Ok lets the bad newsPosted 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 newsEd Davis, DPM on 5/19/03 at 15:41 (119300)
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.
Re: Ok lets the bad newsDr. 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 newsRichard, C.Ped on 5/20/03 at 13:00 (119383)
That is until the insurance big wigs develop PF...then...well, who knows.
Re: Ok lets the bad newsEd Davis, DPM on 5/20/03 at 16:47 (119407)
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.
Re: Ok lets the bad newsjohn 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 newsdave r on 5/21/03 at 13:10 (119519)
John, send the radiologist and the nuerosurgeon a truckload of chickens:)