Fw: Page 2 of Problem with provider, St. Francis

[Guest guest]

Page 2 of Problem with provider, St. Francis

In January of 2007, I became eligible for Medicare Disability. At some point in

2007 after being told for months by my case representative, at St.

Francis, that Medicare was covering this physician ordered and insurance

approved treatment, I was informed that Medicare would no longer be covering

this treatment. This was no problem as Anthem, my secondary insurance, had

already given me approval for the year of coverage. Ms. informed me that

the hospital would definitely being filing an Appeal on my behalf with Medicare

for this treatment.

On October 15, 2007 when I arrived for my treatment from Loveland, Ohio to

Indianapolis, I was presented with a financial liability form to sign prior to

my treatment. I had never, in all the years I have been receiving treatment at

the hospital been told I had to sign a form saying I would pay for this

treatment. I was told that it was necessary because that was the only way that

the hospital could bill my primary, Medicare. I was understandably very upset

and added an amended note to the form stating that I was NOT agreeing to pay

for anything other than my deductible and out of pocket since Anthem had already

approved this treatment. I was also told then that Anthem was not paying for

this treatment despite having given approval for it. Subsequent calls to Anthem

indicated they were and had been paying for the treatment.

That evening when I got home, I contacted a local reporter, at TV

Station Channel 6 in Indianapolis, Indiana. I explained what had occurred at the

hospital that day and my concerns that the hospital might try to use that form

to " balance bill " me and that I had a secondary, Anthem, already agreeing to

cover this treatment. (Less any deductible and out of pocket maximum met) Mr.

replied he would send out a cameraman to film the next day of my

treatment. Photopheresis is a 2 consecutive day treatment.

On October 16, 2007, I arrived for my treatment at St. Francis and the Channel 6

Indianapolis cameraman was there along with my nurse, Jeff , the friend

who drove me, Romick, myself and the billing department at St. Francis

sent a Pam Carlton to the room for the interview. During this taped interview I

questioned the verbiage on the form since the form stated if I did not sign it,

I would not receive the treatment. Ms. Carlton informed me that, " No, we would

not have denied you treatment but you have to sign the form because it is the

only way we can bill Medicare, get the denial and then we can bill Anthem,

unless you sign the form, we cannot bill Medicare. " I stated that I would be

adding to the form then an amendment indicating that I was NOT agreeing to pay

anything other than my deductible and out of pocket maximum from Anthem and Pam

Carlton agreed that was fine. During this taped interview I was told repeatedly

by the hospital representative, Pam Carlton, that the form had to be signed

otherwise St. Francis could not bill Medicare without it AND that the hospital

would NOT be using the form to bill me.