Can my dad get help to pay for shots after chemo?

1 answer | Last updated: Nov 28, 2016
Broncos asked...

My dad has to get these shots after he has his chemo but they cost a lot of money.  How can he get help to pay for these shots?


Expert Answers

One of the big loopholes in Medicare Part B medical coverage is for outpatient hospital or clinic bills. If your dad is getting shots at a hospital or clinic as an outpatient, they can charge him personally for the entire amount of their bill above what Medicare pays them. Because Medicare sets a limited amount as their "approved" charge, and then pays only 80 percent of that, your dad can be left with a big bill for each shot he receives.

There are several ways to try to address this problem. First, you and your dad can go to the administrator or billing office at the hospital where he's getting the shots and ask that the hospital accept "assignment" of the Medicare-approved amount. This means your dad would be personally responsible only for 20 percent of the amount Medicare decides is the appropriate amount, which is usually a lot less than the hospital's unrestricted charges. If the hospital administrators will not agree, your dad can tell them that he will arrange to get his shots elsewhere. That might make them negotiate a lower payment.

If the hospital where your dad's now getting his shots won't change their billing, talk to your dad's oncologist and primary care physician. Explain the problem and ask if it's possible for your dad to get these shots in the doctor's office instead of at the hospital or clinic. If so, Medicare payment rules are different -- your dad would only have to pay 20 percent of the amount Medicare approves for the shots, which is usually much less than what an unrestricted hospital charge is for the same service. If the doctors can't or won't give the shots in their office, ask them to refer your dad to a different outpatient clinic that accepts the Medicare-approved amount as the full charges for the shots.