Medicare Support Group

1-800-Medicare kept me on the phone for two hours asking me to please not hang up while they tried to get to the bottom of it all. Two supervisors there told me there was no way we should have to pay this claim. They both said that Noridian should never have denied it in the first place. The highest ranking one I talked to read me an email she was sending to Noridian and she was also asking them to call us. A lot of good that did. We never recieved a call and nothing changed. I tried to call and talk to either of those supervisors again, but guess what. You get a different person in a different state every time you call 1-800 Medicare and they have no way of connecting you to the same person you had before, even if you know their names, which I did.
Two years ago my 90 year old husband underwent the amputation of his last remaining leg. A couple of days after his operation, the hospital sent him, on doctors orders, to a rehab for recovery. We asked if Medicare covered the ride and were told 'yes'. The first rehab was not equipped to handle his needs and they sent him to another rehab by ambulance, where he stayed for his rehab. Again we were told the ride was covered by Medicare. We had no choice in either case as to what mode of transfer was best and we signed no ABN or anything saying we would pay. We weren't consulted about either ride, or told there might me a chance we would have to pay for it, we just did what was ordered. In both instances my husband could not walk or sit up in a chair and was heavily medicated.
Well, Noridian, Medicare's contractor, denied both claims. I took the first one to the hospital social worker who had originally called for the ambulance and she said the ambulance company must have put down the wrong code or something. She said she would take care of it, but we got the bill again. We did the same thing with the denial of the second ride and took it back to the nursing home. They also said it was a mistake and they would take care of it.
Long story short, it turns out the ambulance company appealed but failed to do it in the proper time alotted, so it was denied again. We tried to get a new review, and were plainly told by Noridian, "no we already reviewed it" The ambulance company, for the life of them, could not understand why Noridian denied the claim because my husband met every criteria Medicare requires. I got the office of our Congressman here in on it and she could not understand why Noridian was denying it either, and could get nowhere with Noridian. They are like a brick wall. By now we have recieved a denial for the second ride and the ambulance company has sent it to a collector who just informed us it is going on my husband's credit record. The original reason Noridian gave us, was that the ambulance company didn't supply enough info. But now, Noridian is saying that both rides are denied because he could have been sent by some other means. Why wasn't that the reason the first time it was denied? At any rate, everyone we talk with says my husband never should have been denied. He couldn't get out of bed, he couldn't walk or sit in a wheelchair. He was drowsy with percoset and didn't even have anything to do with calling an ambualnce, the hospital and nursing home did, but Noridian wants to make us pay. I have his medical records, a letter from his surgeon testifying that ambulance was the only safe way to transport him, I've talked to 1-800-Medicare, and everyone including Medicare consultants and their own manual says that he qualified for those rides, but Noridian says no. We have been appealing for two years and just finished what they call an Independent Review. Problem is, the company that reviews it works for them. That's not independant. Now, they are saying he should have gone by stretcher van instead of ambulance. Exact words: "The patient was not in any pain, except when being moved and could have been transported by stretcher van.Therefore the need for ambulance transport has not been established." All these denial decisions are based on opinions of Noridian's registered nurse and a registered nurse from the independent review. They are not doctors, and have never met my husband and were not there, but they know more than his surgeon or the nursing home doctor. Incredible!
And now to top it all off, guess what. Stretcher vans are illegal in our state! When I told Noridian this they told me that's not their problem. Evidently, they are in a battle with our state over whether or not stretcher vans are safe, and they've made my 92 year old husband their whipping boy. The stress of all this is killing us. These bills are now up to $1500 or more. Now, this 92 year old double amputee with a bad heart is expected to arrange for an ALJ, Administrative Law Judge to listen to his plight. Why is there no limit of liability for us? We signed nothing and were told nothing. Why isn't this a battle between those who actually signed a dotted line? Why isn't this being duked out by the person who called for the wrong mode of transport or the person who failed to put down enough info, or the ambulance company who failed to appeal in time? Why is this disabled 92 year old having to do all the work? My husband is being denied his benefits to Medicare due to someone else's mistake. Benefits he paid for and is still paying for. How can we get justice?
Posted on 03/13/08, 01:03 pm