Guest guest Posted November 30, 2011 Report Share Posted November 30, 2011 Need to have EvLT vein proceedure,Dr. says medicare will not pay for nerve blocks to keep RSD from spreading during proceedure,because it is not nessasary for this proceedure.I need printed material by Drs. to fight medicare on this.Can anyone tell me where to find information on this matter? Viv in Connecticut Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2011 Report Share Posted November 30, 2011 I need to have EvLT vein proceedure. The doctor says medicare will not pay for nerve blocks to keep RSD from spreading during the proceedure,because it is not nessasary. I need printed material by doctors to fight medicare on this. Can anyone tell me where to find information on this matter? Thanks. Viv in Connecticut Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 1, 2011 Report Share Posted December 1, 2011 > I need to have EvLT vein procedure. The doctor says medicare will not pay for nerve blocks to keep RSD from spreading during the procedure,because it is not necessary. > > I need printed material by doctors to fight medicare on this. Can anyone tell me where to find information on this matter? > > Thanks. > > Viv in Connecticut > Vivian, I am going out of town but I will leave you the research. Here is one site that explain what happens, dr offices do not know how to write justifications. http://www.beckersasc.com/asc-coding-billing-and-collections/proper-coding-of-ne\ rve-block-with-emg-guidance-requires-careful-review-of-op-report.html Medicare uses the same cpt codes that Aetna does and here is the criteria. http://www.aetna.com/cpb/medical/data/1_99/0016.html The cpt code the insurance/billing person enters at the doctors office is what gets the procedure paid. If they put in the wrong code or do not know or write the correct justification Medicare kicks it back and some just say " Medicare will not pay for it " . Call Medicare and talk with them about you case and you can appeal this or they will tell you what to get changed to get it paid. I had a nerve block and they used back radulopy which you have a primary problem that was treated as RSD has a trigger that it spreads from, if you can get justication and the Aetna website addressed the procedure you are going to have. Ever time I have called Medicare to help me with this, I have had my procedure paid for. I will be back on group in two weeks and will contact you if I can help or to see how it went. Good Luck Vi- Bennie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2011 Report Share Posted December 2, 2011 Hi Vivian I just want to say don't give up. I had a hard time getting medicare initially to cover my insulin pump supplies due to what they said was lack of medical justification. The provider fought it for a year. Medicare finally covered them. the problem is that if your doctor will not even start the treatment, I don't know how far you will get with medicare. I may have to considering finding a doctor who will fight for your right to the treatment. Check into local advocate groups for medicare/disability. they will also be a good source to help you figure out how to proceed. Let us know how you make out. I'll keep positive thoughts for you. Huge gentle hugs, Tami Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2011 Report Share Posted December 12, 2011 All, I ask what justification items they need and contact the appeal section at Medicare. I then have taken the justification items and addressed them why I need them. I think if you find a case manager at Medicate and deal with one person it helps. Medicare does have a list of advocates and people who will assist you. Hey , you might look into being one of those. There is a website, Center for Medicare Advocacy Inc, and they have a resource section you could check as they list resources: http://www.medicareadvocacy.org/medicare-info/other-resources/ Good Luck and don't give up. Bennie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 14, 2011 Report Share Posted December 14, 2011 Just want to say that Bennie put it very well. I have had conflict with getting medicare to approve a couple things. Once the additional medical input was provided, it was approved. I know you can also find a social security advocate through the website butyoudon'tlooksick.com It is an except site with alot of information on various chronic conditions as well as navigating social security and medicare. Don't give up. You will get through the red tape. Hugs, Tami --- Bennie wrote: > > I ask what justification items they need and contact the appeal section at Medicare. I then have taken the justification items and addressed them why I need them. I think if you find a case manager at Medicate and deal with one person it helps. Medicare does have a list of advocates and people who will assist you. Hey , you might look into being one of those. > > There is a website, Center for Medicare Advocacy Inc, and they have a resource section you could check as they list resources: http://www.medicareadvocacy.org/medicare-info/other-resources/ > > Quote Link to comment Share on other sites More sharing options...
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