Re: FW: medicare ALJ hearing/non-hearing
Jim DeWees
Description
Collection
Title:
Re: FW: medicare ALJ hearing/non-hearing
Creator:
Jim DeWees
Date:
2/25/2013
Text:
This is great news!!! To know that you WON your case.
The White Paper from OPGA, VGM, has a few of these cases well documented
and written up in a manner that is presentable to our US Congressmen and
Senators.
It shows many cases where this exact same story is going on with MANY
providers!
This MUST STOP!!! How can these contractors keep getting away with this
kind of treatment of healthcare providers? Where is the outrage? We are
ALL frustrated with this nonsense! But are WE doing anything about this?
Are WE, as a unified group, doing anything constructive about this?
There are a FEW of us who have taken the time to visit with our congressmen,
and with our senators, and have explained this clearly to them. They have
SEEN examples just like yours, about how WE must provide these services, pay
for components and materials, and THEN we have to fight for 2-3 YEARS to get
paid, only after a JUDGE has reviewed the claims and materials, and then
forces these contractors to pay the provider.
We must join and unite here somehow, to make our cases known to the public,
and also NAME who these contractors are.
In the general population, they think that Medicare is some government group
that processes claims, pays them, administers the claims for the MILLIONS of
beneficiaries. When I tell people, including those in our profession, that
is is NOT Medicare who pays the claims or even sees our claims. In MY
region, it is National Government Services who is doing this kind of stuff
to us. This company is owned by Anthem, which is located here in
Indianapolis.
I am hoping to somehow get the word out to ALL the amputees here in this
area, and hopefully can get 100 or more of us together to go to the actual
Anthem building, and have somewhat of a demonstration. We will leave our
prosthetic limbs at home, OR just bring crutches, or a wheelchair, and put
our prosthetic limbs in a pile somewhere (which will look like the track
side of a paralympic event), and get the media there to cover this and
explain that this apparently what Anthem wants to see going on in this
nation now. All of us without prosthetics! I will be happy to be the
spokesman to the media about how difficult it is to provide these services,
as a Certified Prosthetist and owner of a facility. I will explain how We
do this work, WE provide the services and devices, spending hours of labor
fabricating these custom limbs, and then we have to FIGHT to get paid, and
even spend as much as 2 years in legal battles with Anthem, and then finally
get paid after these ALJ's review our claims. I will explain that Anthem is
responsible for doing this to the MEDICARE patients as well. I will explain
that IF anyone is having problems with Medicare paying the claims here, that
Anthem is the responsible party for this in our region here.
I think this could be a great start to getting this message out that WE
WON'T TAKE THIS ANYMORE!!!!
Others who live in the cities where these contractors have their
headquarters need to ALSO do this! We need to do this for Humana (Kentucky)
and for United Healthcare, and whoever the other big payers are, who are
giving us problems.
I am NOT demonstrator kind of person at all! I have NEVER been part of
any kind of demonstration like this. BUT I think this would be quite a
visible issue...People remember things like this when they see amputees
doing anything. After ANY kind of program about the Wounded Warriors on a
rafting trip is in the news, MANY people talk about it. Or the entire issue
about the South African murder, and how Oscar..... the Blade Runner or the
Double Amputee or whatever.....blah blah....BUT people really SEE the
amputees, and remember the issue.
So, if we can somehow do a demonstration like this, I think it would wake up
the public! I think it would be quite a memorable event for the public, and
what would Anthem or anyone say to defend their actions against these
amputees and the providers???
We also are sending the White Paper to all the legislators, hopefully
everyone will send the copies of this to their elected officials. We have a
list of several legislators who have already gotten the packet. BUT WE NEED
MORE HELP from people in this field!!!
With all this talk going on between us all on this listserve, I have still
not seen or heard anything about AOPA doing anything, except for some survey
they sent out last week. I have not heard or seen anything from our
organizations about this issue, or what they are doing to HELP US. BUT
OPGA is the ONLY group or organization who seems to be working on this.
Thanks again....
Jim DeWees, CP
-----Original Message-----
From: David Sisson
Sent: Monday, February 25, 2013 11:44 AM
To: <Email Address Redacted>
Subject: [OANDP-L] FW: medicare ALJ hearing/non-hearing
> >
> >
> >
> >
> > Here is the next chapter in the over two year old first and only CERT
> > audit I have cooking. I have to say I have been using the wrong
> > acronym in my previous postings I have said rac but meant cert. (the
> > rest are all pre-payment right now). I delivered the denied socket
> > change on 2-3-2011.The CERT audit started8-29-2011 they took back the
> > money in october 2011. All the other appeals were performed. I
> > requested an in person alj hearing on 6-15-2012 I never heard back
> > from them and sent another letter asking what is happening on
> > 12-11-2012 on
> > 1-15-2013 I get a letter denying an in person hearing, on 1-28-2013 I
> > get a notice of a telephone hearing scheduled for today at 12:30 cst .
> > On
> > 1-30-2013 I get a letter confirming the telephone hearing/exhibit list.
> > TODAY at 12:23 p.m. I get a phone call from the Judges asistant and
> > She says that after reviewing the case He has granted Me a full
> > favorable finding and there is no need for a hearing...I was a bit
> dumbfounded to say the least.
> > I asked if and or when I could expect a letter confirming this, She
> > got a bit gruff and said I have absolutely no idea when I asked her
> > again when I could expect payment she said again I have absolutely
> > no idea , look he hasover 1,600 cases on his docket and I have no idea
> > when he will get around to writing them up he'll get to it when he
> > gets to it ! when I asked if I should call back in 90 days if I
> > haven't heard anything She said You can if you want to. and gave me
> > Her name and phone number. So I finally won and I may see my money
> > within two and one-quarter years of doing the work . I'm pretty sure
> > I'll win my other appeals this way too, but waiting over two years to
> > get paid is not viable for materials and labor I paid for over two
> > years ago. I cannot fault the ALJ or his staff. They have a
> > crushing work load due to the the tidal wave of denials and take
> > backs. Butt the providers and beneficiaries are getting screwed.
> > the auditors are just doing what they are contracted to do. HHS
> > hello are you listening ? David Sisson C.P.BOCO
> >
The White Paper from OPGA, VGM, has a few of these cases well documented
and written up in a manner that is presentable to our US Congressmen and
Senators.
It shows many cases where this exact same story is going on with MANY
providers!
This MUST STOP!!! How can these contractors keep getting away with this
kind of treatment of healthcare providers? Where is the outrage? We are
ALL frustrated with this nonsense! But are WE doing anything about this?
Are WE, as a unified group, doing anything constructive about this?
There are a FEW of us who have taken the time to visit with our congressmen,
and with our senators, and have explained this clearly to them. They have
SEEN examples just like yours, about how WE must provide these services, pay
for components and materials, and THEN we have to fight for 2-3 YEARS to get
paid, only after a JUDGE has reviewed the claims and materials, and then
forces these contractors to pay the provider.
We must join and unite here somehow, to make our cases known to the public,
and also NAME who these contractors are.
In the general population, they think that Medicare is some government group
that processes claims, pays them, administers the claims for the MILLIONS of
beneficiaries. When I tell people, including those in our profession, that
is is NOT Medicare who pays the claims or even sees our claims. In MY
region, it is National Government Services who is doing this kind of stuff
to us. This company is owned by Anthem, which is located here in
Indianapolis.
I am hoping to somehow get the word out to ALL the amputees here in this
area, and hopefully can get 100 or more of us together to go to the actual
Anthem building, and have somewhat of a demonstration. We will leave our
prosthetic limbs at home, OR just bring crutches, or a wheelchair, and put
our prosthetic limbs in a pile somewhere (which will look like the track
side of a paralympic event), and get the media there to cover this and
explain that this apparently what Anthem wants to see going on in this
nation now. All of us without prosthetics! I will be happy to be the
spokesman to the media about how difficult it is to provide these services,
as a Certified Prosthetist and owner of a facility. I will explain how We
do this work, WE provide the services and devices, spending hours of labor
fabricating these custom limbs, and then we have to FIGHT to get paid, and
even spend as much as 2 years in legal battles with Anthem, and then finally
get paid after these ALJ's review our claims. I will explain that Anthem is
responsible for doing this to the MEDICARE patients as well. I will explain
that IF anyone is having problems with Medicare paying the claims here, that
Anthem is the responsible party for this in our region here.
I think this could be a great start to getting this message out that WE
WON'T TAKE THIS ANYMORE!!!!
Others who live in the cities where these contractors have their
headquarters need to ALSO do this! We need to do this for Humana (Kentucky)
and for United Healthcare, and whoever the other big payers are, who are
giving us problems.
I am NOT demonstrator kind of person at all! I have NEVER been part of
any kind of demonstration like this. BUT I think this would be quite a
visible issue...People remember things like this when they see amputees
doing anything. After ANY kind of program about the Wounded Warriors on a
rafting trip is in the news, MANY people talk about it. Or the entire issue
about the South African murder, and how Oscar..... the Blade Runner or the
Double Amputee or whatever.....blah blah....BUT people really SEE the
amputees, and remember the issue.
So, if we can somehow do a demonstration like this, I think it would wake up
the public! I think it would be quite a memorable event for the public, and
what would Anthem or anyone say to defend their actions against these
amputees and the providers???
We also are sending the White Paper to all the legislators, hopefully
everyone will send the copies of this to their elected officials. We have a
list of several legislators who have already gotten the packet. BUT WE NEED
MORE HELP from people in this field!!!
With all this talk going on between us all on this listserve, I have still
not seen or heard anything about AOPA doing anything, except for some survey
they sent out last week. I have not heard or seen anything from our
organizations about this issue, or what they are doing to HELP US. BUT
OPGA is the ONLY group or organization who seems to be working on this.
Thanks again....
Jim DeWees, CP
-----Original Message-----
From: David Sisson
Sent: Monday, February 25, 2013 11:44 AM
To: <Email Address Redacted>
Subject: [OANDP-L] FW: medicare ALJ hearing/non-hearing
> >
> >
> >
> >
> > Here is the next chapter in the over two year old first and only CERT
> > audit I have cooking. I have to say I have been using the wrong
> > acronym in my previous postings I have said rac but meant cert. (the
> > rest are all pre-payment right now). I delivered the denied socket
> > change on 2-3-2011.The CERT audit started8-29-2011 they took back the
> > money in october 2011. All the other appeals were performed. I
> > requested an in person alj hearing on 6-15-2012 I never heard back
> > from them and sent another letter asking what is happening on
> > 12-11-2012 on
> > 1-15-2013 I get a letter denying an in person hearing, on 1-28-2013 I
> > get a notice of a telephone hearing scheduled for today at 12:30 cst .
> > On
> > 1-30-2013 I get a letter confirming the telephone hearing/exhibit list.
> > TODAY at 12:23 p.m. I get a phone call from the Judges asistant and
> > She says that after reviewing the case He has granted Me a full
> > favorable finding and there is no need for a hearing...I was a bit
> dumbfounded to say the least.
> > I asked if and or when I could expect a letter confirming this, She
> > got a bit gruff and said I have absolutely no idea when I asked her
> > again when I could expect payment she said again I have absolutely
> > no idea , look he hasover 1,600 cases on his docket and I have no idea
> > when he will get around to writing them up he'll get to it when he
> > gets to it ! when I asked if I should call back in 90 days if I
> > haven't heard anything She said You can if you want to. and gave me
> > Her name and phone number. So I finally won and I may see my money
> > within two and one-quarter years of doing the work . I'm pretty sure
> > I'll win my other appeals this way too, but waiting over two years to
> > get paid is not viable for materials and labor I paid for over two
> > years ago. I cannot fault the ALJ or his staff. They have a
> > crushing work load due to the the tidal wave of denials and take
> > backs. Butt the providers and beneficiaries are getting screwed.
> > the auditors are just doing what they are contracted to do. HHS
> > hello are you listening ? David Sisson C.P.BOCO
> >
Citation
Jim DeWees, “Re: FW: medicare ALJ hearing/non-hearing,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/234670.
