Medicare AHHHHH!!!

[sara06]

Okay guys... I need some serious help. First off, when my mom and I were trying to figure out all of her doctor bills and we were on the phone setting up payment plans, a lady at one of the offices told my mother to pay only what she could afford because when she died my dad would not be responsible for her unpaid medical bills. Has anyone else heard this? I'm not really up to date when it comes to these kinds of laws. I am currently trying to get ahold of a lawyer friend of the family to find out.

Second, my mom was a federal employee, she didn't have to pay regular social security tax however, she did pay medicare tax. She applied for medicare back in July and we just received a letter ( almost a month after her passing ) to notify her that she did not qualify for disability. She didn't want disability, she was retired, she just wanted medicare. The man I spoke to at S.S. said he couldn't talk to me, he needed to talk with my mother. A little too late for that one bud. Then he said she had to have been on disability for 2 years before she qualified for medicare. They didn't tell her that when she went there for an appointment in July.

They sent a pamphlet with the disapproval letter, explaining how you earn social security credits... yada yada yada, and even if you don't qualify for disability, you may qualify for medicare if you have and I quote, " kidney failure and need dialysis, need a kidney transplant, or have ALS." Those are the only two conditions listed. So when I told the man this on the phone, he said "oh, let me check on that," came back to the phone and told me he would send me papers for an appeal. I'm sure some of you have filled these out. I don't have the patience. I don't know if I'm making it out to be more complicated than it really is or what. They want to know things like " since your last disability report, has your illness, injury, or condition changed? Duh! It's ALS people! What do I say to that? I'm just totally overwhelmed. If any of you have experience in this area and could tell me what these people are looking for I'd greatly appreciate it. Maybe it's not the greatest attitude, but if my dad is not responsible for those medical bills, then I will call the dr's offices and tell them to take a flying leap or fill out the medicare/disability forms themselves!

[PamB]

Dear Sara:
Medicare is a nightmare at first but after you get on the system it gets a little better for a while.
The same thing happened to me when we were trying to get my sister on ss they said she had to wait and then we told them that ALS don't have to wait to get on and they were "I'll get back to you on this" for a couple of weeks. Then they finally got with the program but we had to physically go down and talk to the people. I didn't get great results on the phone. what was really bad is the young guy is asking so what's your prognosis? and the look on my sister's face was terrible. She said do you know anything about this disease and he said never heard of it before, ( they should educate thier employee's about this) and it did take time but she did get on they said ALS pt's should have a rush but they had several snafuus so we had to call and send more paperwork. You really just have to do one step at a time. If you can go in ask for superviser and say please walk us through this we need your help. Possible you will get it. Also smaller offices have more time and usually more helpful. I live in a small town in Ohio and I went in and talked to them on how to play the Medicare game and when I went to Conn to help my sister, big city the knowledge helped.
Pam

[Lindoglvr]

Letters from healthcare professionals can help in medicare appeals. I was just able to help my laryngectomee patient, along with a letter from his physician, in getting his appeal for Medicare. I stated in the letter why in my professional opinion he was in need of services, etc and some of the health issues he would have with radiation, etc.

I think if you can get some letters from your primary physician, etc, on the need for services now, it will help you greatly in getting the ruling over turned and to get your mother her medicare benefts much sooner.

Sometimes the people that work in the appeals process actually have no medical background or anything.......a sad fact, so the more detail on the need, the better.

Good luck.

Linda

[Pearl]

Keep in mind that I have not had to do this first hand, but I have been reading a great deal and I have two suggestions:

1. First, ALS is considered differently due to new laws - ALS patients do NOT have to wait the normal waiting period for SSDI or the Medicare that comes with it and the code word for this with social security is supposed to be something like " TERI " - basically it tells the ss people that you/your loved one is termanial and their case needs to be rushed through. There is information on the web about this, but I can't put my hands on it at the moment.

2. Are you in touch with your local ALS association or CLINIC ? A social worker with the clinic can help you. Please try to get in touch with one.

After having my friend deal with Blue Cross Blue Sheid (sheids up so they don't have to pay on any claims...) for over an hour today on the phone and still not getting anywhere with them (they are stalling on paying a claim), I'm just ticked off with the entire, greedy, heartless, freaking, corporate world!

(I'll see if I can find the link).

[Pearl]

Found some info for you to read through. Here is the quote about the code "TERI" , plus the link where it is mentioned. I've also included two more links. Hope they help.


"Note: SSA has an expedited procedure for processing terminal illness cases to ensure that a favorable decision can be made expeditiously. The code word for this type of case is "TERI" case. A person with ALS (particularly if advanced symptoms are present) may want to advise SSA, at the time of application, that TERI case procedures are appropriate."

- http://www.alsa-stl.org/view_story.php?id=144
- http://www.alsa-ncac.org/images/doc_new-social-security-rules.pdf

[sara06]

Well thank you for your suggestions. After reading some of your replies, I'm wondering if some of you realize that my mother is already gone? Also have any of you heard about this law stating that spouses are not responsible for unpaid medical bills?

Hospice was in the home for only 4 days before my mom passed, and besides the initial visit, one nurse came out one time. They said that they would help us to get all of these things in order. There just wasn't enough time. I will be getting in touch with our local ALS chapter this week. Hopefully I'll have some luck.

[paula B]

I am thinking if your mom has already passed away,,,she wont be getting medicare. As far as bills go,,i know when my dad passed my mom didnt pay his remaining bills. Sorry i cant help more.
Paulab

[sara06]

Thank you for your input Paula. When I spoke to the man on the phone I told him my mother had already passed, and he said he would send me the appeal forms... but I think it's a mute point by now. I did get in touch with our lawyer friend, he said it's not a cut and dry, yes or no to whether or not my dad is resposible for the bills. He said that if my dad signed something then he could be and if he didn't there is no way they can go after him. Thank you!

Sara