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Ok lets the bad news

Posted by Dr. Z on 5/17/03 at 19:14 (119142)

I jsut receive the draft proposal for Medicare in the states of NJ, Pa. NY
The position is that there is no proof that ESWT is effective so no coverage. I guess you win some and you lose some. This is local policy and not national policy

Re: Ok lets the bad news

Ed Davis, DPM on 5/19/03 at 15:41 (119300)

Dr. Z:
That can be interpreted in the negative or positive. I would rather have Medicare say no than to say they will cover it at $50 a treatment. The latter scenario would essentially make it impossible to provide the service to Medicare beneficiaries.
Ed

Re: Ok lets the bad news

Dr. Z on 5/19/03 at 16:46 (119311)

Either way its not going to be covered. Most pf patients are over age 65

Re: Ok lets the bad news

Richard, C.Ped on 5/20/03 at 13:00 (119383)

That is until the insurance big wigs develop PF...then...well, who knows.
Richard

Re: Ok lets the bad news

Ed Davis, DPM on 5/20/03 at 16:47 (119407)

Dr. Z:

The problem is that if Medicare labels it as 'covered' but sets the rate below what any provider can afford to provide the service, then it is not permissable to provide the service on a cash basis. If Medicare labels it as non-covered, then providers have the right to directly negotiate an acceptible cash fee with the patient.

Ed

Re: Ok lets the bad news

john h on 5/21/03 at 09:08 (119488)

Ed: Try this on for size. My wife recently was referred by our family physician for a brain MRI because of vertigo. She also had a history of breast cancer which frequently shows up in the brain. The MRI, even to a lay person, seemed most appropriate. The MRI indicated an 8mm brain tumor. A nurosurgeon a week later diagnosed the tumor as a benign hemangioma and and said just forget it as it had probably been there for many years. Medicare refused to pay for the MRI on the basis it was an UNNECESSARY PROCEDURE . They advised me that the MRI Center could not bill me and I was not to pay anyything. Talking about absurd. I appealed on behalf of the MRI Center who stands to take the loss and submitted the diagnosis from the Radiologist and Neurosurgeon. Althhough I have no responsibility for payment I will send this to my Senator if they refuse to pay the MRI Center. I wonder if the Medicare person who made this decision is a medically trained person or a beauracrat? It has been 4 weeks since my appeal and I have heard nothing.

Re: Ok lets the bad news

dave r on 5/21/03 at 13:10 (119519)

John, send the radiologist and the nuerosurgeon a truckload of chickens:)