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Thread: My craziest Medicare experience yet

  1. #1

    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 @
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    http://cccforum55.freehostia.com/

  2. #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 at 04:29 AM. Reason: trach not trash spelling

  3. #3
    Suspended Andy's Avatar
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    The medicare employee needs to justify their existence somehow,uggh

  4. #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.

  5. #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.

  6. #6
    Quote 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 at 01:38 AM.

  7. #7
    Quote 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!

  8. #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 at 08:59 AM.

  9. #9
    Senior Member grommet's Avatar
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    Quote 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.

  10. #10
    Senior Member
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    Insurance can be crazy

    Quote 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.

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