<Sighs>

Since DH lost his job and our private insurance and I have had to depend strictly on Medicare on paying my medical bills it has been a NIGHTMARE. They are EVIL they want me to die they truly do.

Medicare will not pay for my Coumadin checks they feel they are not Medically necessary. HELLO who made them boss who decides that I do or don't need Coumadin checks. I need the medication to keep the blood clots I am medically proven to be prone to at bay, I have to get the labwork done on a regular basis to be sure I am not too high so I don't bleed internally or bleed to death for whatever reason or that I am not too low so as to get a blood clot. So because of them not paying and we have checked the billing codes and they should pay under the diagnostic code used I am now in debt to my Doctor since May 1st for over $700 thats almost my whole SSDI check per month.

This is ridiculous that something that I have to do to keep alive isn't considered medically necessary and you all remember I didn't want to go back on this nasty medicine I was willing to take what was given to me, even dying. Since starting on this medication and the other treatments I have felt pretty good and I have a different outlook on life, I know I am not back to normal like I was say 15 years ago never will be and that I still cant hold a FT job down due to my numerous medical issues and Doctors visits, but man this has to be monitored and I sit here and cant afford it.

DH is still under Doctors care from the neck fusion surgery still not released to do any type of work and they are doing Physical Therapy, he has no health insurance doesn't qualify for medicaid or any help, but they have a charity care program, and now they have a concern that there is a problem at T1-T2 he may need surgery for and that he may never work again anywhere, but at least he got approved for Long Term Disability so thats holding us over a bit now.

Does anyone know other than the complaint I already lodged to Medicare who else I should be complaining to about Medicare I was thinking my State Senators but how do I find who is on the Medicare Committees with Congress?

Thanks for letting me vent and update about DH

Oh and DS is going into 5th Grade and he is going to be a Safety Patrol !! Go Stefan !!!

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

You should contact your good friend, Dee. Dee can help you out with the issues. She is an advocate for this type of thing.

God I hate lupus and fibro fogs I totally forgot about her she escaped my fogged up mind completely will shoot her an email off after we get back from DH's PT THANK YOU !!!

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

Since you are on SSDI can't you qualify for Medicaid?? I think Medicaid is a bit nicer than medicare.

__________________
Support bacteria -- it's the only culture some people have!

If Vegetarians eat Vegetables. Do Humanitarians eat Humans?

'Vegetarian' is an old Native American word for bad hunter.

If you're on Medicare, you should qualify for a Medicare-replacement insurance program. Granted, most of them are HMO's, but they usually save you more out of pocket. It's worth looking into if you haven't already...

Have you appealed Medicares decision? You have to do it in writing, and you can submit letter(s) from your doctor(s) as to the medical necessity of your Coumadin blood draws.

__________________
Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

I feel your pain but my husband and I both work full time and have $600-$900 monthly out of pocket medical expenses, PLUS we get the honor of paying $650 per month for the not so great health insurance. You mention that your expenses suck up your SS check and yeppers, I can relate to that too. After sitting at work all day, spending money for gasoline to get there, money for work clothes, lunches, etc, my take home is eaten up by medical expenses.

Medical issues can just rip a family apart financially, whether you are on medicare, medicaid, or pay for your insurance.

My parents in their 80's have a medicare HMO..I take of their medical issues..It is SO frustrating each time I call..I truly believe they have to be making a lot of money off the eldery or disabled who can't put up with the frustration of appeals, repeated phone calls, or plain understand the system or hear well enough on the phone to get through the push number system..I can attest to the huge amount of time spent in battles, which are "won" by me, only because I have the "abilities" to pursuit it..I wish you the best..If you end up changing to the HMO, find out from the doctor's office who they like to work with..When I mention my parents, they always groan and I can attest to why..

My mom was an RN Claim Rep for Medicare. You need to contact your congressman or woman and file a congressional complaint. She said when Medicare gets a congressional complaint they immediately jump on those

HTH,

Laurie

I have appealed claim denials as I get the summary notices from the Doctors showing medical necessity. So far they have stood firm on their decision

Don't qualify for Medicaid because and I don't get this my income is too high and we have too many resources and I have to do a huge spend-down and I have appealed that and its working through the system now. Same with the Food Stamp Application, They have us making close to $3,000 a month and I don't have one clue where the worker gets that and she cant explain it to me but keeps saying workers comp and DH doesn't get workers comp he just restarted with disability insurance payments but they are less because they are taking taxes out now so he gets about $200 (gross $259) a week plus SSDI checks of $779 where is the $3,000 a month ? I just thank god I listened to Daddy before he died and got insurance on our Mortgage loan and credit lines those are a god send. We used his 401K to pay medical so that will go on taxes as a plus I guess so I dont get the resources our savings are long gone.

Medicare HMO or Managed Plans for anyone under age 65 cost up the backside have checked into several of them and they are no less than $350 a month more per month same with Medicare Supplement Policies. If I were over 65 I could get it for my Part B costs or $40 to 100 more per month. Sadly our system is broken and I hope that whoever our new President is can fix it.

Just waiting on some emails to be returned hoping for some help or guidance I know I am not the only person with this problem.

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

As Lilolme said, you need to file an appeal thru your Congressman or woman, in writing. Do EVERYTHING in writing. I used to process Medicare claims, and these do get looked into very quickly. There is the regular "I don't agree" that you can do, but, that does not get any type of priority.

Without getting too into your business, can you state the reason for the denial that they gave you??? Sometimes the claims or Dx codes are input incorrectly. What code is the doctor's office using to input the claim?

__________________
Doing the right thing isn't always the same as doing the easy thing.

Also wondering if the lab work is being done in the doctor's office??? or are you being sent to a lab? Does the doctor accept assignment?

__________________
Doing the right thing isn't always the same as doing the easy thing.

WHAT?? Where are you getting this information that HMO plans cost out the wazoo each month? That is inaccurate. You get medicare, you know the system obviously as it appears you've been in it a long time. How can you not know that there are free HMOs? My sister, who is 51, is on disability for multiple medical issues too and she has a free plan. She is on social security disability and medicare. Her medicare HMO premiums (supplemental insurance, managed care, whatever you want to call it) are FREE each month. She and I took several months choosing a new plan for her this year because the plan she had last year, Mercy, was lying to her and just being difficult. We found several that had ZERO premium each month. Age has NOTHING to do with it.

Medicare - Home

Anyone can go here and click "medicare options compare" on the left side of the screen, then on next page click "find and compare plans," then do a general search. I did one just based on what you've posted here and not knowing your zip just stuck one in there. There are at LEAST 10 free plans. If you are on original medicare, you qualify for these HMO/PPO plans.

Thats where I did my comparing based on age,zip code and health and the costs were that much when I called to enroll it doesn't match up to what the website shows. I had to stick with plans I knew my providers were with because some of them I have been seeing for over 10 years one over 20 years and I don't want to change physicians its bad enough I had 3 move away in the last year and one completely stop practicing medicine I found a group I trust and I cant see changing something that is good. I just went back to the Website and several plans that were there prior are now gone very interesting many of them my Doctors will not accept or are not participating in. My mom we got her a great plan in FL her co-pays are $5 and she pays nothing more per month, but it seems I am limited here in this big old Washington Dc Metro Area for some reason yet again. I refuse to go to Kaiser had them through DH;s job once and it was a nightmare.

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

In the office rather easy test too they just prick my finger like you would with a glucose test and put it on a strip and stick it in a machine and within seconds viola they have the results, the dr checks the results and it costs a whopping $135 a visit !!! And yes they accept assignment.

I am going to look into my old ICD-9 coding books if I can remember where I packed them up at they maybe outdated but they maybe using some bad codes after all kind of looked at them deeper at the camplot today and I think they could use a more descriptive code to get paid. was trying to get my foster mom's laptop hooked up with book-keeping stuff for her new business venture and the wi-fi was down so I worked on paperwork while down there and typed up a bunch of letters.

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

The codes they are using are rather well "Generic" 790.92 ~ Abnormal Coagulation Profile (which does NOT include my lupus anti-coagulant) and V12.51 ~ Venous Thrombis and Embolism~ Pulmonary Embolism.......... OMO they should be using 286.5 Hemmorrhagic Disorder Due to intrinsic Circulating Anti-Coagulants which includes The Lupus Anti-Coagulant Factor and E934.2 ~ Anti-Coagulants...... So any current coders agree with me? I am pretty rusty but those seem to be the codes "I" would use if "I" were billing the test out.

I searched the Medicare Compare for Plans in my Area none with -0- cost w/my Providers which is a problem and I am in large practice with 20 Providers and is highly respected in this immediate area.

Sorry about any typos I can hardly see this morning my sinuses backed up into my eyes and I am wearing my glasses and I cant hardly see.

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

It seems to me that if you need/want free or very cheap healthcare, that you might have to make a few concessions in terms of doctor choice. Heck, I think most people have to make these kinds of tradeoffs from time to time when benefits enroll or change.

cj/

__________________
I was walking home one night and a guy hammering on a roof called me a paranoid little weirdo. In morse code. -Emo Phillips

Curious about this as it seems as if the OP is finding excuses as to
why her situation is unique and another poster's apparent experience
with the medicare system. After watching the OP kind of make one excuse
after another, I checked the medicare link provided in this thread and
entered the OP's location (Alexandria VA, pulled from her public
profile and indeed in the DC area), her age (under 65) and tried using
both poor health and fair health, and found:



NO LESS than 41 health care companies available to the OP in that "big
old Washington DC area." There are 11 HMOs/PPOs with ZERO monthly
premiums, 14 that were under $50 per month and NONE that were over $200
a month despite the OP claims she checked into the plans and found you
couldn't get any for LESS THAN $350! WHY would she inflate those
numbers like that?



Then when confronted with the fact that there were plans in her area
affordable, she claims she called medicare and they gave her DIFFERENT
rates than what were on the website! NO way. The medicare website is
owned by the US govt and matches what the medicare employees have
because senior citizen advocates and watch groups keep an eye on it.
0AThose groups would have a field day, screaming and carrying on if the
poor and disabled were baited with one rate on the website and another
when you call. This isn't as if Blue Cross is claiming they have these
low rates but when you call it is a different rate. This is a govt run
program that is watched very carefully by many groups. The rates do
vary from location to location just as cost of living varies from
location to location but if you go to the site and plug in the
information for YOUR area, the rate you see online is the rate you
enroll with, which is the same as if you called to enroll. Now given
that the OP lied about the plans available to her and how much they
cost, is she being truthful about this? Or perhaps it is something
that only happens in HER area



So then finally the OP tried to claim she couldn't change plans because
the free ones (the ones she claimed didn't exist at first because all
the plans cost no less than $350??) didn't have her doctors in the
plan. Well, what about the other 14 or so that cost under $20 per
month? Surely her doctors were in ONE of those plans, ESPECIALLY if
they are as highly respected and a large practice as the OP claims.
But hey even if her doctor was in the $190 per month plan, it would
still be cheaper to have that plan than to pay $700 per month (or
almost her whole
social security check)!



As someone else pointed out, if your family is in crisis financially,
shouldn't you be making some concessions? Also, the blood tests for
Coumadin are covered under the HMO/PPO plans. But of course, this
probably isn't going to be available in the OP's area. Of COURSE
not.



If OP would falsely inflate this information, then how are we to
believe any details of her story? And it makes you wonder her motives
for posting this seemingly heart tugging story (and to throw in the
reminder that she has a little boy!).

well, what you are looking at is the diagnosis code. You also need to know what CPT code they are using. Whether or not they are using a modifier, where the procedure is taking place, etc. It's not as simple as getting the correct ICD9 code, you also have to get the correct CPT code, and you also have to make sure that the CPT code is linked to the correct ICD9 code.

And, you know what? If you want free or reduced cost medical care then you may have to suck it up and change providers. What's that old saying? Beggars can't be choosers.

oh yeah--I use to work @ Medicare (actually BCBS who had the Medicare contract), and I currently work in a job that I look at diagnosis codes, cpt codes and whether they are related to the accepted condition/injury/body part. I've denied claims because our body part was the right limb, and the bill was for the left limb.

__________________
Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

Excuse me you dont call Medicare to enroll you stupid ignorant troll you call the Medicare Advantage plan or insurance Company which I have done more than once since April.

When Care First BC/BS was still listed I tried to Enroll I spent over an hour on the phone with them going through the whole gamut with them, NAZ, Age medical conditions. I specifically told them I wanted the Medicare plan they offered off the Medicare Website (which is No longer showing) with the RX plan that was shown for around $38 a month and when we got to the end of the process and into underwriting I was told it was $348.56 a month. So something somewhere was wrong. who knows who put the wrong information where probably on Care First's end but then again read their small print and it tells you subject to underwriting and the costs can change.

I got my mom her Medicare Advantage plan in Florida and wish it was available here but its not. I know which ones my Doctors will not accept assignment from and I am considering switching practices if needed down the line, but I plan on using all my options available to me now to appeal this issue now

Trust me I have spent hours on the Medicare Compare website looking at the different Medicare Advantage plans and some do not have the Rx coverage some wont take you with the conditions I have under certain plans. I prefer to stay with my Doctors and not switch, I looked at the Evercare plan and there are no Doctors in Alexandria and with the price of Gas I wont drive to Annandale or Falls Church, my Doctors are all within 1 1/2 to no more than 7 miles from my home except my rheumatologist who is 26 miles and I dont see her every week so no biggie with her. If I have to change so be it , but it sure wont be Kaiser I hate them with the biggest passion there is.

I wanted to bounce my problem off others here and get advice not be accused of lying by some ignorant troll who hides behind a falsified screenname using God as a backup trust me I trust in him and WOULD NEVER talk to someone like you have you stupid I wont say it because you are Actually beneath what I want to call you.

Would a moderator please lock this thread for me. I dont want this to turn into a cat fight Thank you I will deal with the people who offered me help.

__________________
~ Christine ~
Grammie to Trinity Lorayne Jean Keens Born June 9, 2011 Loving my awesome guitar picking 100% Country Boy boyfriend Kenny !
RIP Daddy~ 01/24/1930-06/01/2007 I miss you !
Dont Think you Can .. know you can ~ Jeff Hardy

You can delete your own thread if you don't want the discussion to continue. Otherwise, I think it's completely fair and helpful for folks to challenge assertions and provide new data and not something to be locked by a moderator. Why would they do that?

cj/

__________________
I was walking home one night and a guy hammering on a roof called me a paranoid little weirdo. In morse code. -Emo Phillips