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Re: [IP] Medicare ALJ case



Shirley,
None of what Medicare or it's payers are doing makes any sense to me. I will 
be sure to post the outcome of the ALJ hearing. So far that is the only item 
that I have had a problem with; test strips.
I am fortunate to have an Endocrinologist that is willing to be heard at the 
hearing and that my supplier is going to speak on my behalf. This is my last 
opportunity to appeal , as I understand it, and I will let you and others 
know what happens.
I'm also fortunate to have a supplier that is not withholding the test 
strips he knows I need and an Endocrinologist that cares for his patients as 
if they were his family.

Phyllis
Ft. Myers, Fl.
_____________
----- Original Message ----- 
From: <email @ redacted>
To: <email @ redacted>
Sent: Thursday, June 30, 2011 8:30 PM
Subject: Re: [IP] Medicare ALJ case


> Phyllis - Medicare denies payment for my supplies (which includes the test
> strips) every time my supplier submits an order. I use between 9-12 strips
> per day. After my Dec. '10 order I received a letter from Noridian
> (Medicare administrator for this area) that an appeal had been submitted 
> by
> the supplier. The letter clearly stated that if the claim was denied I
> would be responsible for payment. Medicare did make the payment but when 
> my
> next order was submitted, Medicare then denied it. Like you, it certainly
> doesn't matter what the doctor has ordered or that I submit my BG test
> results as requested. I know we've had some on IP trying to get Medicare 
> to
> cover CGMS but I think the bigger problem is getting Medicare to just pay
> for the strips we need. With my gastroparesis and hypoglycemia unawareness
> I have a very difficult time maintaining my BG levels. Since my order
> includes both pump & testing supplies I think Medicare would cover the 
> pump
> supplies even if they deny payment for the strips. Keep us informed on 
> what
> happens. I know it may be something I'll have to deal with. Shirley, dx 
> age
> 5, 1954 Type 1; Animas 1250; Animas Ping, Chandler AZ
>
> On , Phyllis <email @ redacted> wrote:
>> I was wondering if anyone has been through the experience of being denied
>> coverage of payment by Medicare for test strips or any other pump related
>> items. Medicare wants to cover test strips in the amount of 3/day. I have
>> been through 2 appeals and the 3rd will go before an Administrative Law
>> Judge. Medicare had always paid for their allowable amount (in dollars)
>> and just last Fall decided as a pump patient I only need 3 tests/day. The
>> payor in the area I live for test strips is CIGNA. My Endo has sent in
>> what is required, my copies of CareLink reports are included every 90
>> days also. My supplier is doing so much for me; filing what is needed and
>> sending me my supplies. Has anyone had their denial issue go before an
>> ALJ? Wondering what it is like.> Phyllis> dx Type I 1939> pumping for 23
>> yrs> MM522 .
> .
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