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Denied treatment by Medicare anyone?
Has anyone received a letter from Medicare post-procedure, stating they not only refuse continued nerve block, (my second before ablation procedure was to be done) but now expect me to pay out of pocket for the second nerve block. I pay over $500 for supplimental insurance as well as Medicare. I have done so for 10 years. I've never had this happen before. Has anyone else been denied by Medicare for pain management from NETs surgery? Thank you.
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@willow5 I definitely would. You have to advocate for yourself, as difficult as it is when your pain has taken over your life. I'm not assuming anything any more when it comes to matters of insurance. Good luck! 💕
@nannybb grateful pain isn't an issue except for the pocket book if i get stuck with this. xolair is to control chronic hives. i'm guessing doc office screwed up on the billing
@willow5
I know epidurals are limited, 4 a year, 3 months apart. It could just be too soon. But yeah, I've most often had the doctors or their office put down the "wrong" diagnosis numbers
@nannybb if this was malpractice consider talking to an attorney; statute is a year to file.
@chosenpuppy1 Yes, I considered going that route after my seeing a second surgeon. He mentioned immediately, after viewing my records, that a robot should never have been used in a lower lobe on a small framed patient. He said he is seeing this more and more. I had no idea, at that time, that what that surgeon did would result in the fall-out I am experiencing at this point. I would have to prove willful intended damages. I believe the surgeon was negligent, but mostly on the basis of his ignorance of what NETs carcinoma actually is. The same with my GP. I believe she is totally oblivious.
@greypole This was a procedure to find the nerve bundle where the robot actually damaged nerves and muscle between ribs. This was all done in view of then doing an ablation. The nerve block was not to end the pain, but to locate it. The pain specialist who called said she did not know who dropped the ball, but she would get it fixed, as it was their fault. She is finally getting me scheduled for the ablation. I know that may not be a long lasting "fix" either, as I have researched all of the above. All I know, is I have to get back to work and am frustrated by the delays. Thank you for your reply. 💕
@jenatsky Thank you. Much appreciated 💕
Medicare has rolled out a 6-year pilot program—the WISeR model—requiring prior authorization for specific procedures in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.The pilot utilizes AI to assist in reviewing coverage requests before treatment is administered to reduce unnecessary procedures.Affected ProceduresThe pilot targets about a dozen specific, costly, or frequently overused items and services. Affected Traditional Medicare procedures include:Electrical nerve stimulator implants (e.g., deep brain or phrenic nerve stimulation)Cervical fusion with disc removalSacral nerve stimulation for urinary incontinenceSpecific epidural steroid injections and impotence. Sorry it’s all run together, but that is how it copied. Every thing I have read said to have your doctor appeal and they are getting paid. I will find out have my injections Thursday so I will see if it gets paid.
@sshachte My doctor said it was their fault and she is taking care of it. I'm sure tgere are probably some unnecessary procedure performed, but trying to discount a person's pain and refuse treatment is not one of them. Let me know how your appt. goes. 💕
@nannybb hoping a good med mal attorney reviewed or discussed this with you. Ignorance does not change standard of care. I worked mostly the defense side as a nurse paralegal for almost 40 years and if our docs gave “bad” care the patient should be compensated (can’t undue the pain). Best of luck to you. I prayed for you for favor and healing.