My RT at Scripps was paid for by Medicare, but that was in January 2010.

Been too busy lately. Here's a quick update about what happened with Medicare.

Medicare paid for the actual radiation, the most expensive part, but the did not pay for the radiologist/Dr. T's charges. Go figure. It makes no sense. I was remiss in that I did not read the Summary of Benefits/EOB carefully at first and by the time I became aware that they did not pay the doctor, I was past the time to appeal. So, I submitted a letter requesting that my late appeal be permitted for good cause. They denied my request for the late appeal, so basically, I still do not know whether they would pay for the doctor as well as the actual radiation.

This was for my 2nd round of radiation. I didn't know it, but the first round was not paid and Scripps wrote it off because they had not had me sign a letter saying I'd have to pay if Medicare didn't. I didn't know they wrote it off until the second round billing. That contributed to my not being on top of reviewing the benefits report (guess I'd better not make an acronym out of Summary of Benefits.) They discounted the bill that Medicare didn't pay for on the 2nd round.

Do review the Summary of Benefits carefully without delay! If they don't pay, get an appeal going right away. Note this: I was told by my supplemental insurance, Anthem Blue Cross, that if I just had only them, they would pay for RT. Since Medicare is my primary insurance, they don't pay for anything if it is not Medicare approved care/procedure.

I submitted documentation justifying paying the doctor with the request to allow the late appeal. I think I have a good case, but they didn't consider it because my appeal was late.

Maybe we can build on what we already know if this comes up for anybody else. I'll be glad to answer more questions if you have them and I'll be glad to share my case. I had help from several people on this forum and have information about insurance companies. Many pay.

flojo:

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Been too busy lately. Here's a quick update about what happened with Medicare.

Edited 09/17/11 20:35

Flora, the summaries from my supplemental insurance and medicare are not easy to figure out, and I'm not sure if I found them all. From the summaries I have, it looks like the hospital charges were $6,456.57 (listed as Xray-op) and that medicare paid $5,829.52. My supplemental policy paid $627.05.

I also have summary notices from Medicare for:

$455.00 - radiation tx management (code 77427)
$178.00 - set radiation therapy field (77290-26 professional charge
$440.00 - radiation therapy planning (77263)
$145.00 - radiation treatment aid (77334-26 professional charge
$184.00 - Teletx isodose plan complex (77315-26 professional charge
$74.00 - radiation therapy dose plan (77300-26 professional charge

Are any of these Dr. T's charges?

It also looks like these were not paid by medicare. There are notes on the summaries saying "the information provided does not support the need for this service or item" and that I "should not be billed for this service". Never noticed that before.

I will look for more summaries and let you know if I find anything else.

Linda

flojo:

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Linda Gail,

Maybe Scripps has gotten it's act together now and Medicare is paying.

Just to be sure, Medicare did pay for Dr. T's charges as well as the actual RT at Scripps Green Hospital, right?

Flora

Very interesting discussion in the Forum . THX to all who contributed; I was just curious and pulled out the two bills which I had to pay for RT with Linear Accelerator in Germany at the Strahlenzentrum Hamburg

1 Hand

GOÄ #34 Set-Uo of the RT Treatment Concept for 1 Target Volume 61,22 Euro
GOÄ # 3 Consultations (E-mail, oral, other contact) 4x 30,60 Euro 121,40 Euro
GOÄ # 8 Physical Examination (per each extremity) 4 x 34,85 Euro 139,38 Euro
GOÄ 5810 Physics Treatment Plan (2D) for 1 Target Volume 26,82 Euro
GOÄ 5812 10 Treatment Sessions with a Linear Accelerator 10 x 11,07 Euro 110,70 Euro
GOÄ # 75 1 Medical Report 26,52 Euro

Individual Manufactured Lead Absorbing Material for each irradiated extremity 160,00 Euro

Material, Photographs, Documentation 10,00 Euro

Total Sum: 656,04 Euro

Edited 09/19/11 20:16