Medicare

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby Cece » Fri May 20, 2011 3:27 pm

If a patient has a past history of MS but gets undiagnosed (or rediagnosed with something else like Lyme that better explains the symptoms), that past history of MS would still trigger denials?
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Postby fogdweller » Fri May 20, 2011 3:56 pm

Cece wrote:If a patient has a past history of MS but gets undiagnosed (or rediagnosed with something else like Lyme that better explains the symptoms), that past history of MS would still trigger denials?


Who knows? How many would fit that description.
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If you have been denied coverage from medicare (US)...

Postby dianabee » Fri May 20, 2011 4:15 pm

... You must first exhaust all of your appeals with Medicare, including possibly going before an administrative law judge. Be advised you will need to have your ducks in a row. It is common now for Medicare admins/experts to attend these hearings in order to fight your appeal. I have read where it is even advisable at some point during the process to have an attorney present (cha-Ching). Also, the claim must be for a minimum dollar amount in order to advance to the next level of appeal. Not sure how that is figured. Hopefully anyone who is appealing will win before the case gets to federal court.
If anyone reading this has appealed or is going to, could you please keep us posted on this thread.
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Re: If you have been denied coverage from medicare (US)...

Postby fogdweller » Fri May 20, 2011 4:32 pm

dianabee wrote:... You must first exhaust all of your appeals with Medicare, including possibly going before an administrative law judge. Be advised you will need to have your ducks in a row. It is common now for Medicare admins/experts to attend these hearings in order to fight your appeal. I have read where it is even advisable at some point during the process to have an attorney present (cha-Ching). Also, the claim must be for a minimum dollar amount in order to advance to the next level of appeal. Not sure how that is figured. Hopefully anyone who is appealing will win before the case gets to federal court.
If anyone reading this has appealed or is going to, could you please keep us posted on this thread.


Medicare appeal or plain ole insurnace appeal? I appealed my insurance claim denial for my treatment, after much effort got partial payment (BC/'BS company) but they have since changed their poicy, now refuse treatment always, and I heard are even asking the doctors to repay amounts they had already reimbused!!! (Yeah, right, good luck wiht that. I want to see them come after me for the paltry aount the ended up paying).
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Re: If you have been denied coverage from medicare (US)...

Postby dianabee » Fri May 20, 2011 8:09 pm

fogdweller wrote:
dianabee wrote:... You must first exhaust all of your appeals with Medicare, including possibly going before an administrative law judge. Be advised you will need to have your ducks in a row. It is common now for Medicare admins/experts to attend these hearings in order to fight your appeal. I have read where it is even advisable at some point during the process to have an attorney present (cha-Ching). Also, the claim must be for a minimum dollar amount in order to advance to the next level of appeal. Not sure how that is figured. Hopefully anyone who is appealing will win before the case gets to federal court.
If anyone reading this has appealed or is going to, could you please keep us posted on this thread.


Medicare appeal or plain ole insurnace appeal? I appealed my insurance claim denial for my treatment, after much effort got partial payment (BC/'BS company) but they have since changed their poicy, now refuse treatment always, and I heard are even asking the doctors to repay amounts they had already reimbused!!! (Yeah, right, good luck wiht that. I want to see them come after me for the paltry aount the ended up paying).


I was referring only to Medicare US. Private Insurers usually have an appeals process as well, but every plan is different....
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Postby HappyPoet » Fri May 20, 2011 9:45 pm

fogdweller wrote:
Cece wrote:If a patient has a past history of MS but gets undiagnosed (or rediagnosed with something else like Lyme that better explains the symptoms), that past history of MS would still trigger denials?

Who knows? How many would fit that description.

I believe I fit that description. I'll be asking for the Lyme blood test at my upcoming primary doctor appt. because all my hiking, camping, and sailing in the Adirondacks definitely exposed me to ticks. I feel I was rushed through the diagnosis process and rushed onto the DMDs.

I'll fight Medicare to the best of my ability if any of my claims are denied because I'll need many follow-up ultrasounds and perhaps more procedures to take care of restenosis -- recoil, thrombosis, intimal hyperplasia, and collapse of vein.
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Postby Blaze » Sat May 21, 2011 10:27 am

Cece wrote:There is the organization "Angioplasty for All" in Canada that was looking into fighting this as discrimination. I wonder if there are any applicable lessons from how they are getting on.


Very slowly is the answer to how Angioplasty for All is getting on. They have hired a lawyer. They have plaintiffs and some expert witnesses lined up and are in the process of raising funds for costs.

Here's a link to their website. http://www.angioplastyforall.com/
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Postby Cece » Sat May 21, 2011 2:21 pm

Thanks, Blaze. It's good to know if we have options but if the legal side take that long, the science might be faster.

Of course if the research come in with mixed results or poor methodology, who knows how long this will take.

As for if it would do any good to get undiagnosed with MS, my previous neurologist had his doubts about the diagnosis, it's possible I could get undiagnosed if I went back to him.
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