Why wouldn't Medicare cover this?

[axeman462]

I've never come across an instance like this.

I have a customer with a Plan F that called me saying that she recently had surgery at Shands UF. Doctor installed a PiccLine, and the vendor for UF is saying that the piccline, the heparin, saline, alchol wipes and bandage for the piccline are not covered by Medicare.

Apparently she has been arguing with them for 2 weeks now about this. What could be causing the discrepancy?

 

[annon123]

I've never come across an instance like this.

I have a customer with a Plan F that called me saying that she recently had surgery at Shands UF. Doctor installed a PiccLine, and the vendor for UF is saying that the piccline, the heparin, saline, alchol wipes and bandage for the piccline are not covered by Medicare.

Apparently she has been arguing with them for 2 weeks now about this. What could be causing the discrepancy?

It might be how the hospital coded that or how they coded the medical condition where she needs that so medicare denied it then F denied it. It likely would be worth calling her Medicare to find out exactly why it was denied. Then her doctor can appeal based on the reason given.

 

[Millwood]

I've never come across an instance like this.

I have a customer with a Plan F that called me saying that she recently had surgery at Shands UF. Doctor installed a PiccLine, and the vendor for UF is saying that the piccline, the heparin, saline, alchol wipes and bandage for the piccline are not covered by Medicare.

Apparently she has been arguing with them for 2 weeks now about this. What could be causing the discrepancy?

Shanda UF have already been paid for it. It's paid as part of the surgery. Call Medicare they can spell it out .

 

[Medicare bro]

I've never come across an instance like this.

I have a customer with a Plan F that called me saying that she recently had surgery at Shands UF. Doctor installed a PiccLine, and the vendor for UF is saying that the piccline, the heparin, saline, alchol wipes and bandage for the piccline are not covered by Medicare.

Apparently she has been arguing with them for 2 weeks now about this. What could be causing the discrepancy?

Sounds like she wants brand name saline, alcohol wipes and bandages. She needs to get a prior Auth for brand name.

 

[somarco]

The Medigap plan has no say in what is covered, what isn't. It doesn't matter if he has F, G or any of the other letters.

It sounds like she has been discharged, so these would be Part B charges including the heparin & saline. Alcohol wipes and bandages should be OTC items.

The picc line is DME and is also a Part B charge.

She needs to check her MyMedicare account and look at the claim summary. I can't think of a single reason why OM would deny the claim.

If the hospital covered these claims there is no reason to think they would deny them as Part B unless the provider (presumably the HHC) billed the MEDIGAP plan and not Medicare.

 

[axeman462]

If the hospital covered these claims there is no reason to think they would deny them as Part B unless the provider (presumably the HHC) billed the MEDIGAP plan and not Medicare.

I think this is what was happening. As she said the claims were being denied, but never actually showed up on her MyMedicare account.

Thank you for your help!

 

[Todd King]

Sounds like she wants brand name saline, alcohol wipes and bandages. She needs to get a prior Auth for brand name.

Talking about a Med Supp, not an MA Plan.

 

[Medicare bro]

Talking about a Med Supp, not an MA Plan.

Sorry, I was being sarcastic.

 

[goillini52]

Sorry, I was being sarcastic.