moffitt business office? The Moffitt social worker? Someone else? My brother has enough on his plate right now without worrying about how to pay for a consult, so I'm trying to do as much of this as I can without involving him. I would appreciate  any help I can get.

buffcody - (12/19/2012 - 6:03am)

The one thing that stood out for me in reading this is your "assumptions" about Moffit not taking Medicare.  I find that hard to believe that a major medical institution would not accept Medicare.  So I would definitely consult with the business office at Moffit to see if your assumption is correct first thing today.  That may solve your problem, or, if not, at least give you some certainty as you move forward to other possible solutions. I don't know if you use the MIF forum at all, but Catherine Poole often has some ideas about things like you are facing that may prove helpful.  Good luck.  I hate to see you stuck in a quandary like you're in.

POW - (12/19/2012 - 11:05am)

Hey, Buffcody, your advice was spot on! Thank you so much!

When my brother got a refusal letter from Medicaid, I assumed that Moffitt did not accept Medicare. Why else would Medicaid come into the picture? However, after reading your response, I screwed up my courage and called the Moffitt business office. It turns out that yes, Moffitt does accept Medicare as well as VA benefits. Furthermore, my brother has no outstanding balance at Moffitt. 

I still can't figure out how Medicaid got involved here (and neither could the business office rep I talked to) but the bottom line is that everything is OK with my brother and Moffitt. Now he can go to his second clinical trial consult at Moffitt next week without worrying about any financial hardship.

Thank you again!