Need evidence that Medicare Advantage plan has paid for 2 level Lumbar ADR surgery
Hi everyone,
I have Social Security disability and Medicare ins with Cigna as the Medicare advantage plan. I am appealing a denial for a 2 level surgery with Medicare. I have been working on this all year. I am up to the Medicare Appeals Council level. The next level is the highest, Federal Court, won't that be fun! Anyway, both Medicare and Cigna are only approving me for a single level. If anyone has had a 2 level surgery paid for by a Medicare advantage plan, I would like to get a copy of maybe an approval letter for surgery or a "Medical claim detail" for surgery services already paid. I think this would really help my case. I only have until Jan 15 2010 to send it to the Medicare Appeals council. If anyone can help me, please let me know ASAP. Thanks, Juli |
Sorry for the late reply
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Juli,
By now, you've probably done some deep digging through the Medicare regs, so you may already know about these: However, replacement of purchased equipment can be made for: Certain prosthetic devices (which replace all or part of an internal body organ, or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ. Some examples include Parenteral and Enteral Nutrition (PEN), insertion trays, catheters, drainage bags, skin barriers, lumbar-sacral orthosis (LSO), prostheses (leg, foot, breast, knee, ankle), cardiac pacemakers, prosthetic lenses, maxillofacial devices, and devices which replace all or part of the ear or nose.)http://www.medicareadvocacy.org/FAQ_PartB.htm Also, see attached...and also the fine print. |
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