As every caregiver knows, I have been frustrated so often by insurance companies and physicians offices that I, well…started a blog.

If  you’ve read my : Never call an ambulance if  you’re old…..Part 2  and  Ambulance…”part trois”….., you know that one of Medicare‘s absurd rules is how to transport the infirm. They will pay for transport from facility to facility, but they will not pay for transport from your home to any medical appointment or hospital test (with certain exceptions). So, if you are completely wheel chair bound, like my brother-in-law, have no use of your legs, and your doctor orders a CAT Scan or MRI, or even the lowly X-ray, you:

A.  Can’t get there

B.  Can’t get ON the table when you get there

C.  Better have a bucket of cash stowed somewhere to pay for private transport

After days, weeks and months of figuring out the rules, and hacking at the system. I found that if my brother-in-law could be transported upright, so that he didn’t have to get out of the wheelchair, he would have to make all the arrangements with the ambulance company and pay for it himself.

If, however, he needed to get on to a medical table for any kind of test or examination AND the test or examination was at a hospital, then Medicare would pay for the ambulance and I would still have to make all the arrangements for transport.

This is how I found that out.

Medicare denied payment of a transport for a CAT scan. I followed all the rules, contacted all the right people. Got all the pre-certs, the approval numbers and the referrals. But since I had already scheduled the scan, I just used the information the insurance company gave me and had the test done.

Several weeks later, I get the denial for payment. I made a thousand phone calls, appealed the decision, twice, and was still denied as transport not an emergency or medically necessary.

Now I had to appeal to an Administrative Law Judge. This law degree I have and over 15 years of practice in Elder Law came in handy. I jump in with both feet and file the appeal. But because I’ve been around this block many times with many people, I know that a simple paper appeal will not work. Short of asking the ALJ to come to my brother-in-law’s apartment and see how the hired caregivers get him ready for the day, I’m pretty sure the information I would send would not shift the decision.

Yay….social media…..Yay….youtube.

I get up very early in the morning and with my brother-in-law’s approval, I take that amazing little iPhone I have and make a movie of the two caregivers dressing him, washing him, lifting him out of his bed and into his wheelchair, combing his hair,  helping him brush his teeth and shave, and giving him a nice pat on the head to have a good day.

I make a copy of the video, put it on a CD (yeah the Medicare appeal system isn’t that tech savvy that I could upload it), mail it to the judge, and wait.

Lo and behold after 3 hearing cancellations by the insurance company, I get a phone call from the judge’s office saying that the insurance company has decided to pay the claim and there would be no hearing.

I take a bow and accept my Oscar for best performance by  a caregiver.

You just have to Laugh……

Cathy Sikorski