ficticious vills

[helpmate]

My husband is a Medicare only dialysis patient. Recently he was admitted as an outpatient to have his upper arm fistula checked. The Dr. put in a shunt to check for blockage and he told my husband that you do not have a blockage. The bruise is caused by an invasion of the vein on both sides. He did not have to do a repair. However, on his Medicare summary, Medicare paid for a venous repair and did not pay for the second venous repair under a different code at the 80/20 rate. I wrote Medicare a letter and told them that no repair was done. They investigated and told me upon reading the Dr.'s notes that they decided in the hospitals favor. I called billing and asked why they charged for two procedures and asked what the code for the second one was for. The lady in billing said she could not tell me...only that I needed to pay for it. I looked on the net and found the code was for a PA to assist in the surgery. Medicare will only pay 16% of the charge. I am outraged. It never happened! I am appealing again, and will continue to appeal until He** freezes over. Medicare asks people to report frauds and then does not believe it when you do report it!Has anyone else had this experience???Something needs to be done to stop this outrageous fraud on the part of Doctors and hospitals.No wonder Medicare is going broke. No one seems to care at this point, but they will care when all the money is gone.Helpmate

[Joe Paul]

Does the unit your husband goes to have a social worker? Id check with that person, then have him/her check into the bill. Also, I would check and see if you are eligible for some sort of medical assistance. More often than not, there is a "medigap" plan of some sort than can help with these type bills.

[Rerun]

Does the unit your husband goes to have a social worker? Id check with that person, then have him/her check into the bill. Also, I would check and see if you are eligible for some sort of medical assistance. More often than not, there is a "medigap" plan of some sort than can help with these type bills.

The "point" is the procedure was NOT done and they billed Medicare and Medicare paid for "their" share of the first code and the patient is stuck with the second part which, again, never happened.  I'd keep calling medicare and ask to speak to a supervisor or go to the hospital billing office and get in their face and threaten going to the local news!

[angieskidney]

and threaten going to the local news!

 Ya from what I see from Canada on the American news (since I live on the border I see both worlds ) it works! If you don't get justice call the local news!!




EDITED:  Fixed quote - Goofynina

[sandman]

and threaten going to the local news!

Ya from what I see from Canada on the American news (since I live on the border I see both worlds ) it works! If you don't get justice call the local news!!

I can attest to that.  Even a simple threat that you will take your argument to the news will get reactions.