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colette
Posts: 360
Joined: Jul 2009
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Tuesday June 29, 2010 12:27 AM
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The business manager (mgr) is a caregiver, also. She said she could empathize with my situation.
Although S.I.L.'s papers for medical power of attorney and H.I.P.P.A. were copied by the front office staff at the doctor's meeting in May, the copies were not scanned into her chart. Mgr tried to defend having S.I.L. sign the papers with the reasons: 1) Medicare had to have this paper signed; 2) Staff did not know my S.I.L. personally to know that S.I.L. did not understand what she was signing, and did not have the Medical PoA to refer to.
I explained S.I.L. felt special because she was asked for her signature. If S.I.L. had been asked what the paper stated that she signed, she would not have known. (I realize it is not the staff's duty to make sure patients understand what they are putting their signature to.) If you were to ask S.I.L. today, she would sound as if she knew because she would said state what I told her the paperwork was about.
In our conversation I told mgr had this been private insurance (i.e. Cigna), I would have paid the copay and any deductible when the appt for the colonoscopy was was made. Why was this Medicare form not presented to me when I filled out paperwork at the dr's appt? Had I been with S.I.L. like I normally am for procedures & this form had been presented, the colonoscopy would have been canceled until I learned what (if any) of the bill Medicare covered.
Mgr also clarified "secondary insurance." That refers to private insurance. If Medicare does not cover this, THEN THE BILL WILL AUTOMATICALLY BE SUBMITTED TO MEDICAID which is S.I.L.'s secondary insurance. Mgr went on to say that a routine screening is allowed by Medicare only ONCE EVERY 10 YRS. I suggested she review the patient's history as there is personal and family history of colon problems. Even with a history Mgr states Medicare pays for ONE SCREENING EVERY 24 MOS according to the business manager.
If that is the case, the doctor should not have ordered the procedure, or Ms. Ming should have received a letter to that effect (informed consent) well before the procedure date so that Medicare could have been contacted in advance regarding the billing.
Yes, it was brought up my husband (S.I.L's brother) should have taken a more active role (trying to throw the ball in my court.) Unfortunately I think he is still in denial that sis is incompetent to sign legal & medical papers, and I thought I had signed all the paperwork 2 weeks prior. From here on out, I will be at any procedure for S.I.L.
At this point I am waiting for the MSN from Medicare. I am ready to appeal it if they deny the claim, especially if Medicaid does not pay the claim. I do need to find out what code was used to process the claim for Medicare. At the time of this meeting the billing had not been filed w/Medicare.
Sincerely,
Colette
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Family Caregivers are not paid because they are worthless; Family Caregivers are PRICELESS!
(paraphrased & source unknown)
Edited: Tuesday June 29, 2010 at 12:29 AM by colette
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myonly
Posts: 311
Joined: Apr 2010
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Tuesday June 29, 2010 3:55 PM
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Dear Colette,
What a royal mess for you to have to untangle!! My first thought, from a medical perspective, regards the informed consent. In our documentation, the doctor has to note in the patient's chart that he/she informed the patient about the risks/benefits of the procedure and that the patient asked appropriate questions. In addition to this, the physician often has the patient voice their understanding of what will happen in the proposed surgery and what the goal of the surgery is. There are big flags on our patient charts in regards to a patient's not being competent to give proper informed consent.
Oftentimes, I'm afraid, folks in medicine are just trying to "get their job done" and get through what they see as formalities. Unfortunately, these oversights can and do have a huge impact on the patient and their course of recovery, as well as their billing status. I'm sorry you have to slog through this.
Gab
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