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Author Topic: medicare claim taking too long  (Read 4698 times)
sullidog
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« on: April 13, 2010, 11:39:30 AM »

I applied for medicare back in september a long with social security. I haven't been getting any updates on the situation so being quite curious I called the other day, well they said they'd have to have a supervisor call me back because it was with a department that was closed, never got the phone call which does not surprise me with that office, so I called them again today and they told me that back in January they couldn't make a decision locally that they had to send my claim to the quality review board. and that it takes 90 days before a decision will be made. The rep I spoke with dsaid they should be making a decision any day now and letting me know. I told the rep I was a dialysis patient and applied back in September and that it shouldn't take this long, he could not give me any answers as to why they had to send it to quality or anything butwas aware that I was on dialysis. Has anyone else gone through troubles applying for benifits? My transplant social worker thinks they submited the wrong application and did not do it through renal failure which they said they did apply me for medicare because of renal failure. I also applied for disability benifits to get a monthly check as well but one would think they would do the medicare first before doing the other. I sware I don't understand that office sometimes. Has a dialysis patient ever been denied medicare? If so what would be the next step in case this happens. This has been a long and drawn out process and shouldn't be.
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May 13, 2009, went to urgent care with shortness of breath
May 19, 2009, went to doctor for severe nausea
May 20, 2009, admited to hospital for kidney failure
May 20, 2009, started dialysis with a groin cath
May 25, 2009, permacath was placed
august 24, 2009, was suppose to have access placement but instead was admited to hospital for low potassium
august 25, 2009, access placement
January 16, 2010 thrombectomy was done on access
thegrammalady
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« Reply #1 on: April 13, 2010, 01:10:56 PM »

medicare and ssdi are two different things. you can apply and receive medicare because of renal failure but don't have to apply or receive disability. there is a 4 month waiting period from application for medicare. each state is different as far as disability goes. in collorado it takes 9 months. i used to get real grouchy because i'm sure in some situations they could do it faster, but because they have 9 months they just don't.
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sullidog
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« Reply #2 on: April 13, 2010, 04:39:18 PM »

I applied for both at the same time. They said they'd work on the medicare first, but it appears they are working on them both at the same time.
Troy
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May 13, 2009, went to urgent care with shortness of breath
May 19, 2009, went to doctor for severe nausea
May 20, 2009, admited to hospital for kidney failure
May 20, 2009, started dialysis with a groin cath
May 25, 2009, permacath was placed
august 24, 2009, was suppose to have access placement but instead was admited to hospital for low potassium
august 25, 2009, access placement
January 16, 2010 thrombectomy was done on access
pdpatty
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« Reply #3 on: April 14, 2010, 05:15:55 PM »

See you live in Ohio. They aere known for dragging the waiting time out for sometimes years.
Can't see them denying you but if they do,there are quite a few good lawyers in Columbus that will help. Husband fought for over two years and finally won.
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cookie2008
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« Reply #4 on: April 14, 2010, 07:49:01 PM »

I live in NJ and it took 3 months for medicare and 6 months for Social Security Disability.  I took paperwork from my dialysis unit stating the day I started Hemo.
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Started PD in 11/07
Started Hemo in 7/08
Started NxStage 5/09
Quickfeet
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Mack Potato

« Reply #5 on: September 30, 2010, 01:01:56 PM »

i am going through trouble with medicare too. All they can tell me is that it is still pending. I talked to two different people and they both said it is usually approved by now. Its funny, my disability application was problem free; So I thought medicare would be even easier.
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vcarmody
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« Reply #6 on: September 30, 2010, 01:37:51 PM »

I was told to apply by Prudential ASAP (that is my husbands short term/long term disability carrier though his employer).  They told me at a minimum they would take 5 month to make there decision even thought when you on dialysis it is automatic coverage.  It took exactly 5 months to get the decision in the mail.  I followed his application on line the whole time they were reviewing it, so I know what steps they were on.  When he first applied (we did it on line) one of the workers at the SS office called and tried telling us he didn't think my husband would get approved because he didn't think he had a extensive enough medical history.  I was told by Prudential that disability and Medicare are automatic for ESRD as long as your doctors supports the fact that you are unable to work.  I'm hoping it is faster for you.  I know how frustrating :stressed; it is waiting for that decision.
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Caregiver to husband Chris, NxStage 11-2009
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