If I could give this a NO-STAR rating, I would. The biggest problem with the PEBTF is that they have eliminated coverage for most MEDICALLY NECESSARY DIAGNOSTIC PROCEDURES. If you have a medical condition that must be monitored semi-annually or annually, monitoring for that condition IS NOT COVERED until you pay between $700-$2400 FIRST. For example I have atrial fibrillation due to valve leakage and must have annual echo-cardiograms so the doctor can track and prevent any problems. This medically necessary procedure costs $1500 and none of the cost is covered. Because of this high expense, I am now forced to FORGO this procedure until I get my Medicare coverage 2-1/2 years from now. I can understand the need to keep costs low, but this could have been done by limiting coverage for diagnostics to people for whom they are medically necessary. Because I cannot afford the copay/deductible on this I have to refuse the services that a doctor has recommended due to my condition. I realize that this could result in my severe illness or even death, so it is my intention to SUE PEBTF if anything bad happens to me due to their decision not to cover MEDICALLY NECESSARY diagnostics.
It's nearly impossible to get an exemption to any exclusions, no matter how medically necessary your doctor believes the treatment is, or what cost savings it may provide.PA is one of only 4 states who refuse to cover any treatment at all for obesity. How stupid.
thieves
Horrible
I cannot understand how PEBTF will not cover Continuous Glucose Monitors for Diabetics T1. I was driving home the other day and by the time I tested my sugar glucose was 46. That would never happen if I had the monitor alert me that my sugar was going down being that my body doesn't feel it until is dangerously low. I could have passed out while driving and then the hospital stay would be covered, providing I don't kill myself in the process. The technology is there and the new pumps are amazing and I am grateful that they are covered but we cannot take advantage of the full benefit they offer. It does not make sense. I pray and hope they start covering CGM's real soon and avoid some of the complications of this disease.