Denied treatment by Medicare anyone?

I am very concerned about this. I have sent this email to my Representatives. Hopefully other people will speak up before it's everywhere.

I am writing to express my concern about the expansion of prior authorization requirements within Original Medicare.
While reducing waste is an important goal, prior authorization often creates delays in treatment, adds administrative burdens to already overextended medical practices, and inserts additional barriers between patients and their physicians. Decisions that should be made in the exam room increasingly become subject to paperwork, reviews, and waiting periods.
For older adults and those living with chronic pain or disabling conditions, delays are not merely inconvenient. They can prolong suffering, postpone recovery, and increase anxiety at times when patients are already vulnerable.
Programs such as these also contribute to the growing depersonalization of medical care. Patients deserve a healthcare system that trusts qualified physicians to make appropriate treatment decisions and allows them to focus on care rather than bureaucracy.
I urge you to carefully examine the impact of expanding prior authorization requirements and to prioritize timely, patient-centered care.
Thank you for your consideration.

@nannybb in order for a Medicare beneficiary to be held responsible for any cost related to any procedure the doctor performing the procedure must have you sign a form indicating that you may be held responsible for any cost not covered by insurance prior to the procedure. If this was not done you are off the hook.

@jenatsky There is no doubt that I signed forms prior to the first nerve block. The reason for that block was to find the area where the robot damaged nerves and muscle. I am sure I signed forms for treatment at that time. It was determined, by the same doctor, a second nerve block should be performed because they did not totally capture all of the offending nerves. After doing the second block, the plan of treatment was to then go back in and do an ablation. I have been in extreme pain for almost a year. The only med. I can take is Tylenol. I have gone to an oncologist (by recommendation) of someone in here, to be reevaluated. He has ordered additional testing and another PET scan. He is not convinced I have DIPNECH. This whole amount of treatment has been done with the same doctors working at the same hospital in tandem. They were all on board going forward. Evidently, Medicare has determined the treatment is no longer warranted, even though I am still in pain, and there was an original "plan," in place. I am beyond frustrated. Sorry this is so long.

@nannybb you have options so don’t just sit back and accept a bad decision. Try and remember whether anyone discussed the possibility that the procedure would not be covered? This is something that shocks the senses when you hear it. Also, check the paper records you have from the surgery because you had to receive a copy of it signed by you and the doctor or his representative. If you don’t find it simply ask the hospital for a copy of the signed document. If it was done they’ll have a copy. If they cannot produce it you are off the hook. Prior to retiring as an RN I performed Medicare compliance work for hospitals and doctors. I’m not BS’ing you. The document is Advanced Beneficiary Notice (ABN).

@jenatsky Thank you for your reply. I do not plan on just sitting back. I have worked clinic, and in a hospital. I'm sure you are more knowledgeable in the legal end by what you are saying. I am familiar with the world of medicine. I am in so much pain right now. I have been in contact with my pain specialist over and over again. I am at a point of extreme pain. If it had been a decision by United Healthcare, I probably would not have been so surprised. I know they have been in trouble with doctors in general here in Portland. But to have it be Medicare? I only have me. I'm going to have to look for an advocate this week. As I said, the protocol/plan for eradicating my pain was all laid out and followed for the past 6 months. I HAVE to get back to work. The doctors I have been working with all know this. Up to this point, there was not even a hint of a problem.

@kdks99
This is interesting. I’ve been receiving Xolair injections since 2018, every 28 days. In my Medicare summary it shows they won’t cover it because it is being done more often than is accepted. ???? I’m hoping the allergist’s billing department used the wrong code. I suppose I could call the allergist billing and/or Medicare sooner than later, since there is a time line for appeals.

I don't know what NETs are, but things are getting very, very tight. Expect more of the same. I am on Medicare Direct. I live in California. (thank God!) But the doctors here are getting prior auths just in case. It does complicate some care now, but better to be safe than sorry.
Once Molina Medi-Cal denied a procedure that was necessary. Draining a fluid-filled cyst on my spine. It was only a $500 procedure. I appealed it. I took it to arbitration. They were CORRUPT and spent THOUSANDS trying to defend their position. The judge ruled on an 18-page letter. I didn't understand, but an attorney friend told me I won! THEN, Molina tried not to pay it! Can you believe that?! So I told them I'd go back to arbitration. I got a check 3 days later. There's a lot you have told us in your brief statement. but you should talk to your doctor and ask them to resubmit or appeal yourself.
They had tried to use an excuse like they needed to prior auth it. This was way back. The state ruled properly. Insurance and Medicare/medi-Cal systems are required to notify people in certain cases.

@nannybb good luck Nanny and I’m always here if you need an ear.

Thank you so much! My prayers were answered this morning. Out of the blue, the pain specialist called (herself), and asked how I have been doing. I told her about the bill from Medicare...she assured me it was their fault and they would handle it, and she is getting me on the schedule for the ablation. She wondered if I wanted her to speak to the surgeon. I didn't think that was a good plan at this time, because he was upset I brought an oncologist on board. She said that should not matter. I told her I now have heart involvement....most likely from the stress of this whole last year. She understood. I'll just have to keep praying I get the pain resolved so I can get back to work. Thank you again💕

@loriesco NETs are a type of carcinoid tumors which can be cancerous. I had my lower right lung wedged almost a year ago. The pain was caused by the surgeon using a robot on a small framed person...me. My pain specialist called this morning and stated the Medicare problem was their fault and she would take care of it.
She is also going to get me scheduled for the ablation. Hallelujah! The hospital I'm using is a teaching one. I'm assuming that is how all of this occurred.
Thank you for your response 💕