Another Chapter

       If you happen to be a regular reader of my blog, you just might remember the blog that I wrote on March 20, 2015 entitled "Three Years".  In it I shared the problem that I had with the incompetence and carelessness of some medicare employes.
         My complaint was based on the denial of payment of a claim for $285 for a dexascan that was ordered by both my gastroenterologist and my family doctor.  My wife had the very same test at the very same location about the same time.  Her's was paid for and mine was denied ... without explanation.  It was filed again, twice more, with different code numbers and each time it was still denied.  Apparently it was fine for a female to have the test but not a male.
         So I decided to use Medicare's appeal process.  I gathered the many forms needed, completed all the paper work required and sent it to the address which they gave me.  Then I waited and waited and heard nothing.  I finally assumed that it was just rejected again and eventually forgot about it.  But exactly three years later I received the packet back with a note that it was sent to the wrong address.  For three years it was there and nobody did anything with it.  That is gross incompetence in my estimation.
          I decided that I needed some help with this problem so I contacted the office of Representative Joseph Pitts and Senator Pat Toomey.  Pitts never even acknowledged my contact but Toomey assigned a person to my case.  And so, for about four months, this representative has been working on my appeal.  This was a great help and I commend the senator and his office for this.  The senator will get my vote when he runs again.
         But this has still been frustrating because Medicare has replied with such things as there is no record of service on this date - it wasn't even the date I had given them so of course there wasn't any service on that date.  Another time they claimed the appeal was beyond their "generous" time allowed for an appeal.  Of course it was - they lost it. But fortunately Toomey's office kept after it for me.  Finally Medicare agreed to review it again as an appeal from a beneficiary - whatever that means.
          And finally I received a four page Final Medicare Appeal Decision.  I was again turned down because Medicare does not cover this test.  Really?  They have for my wife.   Is this sexual discrimination?
          But the possible good news - Medicare says that the Imaging Center should have been aware that this would be denied and should have informed me of it.  They also claim that they can find no record of them informing me of this fact.  And I certainly don't remember it or I would have reconsidered having the test.  And because of this the Imaging Center is to refund my money, four years and three months after the test.
          I have submitted a letter requesting the refund along with the documentation that Medicare has sent me.  Will they pay me?  If so, how long will it take?  And will I then be "blacklisted" from future service there?   Who knows? I don't. This has been an "interesting" journey with many twists and turns.  Stay tuned to see what happens next.
          P.S. - My wife just had another one of these scans yesterday.  On her instructions it says that Medicare will pay for this once every two years.  So if that is the case, why wouldn't they pay for mine?  I guess I'll never know.