Medicare Denies A Claim

A while ago, I wrote about a coughing spree I had been going through (click here) and how I had a gut feeling my then pulmonologist was bleeding the Medicare system. The doctor ordered all these unnecessary tests (in my opinion) to get to the bottom of my coughing and cure me. Turns out, all I had to do was stop taking a certain medication and my coughing spree was over. Seven months later.

medicare

Fast forward to today and I am still being inundated with all the excessive medical tests and office billing this doctor bitch ordered. Until yesterday. I got a notice from Medicare that they were no longer going to pay the doctor’s claims nor pay for any of the medical tests she ordered. So far, Medicare has denied three requests.

The notes Medicare posted are as follows:

A. B. The information provided does not support the need for this many services or items within this period of time.

C. The information provided does not support the need for this service or item.

D. We used Local Coverage Determination (LCD) to decide coverage for your claim.

And in case you’re wondering if I am going to get stuck paying these ridiculous medical claims, Medicare was kind enough to post this last note……..

F. You (meaning me, Cindi) didn’t know this service isn’t covered so you don’t have to pay. Maximum amount you (meaning me, Cindi) may be billed is $0.00 (that’s a zero!!!!)

I remember when I first starting writing about my medical episode that Medicare was limited. I was told there was no limit and I shouldn’t worry about all the excessive medical treatments. Well, there is a limit and thank goodness there is! It’s a well-known fact that many doctors are unscrupulous when it comes to medicare billing. They like to bleed the system to death! Fair warning, Medicare is on to these doctors and are watching the expenditures very, very closely. You should too. Because I’m hoping to God these medical providers do NOT come after me for payment anyway.

I’ve since changed doctors. I went back to my original pulmonologist. He’s someone who I know I can trust! The doctor did order a test but I’m not going to do anything for the rest of this year. My health can wait a few more weeks. In the interim, my coughing is gone. I’m on new, different meds and I feel absolutely fine.

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3 comments

  1. My SIL is 85 years old. Over the weekend she developed a bloody cough and we all told her to go to the ER. However, she said she couldn’t go to the ER because her insurance will not pay for any ER charges if the patient is Not admitted to the hospital. So she would be risking being charged many thousands of dollars if she was given prescriptions for medications and sent home. This sort of thing should be illegal. We have the most bizarre healthcare “system “ in the developed world.

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    • Florence, I think your SIL could have gone to an Emergency Care walk-in clinic and medicare would cover that. I did go to our ER this summer, due to non-breathing and that assinine cough. Medicare and my supplemental insurance covered everything. Yes, it was in the thousands of dollars. I still had to pay around $100 or so bucks. A lot of money nonetheless. Especially when on a fixed income.

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