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My craziest Medicare experience yet

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  • My craziest Medicare experience yet

    It is hard to believe the phone conversation I just had with the medical supply company that supplies my urostomy pouches. I use a box a month and order a 3 month supply every 3 months as Medicare allows. I mark the reorder date on my calendar so I do not forget and run short. I reordered last month (October 24), which was the date I had marked. As usual my supplier promptly shipped my order and billed Medicare.

    Today I got a call from my supplier who received a payment denial from Medicare. Why? Because earlier in October I was in the hospital with pneumonia and a heart rhythm issue. Medicare stated that because I was in the hospital, the hospital was supposed to supply my pouches.and they maintained that I was provided one month of supplies too many in my order. First, I was only in the hospital for 8 days, not the whole month. Second, I changed my pouch twice during the stay and used my own pouches. The hospital does not stock the pouch I use. But Medicare rules are rules that must be followed. My supplier has to rebill Medicare for only 2 boxes.and I have to ship a box back to the supplier. My supplier has arranged for a Fed Ex pick up at my home and paying for it. But that is not the end of the story.

    As soon as my supplier receives my returned box and adjusts their books they can ship the box back and bill Medicare for one month/box of pouches. This will conform to Medicare’s “rules.” It is now past the month of my hospitalization. Medicare will reimburse the supplier for the 2 separate orders in 2 separate payments.

    I am not smoking anything. This really happened.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  • #2
    On the last day of each month I put in a large order with our local supplier.
    Because it is complicated there is a "dedicated" worker that keys in Dave's order and I go to her with any issues.
    One month 2 trach tubes came were on the invoice. He is allowed one per month in Medicare.
    I called with the error and she said I'd have to return the extra one to be credited.
    The extra one would be thrown away as could not be sent to anyone else.
    I hate waste and suggested I send it back with Dave's name on it and she could keep it til next months order which she did.
    Not the same 55, but some of it ridiculous.
    Last edited by LindaT; 11-17-2012, 04:29 AM. Reason: trach not trash spelling

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    • #3
      The medicare employee needs to justify their existence somehow,uggh

      Comment


      • #4
        It is crazy. I have a walker I can't use. I had to buy it to get out of the hospital. They would not release me without it, cost 20 dollars, Medicare picked up the rest. Then when I got home PT told me I was not eligible for a wheelchair because they bought me a walker.
        I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

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        • #5
          I love Medicare, here is another:
          Tuesday I called to confirm my MDA doctor appt. The receptionist said it had not been approved by my insurance which was true because I had been negligent, lazy. But since MDA pays half and I know the other half is only $200, I offered to pay cash and leave the insurance out of it. She told me no. It would not be legal to do so as I have *Medicare*. Either get it approved or cancel. She said they can’t charge patients on Medicare. Fortunately approval wasn’t all that difficult so I did see the doc.
          I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

          Comment


          • #6
            Originally posted by nonoise View Post
            I love Medicare, here is another:
            Tuesday I called to confirm my MDA doctor appt. The receptionist said it had not been approved by my insurance which was true because I had been negligent, lazy. But since MDA pays half and I know the other half is only $200, I offered to pay cash and leave the insurance out of it. She told me no. It would not be legal to do so as I have *Medicare*. Either get it approved or cancel. She said they can’t charge patients on Medicare. Fortunately approval wasn’t all that difficult so I did see the doc.
            i'm proof they can bill medicare recipients. i also live in seattle area. i have been billed repeatedly by several doctors/hospitals for my numerous tests for undx'd pelvic pain since april. i'm also betting your equipment supplier is care medical. i can't get urocare leg bags out of them because "no one uses those"; hello? i have gotten them thru care medical for yrs when still able to work.
            Last edited by cass; 11-17-2012, 01:38 AM.

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            • #7
              Originally posted by nonoise View Post
              It is crazy. I have a walker I can't use. I had to buy it to get out of the hospital. They would not release me without it, cost 20 dollars, Medicare picked up the rest. Then when I got home PT told me I was not eligible for a wheelchair because they bought me a walker.
              THAT is crazy!

              Comment


              • #8
                Take it from someone who worked in the industry, a big part of health insurance is INTENDED to daze, confuse and stifle. Our "free market" health financing system is a complete joke. Oh the lengths we'll go to give the impression of free markets.

                And yes Medicare is part of our free market health system.
                Last edited by Patton57; 11-17-2012, 08:59 AM.

                Comment


                • #9
                  Originally posted by SCIfor55yrs. View Post
                  It is hard to believe the phone conversation I just had with the medical supply company that supplies my urostomy pouches. I use a box a month and order a 3 month supply every 3 months as Medicare allows. I mark the reorder date on my calendar so I do not forget and run short. I reordered last month (October 24), which was the date I had marked. As usual my supplier promptly shipped my order and billed Medicare.

                  Today I got a call from my supplier who received a payment denial from Medicare. Why? Because earlier in October I was in the hospital with pneumonia and a heart rhythm issue. Medicare stated that because I was in the hospital, the hospital was supposed to supply my pouches.and they maintained that I was provided one month of supplies too many in my order. First, I was only in the hospital for 8 days, not the whole month. Second, I changed my pouch twice during the stay and used my own pouches. The hospital does not stock the pouch I use. But Medicare rules are rules that must be followed. My supplier has to rebill Medicare for only 2 boxes.and I have to ship a box back to the supplier. My supplier has arranged for a Fed Ex pick up at my home and paying for it. But that is not the end of the story.

                  As soon as my supplier receives my returned box and adjusts their books they can ship the box back and bill Medicare for one month/box of pouches. This will conform to Medicare’s “rules.” It is now past the month of my hospitalization. Medicare will reimburse the supplier for the 2 separate orders in 2 separate payments.

                  I am not smoking anything. This really happened.
                  Nothing insurance can do to surprise me anymore. Years ago I wanted to replace the seatback fabric on my Jay2 Deep and Tall. The fabric was $40 but insurance wouldn't pay for it. They would however pay for a brand new Jay Deep and Tall seatback that comes with new seat fabric for $640. Yeah, okay. I gave up a long time ago on trying to make any sense out of it all.

                  Comment


                  • #10
                    Insurance can be crazy

                    Originally posted by grommet View Post
                    Nothing insurance can do to surprise me anymore. Years ago I wanted to replace the seatback fabric on my Jay2 Deep and Tall. The fabric was $40 but insurance wouldn't pay for it. They would however pay for a brand new Jay Deep and Tall seatback that comes with new seat fabric for $640. Yeah, okay. I gave up a long time ago on trying to make any sense out of it all.

                    Insurance seems to get crazier and crazier with what they will & won't cover. I have BCBS through work and Medicaid, both cover DME and cath supplies at 100% (in theory). The company I was getting my S/P tube supplies from called to my insurance wouldnt pay for insertion kits because they aren't needed...what! They didn't take Medicaid either so they were going to bill me. Had to switch to company that also takes Medicaid.

                    My favorite is with prescriptions...my insurance requires a 90-day supply and then Medicaid covers the copay left from the insurance. However Medicaid only lets me get 30 days at a time for about half of the meds or I "have too many pills"...so they get the entire bill instead.

                    Comment


                    • #11
                      I have Medicare. No Medicaid. You want get titanium wheelchair and they flat out say "no." Why don't they have some type of "cap" limit and allow yout to simply pay 100% over the cap if you choose? I getting new chair and should be delivered anytime now, I told the place forget about insurance I will pay 100%. I did get them down to Internet price which really is the 80% Medicare would pay. I don't argue with them. Simply hope not to need them.

                      Comment


                      • #12
                        Originally posted by cass View Post
                        i can't get urocare leg bags out of them because "no one uses those"; hello? i have gotten them thru care medical for yrs when still able to work.
                        Hi Cass.
                        If you are having trouble getting Urocare leg bags from your supplier, Edgepark Medical Supplies maybe able to help you out via mail order (covered by Medicare and my secondary). I get mine there. Getting set up with Edgepark may take some time for them to get it right, especially if you use more leg bags than 2 per month. But, eventually, they do get it right and call and/or email monthly for your approval to send out the supplies.

                        Originally posted by sledgrl View Post
                        Insurance seems to get crazier and crazier with what they will & won't cover. I have BCBS through work and Medicaid, both cover DME and cath supplies at 100% (in theory). The company I was getting my S/P tube supplies from called to my insurance wouldnt pay for insertion kits because they aren't needed...what! They didn't take Medicaid either so they were going to bill me. Had to switch to company that also takes Medicaid.
                        Hi "sledgrl,"
                        We have never used an insertion kit for my suprapubic catheter (2+ years). NL changes my SP catheter every month. She lines a plastic shoe box lid with plastic food wrap film and lays out the changing supplies on that, i.e., povidone swabs, 10cc syringe filled with sterile water or saline, lubricated new catheter, emesis tray with gloves to place the removed catheter, sterile gloves for insertion of new catheter. I guess I never thought about trying to get these supplies paid for by Medicare. My company provided private insurance never paid for any intermittent catheter supplies other than the catheters (no lubricant, skin antiseptics etc.)


                        All the best,
                        GJ

                        Comment


                        • #13
                          GJ-Smart idea for the SP insertion kit. We have not had trouble getting the kits, but very clever thinking on you and NL's part.
                          We have all the components on hand for other things.

                          My biggest surprise was when the powerchair needed some work and parts.
                          We were told Medicare would not pay for repairs because the chair "did not exisit."
                          I had very good private insurance at the time the chair was bought.
                          When COBRA ran out I assumed medicare or medicaid would cover it.

                          DME said medicare would buy a new chair (not that it is a simple snag free thing from what I read here) bit not repairs.
                          They encouraged us to do this!

                          Now the VA maintains the chair.

                          Comment


                          • #14
                            Originally posted by LindaT View Post
                            GJ
                            My biggest surprise was when the powerchair needed some work and parts.
                            We were told Medicare would not pay for repairs because the chair "did not exisit."
                            I had very good private insurance at the time the chair was bought.
                            When COBRA ran out I assumed medicare or medicaid would cover it.

                            DME said medicare would buy a new chair (not that it is a simple snag free thing from what I read here) bit not repairs.
                            They encouraged us to do this!

                            Now the VA maintains the chair.
                            This pre-existing chair (purchased before Medicare eligibility)/maintenance thing is an incredible puzzle. My private insurance purchased a power chair that was delivered in late 2009, about 6 months before I became age eligible for Medicare. Just a few weeks after joining Medicare in late middle of 2010, a stop (to limit how far back the arm would rotate) broke on one of the arms. I called the durable medical equipment supplier I use to get the repair. The wheelchair manufacturer would pay for the part under warrantee, but not the labor. I looked to Medicare and my supplemental insurance to pick up that up.

                            Because my chair was less than a year old, my durable medical equipment supplier could record my chair into Medicare records. Medicare and my supplement picked up the labor for that repair. Now in late 2012, I need a new gear box and motor (I only need the gear box, but the manufacturer only supplies gear box and motor as a package replacement part) and new batteries. I visited my supplier last week and because my chair is in Medicare records (it exists), there is no problem with Medicare and my supplement picking up the repair. And, as has been discussed on threads before, this repair WILL NOT "start the clock running" as if this chair were brand new. Since Medicare will provide a new chair every 5 years, I was told by my supplier that I will be able to start the process of replacing this chair in early 2015.

                            My supplier told me the key to getting Medicare to cover the repairs I have had was getting the chair in Medicare records before the chair was one year old, even though I was not a Medicare participant when the chair was purchased and Medicare did not provide the chair.

                            Linda, very glad that VA connection you discovered paid off you and Dave.

                            All the best,
                            GJ

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                            • #15
                              Yes

                              Originally posted by grommet View Post
                              Nothing insurance can do to surprise me anymore. Years ago I wanted to replace the seatback fabric on my Jay2 Deep and Tall. The fabric was $40 but insurance wouldn't pay for it. They would however pay for a brand new Jay Deep and Tall seatback that comes with new seat fabric for $640. Yeah, okay. I gave up a long time ago on trying to make any sense out of it all.
                              I not understand why they tell you go float on all of this stuff when not within thier guidelines. Why don't they have an intelligent cap system that pays no matter what and you/we just get stuck with remainder.

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