Fw: Page 3, Problem with Provider, St. Francis

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Page 3, Problem with Provider, St. Francis

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Ms. Carlton reiterated it was only necessary I sign it in order to bill

Medicare, get the denial and then they could bill Anthem. I was still leery but

since Medicare is my primary and I was being told I had to sign it in order for

the hospital to bill my primary, I had no choice. Each time I have signed this

form I have signed it with an amended note indicating I am NOT agreeing to pay

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

This has never been questioned by St. Francis . (Copies available upon request)

Over the past year I have received and continue to receive numerous bills from

St. Francis that are far over my deductible and out of pocket maximum. I have

spent hours on the phone with Anthem, the hospital billing department and

Medicare in an effort to clear up this very convoluted mess. When I speak with

Anthem customer service, they have said not to sign the form then, that it is an

inappropriate use of an ABN. However, if I don't sign it then ST. Francis says

they are then unable to bill my primary insurance, get the denial and

subsequently bill my secondary, Anthem. In my numerous calls, I spoke with a

Medicare customer service, Shaquin . Ms. informed me that " St.

Francis telling the patient that they have to sign the form in order to bill

Medicare is not true " . Per Ms. , " All St. Francis needs is the EOB showing

Medicare did not cover what was denied, which should automatically be sent to

Anthem " . Since Anthem has approval on file for the years, 2005, 2006, 2007, 2008

and just given approval for treatment for 2009, billing for my treatment should

not be a problem.

St. Francis also indicated to me in July of 2007 when first informing me that

Medicare would no longer be covering my treatment that St. Francis would be

appealing the denial of coverage for photopheresis. I was assured by my case

rep, , that the hospital was appealing my denial of coverage by

Medicare, for months. In January, 2008, I emailed Ms. and asked to speak

to whomever was in charge of the appeal to Medicare and was emailed the contact

information. I was then informed that St. Francis had neglected to file any

appeal with Medicare and that the time allowed to file such an appeal, 120 days

was long over.

In addition, St. Francis has sent me numerous bills over the past 3 years where

they neglected to bill my secondary, stating that I, the patient owed the

balance. They have also sent me bills where they billed my secondary as first,

meaning Anthem promptly denied them, correctly citing Coordination of Benefits

and then the hospital billed me thus requiring hours of phone calls, on my part

to clear up. Copies of these bills are available upon request.