Wellness

[judianne]

When l had my TKR 2 years ago , the Dr ordered a CPM machine , Continuous Passive Motion is what it is called . Plus an ice machine . I was told it was so much a day , and would of been around 300  total copay if I kept it the whole time . I believe my Medicare paid some , it was around $100 a day  rental so if not covered it would of been close to $3000 dollars for the month.  I didn’t take the ice machine as it wasn’t covered at all. I found the CPM  not necessary and cumbersome so I had them come and get it 2 days after I got home from the hospital . The company had sent a guy to my house to bring it and instructions for use before my surgery. It moved your knee up and down slowly. I’m thinking that’s what you had , l don’t see why you would be sent home with a compression machine , thats more for people who don’t move at all. Needless to say, my bill was only about $25, and the company was surprised l wanted it gone so soon.

[Nonametoday]

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@chrystaltree wrote:

I didn't have one of those machines but I know a couple of people who did.  Your surgeon just assumed Medicare would cover it and ordered but he should VERIFIED coverage with Medicare  first and upon finding out that it was a Non Covered Service, he should have told you that.  You have Medicare, you had the booklet so you must know that  Medicare like every other insurer does not cover every single thing a doctor orders. Even if the doctor writes an order.  Insurance doesn't work like that.  Of course, you can appeal if you choose to but if you do, get a letter from the surgeon stating why he ordered it and why there was no other way to avoid a blood clot.  I'm 90% percent sure that they won't over turn the denial but you can still try.  Their rationale will be that the machine is "preventative".  It did not "cure" or "treat" you.     

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@chrystaltree These items regarding coverage, etc., are usually covered by the discharging charge nurse and the social worker, who work together to submit discharge plans on behalf of the doctors, hospital for the patient's ultimate care and goals.  The social worker or discharge nurse should have explained to you that this might be an optional item and that you might/might not have to pay (even if she/he had not inquired with the insurance company and your provider).  However, if they did not do that, speak with your doctor, let him handle it and let him handle the staff who did not carry out the details of their discharge plan which they should have done.

[Nonametoday]

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@SeaMaiden wrote:

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@Carmie wrote:

@SeaMaiden   How would this plump up a doctor's pay check?  The doctor would not receive any more money for prescribing this.

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 many doctors accept kickbacks from  medical companies  ( very common with Phamacutical companies)... not something discussed or talked about.... this is done all the time.   Is it right...  no, but it is done.

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@SeaMaiden   This is not a pharmaceutical company but probably a small medical supply company which kickback would not be that much for something they provided at a cost of $300.  This is most likely the discharging nurse and social worker dropping the ball on the coverage and not informing the patient or not ensuring the coverage was cared for by the provider.  

[Nonametoday]

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@SeaMaiden wrote:

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@Drythe wrote:

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@SeaMaiden wrote:

I had both knees replaced in 2013, and had no blood clot machine....my Dr. said it was not necessary....and that is with both knees done together at once. So your Dr. must be plumping up his pay check.

 Always ask what is covered by insurance BEFORE accepting anything and assuming it will be covered.... you must be very proactive in your healthcare and not ASSUME ANTHING IS JUST COVERED because it is suggested.

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@SeaMaiden 

Or, it could be that you and @Goodie2shoes have different medical issues which require different treatments.  

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@Drythe   I went to a very well known joint replacement hospital here.  They did not use ice machines or blood clot machines for ANYONE. 

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@SeaMaiden  That has nothing to do with the price of eggs in China.  She is not talking about an ice machine.  She is talking about a compression device.  No two people have the same needs or same surgeon, same insurance, same legs or procedures.  Sometimes the patient's bleeding time and medications they are on will determine their needs in that regard. 

[Nonametoday]

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@Goodie2shoes wrote:

A little update, more to come. So I am determined to find out why such an important piece of equiptment would not be covered so I called Medicare this morning and a very informed rep explained to me that they never recieved a claim from my insurance company and never would have because the insurance company is contracted to handle medicare claims and it's up to them as to what they will cover. If I had my health benefits strictly through medicare it may have been covered but insurance companies decide what they will cover and what they won't so basically I was given the wrong information. Now I have been with this insurance company for many many years, way before I retired so I decided to stay with them after I retired. The medicare rep suggested I call my carrier and speak with a supervisor.

I called my carrier, s/w a supervisor, explained what they're rep told me and what medicare said so she  contacted the compression machine provider and they told her they  contacted medicare who denied the equiptment and they would not be sending medical necessity to the insurance company. This is crazy ! and I intend to find out why it's not covered or get it reversed. So I called my Ortho's office, explained the situation, they will address the problem with the doctor and let me know the status of sending medical necessity to the carrier. 

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@Goodie2shoes  Your doctor should be able to take care of it.  Like I said a page or so ago, he/she is the one who should be working out the medical necessity with the provider and the insurance companies.  

[Nonametoday]

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@Kachina624 wrote:

@Goodie2shoes.  It's a good thing you're retired and presumably have lots of time.

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@Kachina624   Especially when all she had to do was what I told her, call the surgeon's office and let them fix it.

[Kachina624]

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@Nonametoday wrote:

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@Kachina624 wrote:

@Goodie2shoes.  It's a good thing you're retired and presumably have lots of time.

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@Kachina624   Especially when all she had to do was what I told her, call the surgeon's office and let them fix it.

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@Nonametoday.  I suggested that back in post #2 of this thread.

[RespectLife]

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@Goodie2shoes wrote:

@RespectLife   thanks for your best wishes, yes I also have the ice machine, no return needed on that. I had a compression machine with my Lft knee replacement in 2015, no issues with payment but that was before I retired. I was told by the company that provided the current  compression machine that it's rented for a cost of $2,000 total.  Nowadays you really need to have some type of medical insurance after retirement because I understand many Seniors do not have enough money to pay their bills, eat and pay for a place to stay. I am not in that type of situation  thank goodness.

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@Goodie2shoes 

I had been telling DH it would probably be a good idea to get the second replacement while we have our current insurance.  He 'ya...ya'd' me!

When I saw your post, I called him and mentioned what you were going through and it proved to me that it should be done before we have to go on medicare in the future.

He's got a few years still, but I will be on it!  LOL  Thanks for helping me get through to him!  Why tempt fate?  We know this current insurance covered it all!

[chlema]

@judianne Interesting that you said Medicare would not pay for the ice machine.  Had both knees done last year, one in May, other in October.  Both times they sent me home with an ice machine that did not require me to return it.  Medicare covered both times.  I wonder if it depends on what medicare package one has.  As for the CPM, surgeon did not put me on that, just told me to continue the use of compression stockings to keep swelling under control and most importantly to get up and move for at least 15 minutes every hour.

[sfnative]

@Goodie2shoes 

"Durable Medical Equipment" is rarely covered, especially in instances when a more common method of preventing post-op blood clots is used across-the-board, such as a more sophisticated blood thinning medication.  These days it can amount to simply ONE tablet/capsule vice a piece of equipment.

Is it possible that you had a clinically extenuating circumstance, which prevented your surgeon from dosing you with a single dose of a blood thinner post-op?  If there is an extenuating circumstance, your surgeon should have had a conversation with you!  Even if not, your surgeon or his/her PA or RN should have had a conversation with you regarding the fact that insurance rarely pays for durable medical equipment, when it comes to rentals.

I'd be interested to know if your surgeon has a financial interest in the company which manufactures the device of which you spoke.  I'd look into it and also into the fact that no one in that office was straight with you regarding device billing information and the likelihood that you'd be paying for it.  And, don't let them tell you that they just don't know that sort of thing.  Balderdash!