Search Weight Loss Topics:




Jan 7

Holt woman who dropped to 66 pounds says Medicare won’t cover what she needs to survive – Lansing State Journal

Long Term Weight Loss Comments Off on Holt woman who dropped to 66 pounds says Medicare won’t cover what she needs to survive – Lansing State Journal

Buy Photo

"If I didn't have this bag, everything I put in my mouth would drain down the front of me," Shelly Lienhart, 55, of Holt says Monday, Dec. 30, 2019.(Photo: Matthew Dae Smith/Lansing State Journal)

Shelly Lienhart has lost nearly 10 pounds in the last five months. It wasnt a cause for celebration. The weight loss worried her.

At 52, sheweighs 66 pounds.

And she fears shell keep losingweight if Medicare continues refusing to cover the medical equipment and medicine she saysshe needs to survive.

They are letting me waste away to nothing like my life doesnt matter. How much weight can I lose? Lienhart said. I feel like Im starving to death, and Medicare isnt doing anything about it.

Lienhart, who lives in Holt, weighed 100 pounds at her healthiest. But that all changed after cancer ravaged her body five times and left her with long-term medical issues.

Surgeons removed her stomach and esophagus after she suffered from stomach cancer and four bouts of esophageal cancer.

Lienhart wasleft with a unique medical condition that befuddled her doctors, she said. Because of it, she qualified for disability and then Medicare, the federal health insurance program thatcovers thoseage 65-plus and disabled individuals.

Im so unique. (Doctors) dont know what to do with me, Lienhart said. Anytime I go in (for an appointment), theyre like What do I do?

Lienhart began advocating for herself after Medicare denied her medical claims for ostomy bags, which she attaches to a hole in her neck to drain saliva and collect any food or drink she tastes, and also a nutritional formula thatshe said will help her gain weight.

The 55-year-olduploaded a video about her health challenges to Facebook in December. Since then, the video has received nearly 10,000 views.

Medical equipment suppliers and businesses donated 15 boxes of ostomy bags to Lienhart in response.Each box contains 10 ostomy bags, the medical equipment Lienhart said she will need for the rest of her life.

But Medicare told her she isn't using the ostomy bagsas intended.Ostomy bags are traditionally used to collect stool and urine.

Considering Lienhart uses one ostomy bag a day, eventually shell need to buy more on her limited income, she said.

And so shes seeking a permanent solution.

Lienhart was first diagnosed with stomach cancer in 2002.

She battled esophageal cancer from2012 to 2015, which iswhen she had her last surgery.

Lienhart wasnt a candidate for a procedure in which doctors stretch the intestine so that patients can eat and swallow post-surgery. Radiation had done too much damage.

So Lienhart was forced to havea hole in her neck, a fistula.

Anything I put in my mouth goes through that hole, Lienhart explained.

Lienhartattaches an ostomy bag to her neck, which she saidhelps drain fluid, such as saliva.

Shelly Lienhart, 55, of Holt on Monday, Dec. 30, 2019. She is a survivor of stomach and esophageal cancer. Her nutritional needs are met intravenously. Everything that goes into her mouth, as well as saliva, drains into an ostomy bag.(Photo: Matthew Dae Smith/Lansing State Journal)

Nurse PractitionerCaralee Kay Smithdiscovered Lienharthad droppedfrom 95 to 91 pounds within a monthpost-surgeryin September 2015, according to copies of University of Michigan Hospital recordsLienhart shared with Lansing State Journal.

Lienhart told Smith she hadn't received her"neck ostomy supplies and her feeding tube formula in a timely fashion," according to Smith'srecords. That is why Lienhart believed she lost the 4 pounds, the records said.

Smith's records also indicatedthat Lienhart neededthe ostomy bags for "drainage." The nurse practitioner wrote:

"We contacted outpatient discharge planning and asked them to contact the patient regarding her inability to obtain both feeding tube supplies and ostomy supplies in a timely manner. She wishes to return to work and may do so after collaboration with her ostomy team in finding her a suitable drainage bag and when she is ready."

From that point forward, Lienhart's ostomy bags were covered by Medicare.

Medicare stopped covering themin 2017, Lienhart said, because she wasnt an ostomy patient using them to collect stool or urine.

She now pays out of pocket for the bags. She has paid anywhere from $33 for a box of 20 on Wish.com to $68 for a box of 10, depending on the supplier.

Lienhart has been seeking help ever since, but there is one assistance program she hadnt yet explored.

The Michigan Medicare/Medicaid Assistance Programis a non-profit that provides freecounseling to residents throughout the state.

The programs executive director Jo Murphy advisesMedicare beneficiaries to appeal when a claim is turned down.

There are different steps in an appeal. It can be expedited if someone was going to die tomorrow, but its case by case, Murphy said. Sometimes it could be an easy fix. Sometimes its something as crazy as a billing code (causing the denial).

Lienhart contacted Medicare after her claim was denied. She also found an online advocacy firm to help her with an appeal. But she hasnt heard back from the agency, and she isnt sure if theyre still working on her case.

People should not just give up if they have a claim turned down, Murphy added.

Murphy recommended working with community agencies, including her program,which was employeeswho specifically work on tough cases.

After speaking with Lansing State Journal, Murphy recommended that Lienhart get in touch with her organization to discuss her case.

Another option for Medicare beneficiaries is to see if they qualify for Medicaid.

Medicaid coverage is based on income and assets, according to Lynn Sutfin, public information officer at the Michigan Department of Health & Human Services.

Lienhart, who said she lives on a limited income, wasnt sure if she qualified for Medicaid, citing her Medicare, which she qualified for because she is on disability.

But it is possible to be eligible for both.

If Medicare does not cover an item, Medicaid could potentially cover it if the item is deemed medically necessary, Sutfin said. However, if Medicare deems an item not medically necessary, Medicaid is prohibited from covering the item.

Sutfin recommended that Lienhart and others in similar situations check their Medicaid eligibility.

Medicare told Lienhart they also wouldnt cover Total Parenteral Nutrition, a nutritional formula thats inserted into the bloodstream.

With this dietary (formula), maybe there are other options, said Murphy. With Medicare, everything needs to be medically necessary and doctored ordered.

In Lienharts case, Medicare covers Vivonex RTF, a 2,000-calorie nutritional formula that she puts into her body intravenously. The formula typically costs $9,000 a month, and TPN is much more expensive, according to Lienhart.

The cost of a Parenteral Nutrition program is reported to be "very high," according to theNational Institutes on Health.

But many things factor into the cost, such as"the condition being treated, the type of nutritional product, the composition of the nutrition, levels of nutrients, various supplies" and more, explained Sutfin.

Temporarily using Total Parenteral Nutrition in conjunction with Vivonex RTF would help her gain weight, Lienhartsaid.

With Vivonex RTF alone, Lienhart added,she dropped to 66 pounds over the last few years.

Total Parenteral Nutritionis usually covered by Medicare, according to Sutfin.

So it is unclear why Medicare wont cover Total Parenteral Nutrition for Lienhart, but its possible the provider is choosing to cover one formula rather than both.

No matter the reason a Medicare beneficiary is turned down, Murphy believes its important for everyone to learn to advocate for themselves.

Its unfortunate, but that is how health care is. Its a complicated and overwhelming system," Murphy said."Some give up, and we dont want them to do that. There are other options. There is more than one option in most cases.

Lienhart hasnt given up.

Because of her Facebook video, two members of Congress,Sens. Debbie Stabenow and Gary Peters,have reached out and offered to help her get her ostomy bags covered.

Whether shell get TPN covered to help her gain weight is still a question mark.

"I've lost muscle because I have no more fat to lose," Lienhart said.

To apply for Medicare, visitwww.medicare.gov

To appeal a decision from Medicare, visitwww.medicare.gov/claims-appeals

To apply for Medicaid, visitwww.michigan.gov/mibridges or contact a Michigan Department of Health & Human Services office atwww.michigan.gov/mdhhs/0,5885,7-339-73970_5461---,00.html

To appeal a decision from Medicaid, visitwww.michigan.gov/mdhhs/0,5885,7-339-71547_4860_78446_78448-16825--,00.html

Contact LSJ reporter Kristan Obeng at KObeng@lsj.com or 517-267-1344. Follow her on Twitter @KrissyObeng.

Support local journalism: Subscribe to LSJtoday.

Read or Share this story: https://www.lansingstatejournal.com/story/news/2020/01/06/holt-woman-says-medicare-wont-cover-what-she-needs-survive/2776460001/

See original here:
Holt woman who dropped to 66 pounds says Medicare won't cover what she needs to survive - Lansing State Journal

Related Posts

    Your Full Name

    Your Email

    Your Phone Number

    Select your age (30+ only)

    Select Your US State

    Program Choice

    Confirm over 30 years old

    Yes

    Confirm that you resident in USA

    Yes

    This is a Serious Inquiry

    Yes

    Message:



    matomo tracker