By: Alice Harrison

Alice Harrison — Fri, 12 Oct 2007 03:59:21 +0000

How can Medicare get away with breaking their contract with thier clients? If it’s written in the policy that claims which meet the criteria in the contract are legitimate, then they should have to honor that and pay up. Medicare is denying legitimate claims. About CMS auditing…
My 91 year old husband underwent an amputation of his only remaining leg, his right leg, after loosing his left leg a few years before. After the operation, he is dizzy on pain medication, has no legs, and cannot even wear the prosthesis on his left leg. He has a huge cast on his right stump with tubes coming out of it to drain the wound. If the cast is upset the wound will be upset. Medicare is refusing to pay for his ambulance ride from the hospital to the rehab center, claiming he could have been transported some other way. (What, sitting up in a wheel chair or maybe taken in a stretcher van, which are illegal here in Washington? Maybe I should have pulled him in our little red wagon.) The doctor, the hospital social workers, hospital billing, even the ambulance company who is now billing us, all say Medicare never should have denied his claim. They were all so shocked that it was denied, they thought it might have been from a mistake when they wrote down the procedure code. Nope. That wasn’t it. The hospital appealed, but it was denied, by none other than Noridian, a CMS contracted carrier, who stated the appeal was denied because it was not filed within their time limit. I requested a redetermination, and that was denied and the reason was “because we found that the claim issue has already received a review” My gosh, that sounds like God talking, doesn’t it? What kind of answer is that? Why didn’t they just say “Because we said so. So there!” Ha! God has spoken! What a racket.
We never called for the ambulance, the doctor did, and were told it was covered. We never signed anything saying we would pay if someone made a mistake or if Medicare refused. We had no choices in any of this. But we are going to have to pay. Thanks for letting me vent.

Comments on: Private Medicare fraud auditor will collect millions denying claims

By: Alice Harrison