Make way for a Victory Lap! Yup, that would be for me! It’s Exclamation Point Day!
Here’s the latest happening on the fight for Freedom from Debt.
The insurance company (IC) has, after careful review, agreed with me. They’ve decided to reprocess my claim.
Let’s review the case a little. Twice the IC denied my request for payment of the laboratory services meant to determine the new mutation of my lung cancer tumor. The reason for the first denial was that Dr Brevity did not furnish the requested paperwork. After Dr Brevity furnished the paperwork, came the second denial with a new reason: My Primary Care Physician from the IC network was not the requestor of the services.
The IC changed the decision because the diagnosis is lung cancer for which molecular pathology testing (Guardant) was requested. The Medicare Program Integrity Manual Chapter 13, Section 13.5.1 indicates that in order to be covered under Medicare, a service shall be reasonable and necessary including service being furnished in a setting appropriate to the patient’s medical needs and condition and one that meets but does not exceed the patient’s medical needs.
Based on this decision, my claim has been reprocessed. According to Medicare regulations, this claim must be reprocessed within 60 calendar days of the date they received my appeal.
In view of the latest event, I am tempted to crow that I’m an indomitable senior babe who refuses to bend to anyone who gets in my way. But I can’t do that. Tons of help came my way. Guardant represented me in my last appeal. Seasoned Medicare case appellants, they definitely know they’d get paid when I get paid. In addition, the IC wrote me the letter of reconsideration. All I did was read the letter and expressed everything in first person. Less than 30% of the language in the preceding paragraphs is mine. In other words, I’m no authority here; just an honest crafty blogger who tries to get away with sounding impressive. That’s all.
Now success-in-progress has gotten me intoxicated. I’m staggering on, figuring out how to totally eliminate any co-pay. Push a little farther while the momentum exists!
Isn’t that an awesome turn of events?