This is a Medicare Card. Everyone’s Medicare Number is their Social Security Number.
Conversation with Medicare Appeal Board:
“Do you have the Social Security Number of the person who is appealing?”
“Sorry, I don’t.”
“That’s okay. Do you have their Medicare Number instead?”
I rest my case.
“You Just have to Laugh…..”
©2015 Cathy Sikorski
Just a very brief update…..
I am taking my cell phone with me absolutely EVERYWHERE. I am NOT going to miss the call again from the Medicare independent contractor, CMS. Because, as you know, if you miss the call, you can NEVER talk to anyone. Out of sheer exhaustion one afternoon this week, I go to lie down, just for 20 minutes or so, and put that cell phone under my pillow…like shotgun….I am NOT going to even think about RESTING without that ordnance by my side.
Lo and behold, that cell phone vibrates under my head like a 25 cent bed in a cheap motel. Of course, I’m in a dead-to-the-world sleep, but, as a caregiver, I am so committed to alertness that any signal of distress, alarm, help, or hunger has me jumping up like a thoroughbred at a starting gate.
“Hello? Hello?” I’m yelling into the phone like it’s a crank phone with a party line.
“Hello. may I speak to Cathy?” says the other line.
“Yes, this is me,”I say.
“This is Rebecca at CMS, the independent contractor for Medicare Appeals!” (you may wonder why I always put that in italics. It is because they use that phrase like it is a papal dispensation for everything that is about to follow)
So I carefully and slowly and without rancor(really I try as hard as I can to keep under control, “more flies with honey than with vinegar” theory) explain to Rebecca that I have sent them the necessary documents for my AUTHORITY for this appeal, three times.
( n.b.(which means ‘note well’) they readily admit they have all the documents for the ACTUAL appeal, they just claim to not possess the documents needed for ME to appeal. And you wonder why caregivers sometimes pretend to be 96 year-old men just to get something accomplished. I digress……)
To her credit, Rebecca stays on the line with me for 10 minutes or so and by listening to me as I document every date and page I have sent them, and looking, really looking: EUREKA! She finds ‘my authority’!
“Ok, she says,” now I have to see if it was filed in a timely manner.”
Since I KNOW it was filed in a timely manner, I just sit on the other end of the phone with steam coming out of my ears waiting for her to confirm that.
As we wrap it up, she tells me:
“Okay you will get a confirming letter re-opening this appeal from it’s dismissal in about 2 to 3 weeks. Then we will review the appeal and send a notice of our decision.”
“So, just so I understand, since I have to report this to the collection agency,” I say through clenched teeth,”you will let me know you FOUND the paper work I’ve sent you three times and THEN weeks or months from now you will let me know your decision on the appeal?”
“Yes, ma’am, that’s correct.”
“Thanks, Rebecca,”I say as I reach for the Pinot Grigio and go back to bed.
You just have to laugh……..
Cathy Sikorski
I think I have spent about $5,000 ( at least in legal time and photocopying) trying NOT to pay an ambulance bill. I began this tale as one of my first blogs, Do you really need an Ambulance? I think not. I related that my dear 95 year-old mother-in-law was found in pain in her assisted living facility, and the staff correctly called an ambulance. Her pain was evident, so even though she suffered from dementia, which was documented, the ambulance drivers decided to take her to the hospital.
For over a year now, I have been fighting with Medicare to pay this bill. I have told the Ambulance Company, I will not pay this bill, as there is no way my mother-in-law could have made the decision to go to the hospital, let alone CALL for an ambulance. I do not wish to leave these hard working emergency first responders without pay. However, there has to be some manner in which they can support the patient when the first responders make a medical call, that requires an ambulance.
My mother-in-law does not drive. She has never driven. She has never had a car. In an assisted living facility, she has no transportation to go anywhere without it being directed by someone else. The facility is also doing the right thing by calling for an ambulance for a client who seems to need medical help.
Okay, so we’ve established that everyone who actually PARTICIPATED in this trip to the hospital made a rational and correct decision. The only people who don’t agree with this is Medicare and it’s not even Medicare. It’s a company called CMS, an independent contractor, who assesses whether the claim should be paid. So I send 22 pages of documentation with a letter of explanation telling this independent contractor why they should pay this bill.
The first denial is because this darling old lady really didn’t need to go to the hospital. They found nothing wrong with her and sent her home. Yep…..that’s absolutely true. But, I persist with an appeal.
The SECOND DENIAL is because I have NO AUTHORITY to appeal. I call to clarify this.
” If you would like to leave a message, please leave the appeal number, the claimant’s social security number, the date of service and the provider for which you are appealing. Please leave a phone number and we will return your call.”
YOU CANNOT TALK TO ANYONE…..EVER.
They do call me back, and I explain that I am holding in my hand the appointment of representative form that gives me authority to talk to them AND to APPEAL.
“O well, sometimes Medicare doesn’t send us all the paper work in the file so you need to send it to us again.”
I grind my teeth. Call the ambulance company AGAIN to reply to the bill they have sent ME again, and tell them I am still appealing.
The THIRD DENIAL comes because they still didn’t get my paper work. I call them again and they say….”oops”….and ask me to send it again. I ask the representative to explain to me how I will know if they get it…she says:
“Well you might get a notice that we received it…..wait, no, no I don’t think you will.”
Yesterday, I got the ambulance collection agency notice. They are going to sue my mother-in-law, which I kind of want to let them, because she died.
But I leave a message for the independent contractor, who calls me when I am in a meeting and can’t answer the phone. AND THE MESSAGE IS:
“This appeal was dismissed twice for failure to have the proper paper work to authorize you to appeal.”
I am not fing kidding. I’m not.
I was just going to pay the $797.20 bill. I mean they are just wearing me down to the nub. But I decided to give it one more try. I’m waiting for the return call.
To be continued……
And you really, really do…….
Just have to laugh….
Cathy Sikorski