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  • FourDirect@aol.com
    Deal all, I have a reimbursement question for any of you out there. As many of you know, I ve had a Peace Corps illness for about 21 years. In years back I
    Message 1 of 13 , Sep 13 10:06 PM
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      Deal all,

      I have a reimbursement question for any of you out there. As many of you know, I've had a Peace Corps illness for about 21 years. In years back I used to have to pay my bills up front and then attempt to get reimbursed, which was sometimes successful and many times not.

      During intervening years I've had direct payment to practitioners (when that has worked). However, now with ACS and the need for practitioners to "enroll" I am finding that most of my NY physicians will not cooperate with this system and justifiably so, as their payment is erratic and slow.

      I cannot pay out of pocket for all my needs but I need very particular specialists and can't afford to lose them, either. When ACS first took over it didn't seem possible to seek personal reimbursement for payments I had made. But now the issue is again critical for my care. If I pay a practitioner up front I wonder if I can submit a HCFA 1500 and receive payment to myself. Has anyone had experience in the past year with ACS for obtaining retroactive reimbursement to themselves (assuming I get preapproval and prior authorization and all of that) and if so, how to do so and what forms are needed?

      Thanks for your help.

      Best,
      Nancy T.
      NYC
    • lajarvis78
      This has been my problem over the past year. I was told when I was medically separated in January, to just pay for doctor bills out of my pocket and I would
      Message 2 of 13 , Sep 14 9:40 AM
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        This has been my problem over the past year. I was told when I was
        medically separated in January, to just pay for doctor bills out of
        my pocket and I would be reimbursed by FECA or Corps Care depending
        on whether my case was accepted. It was and now I have been
        fighting to get my money back. Luckily have gotten most of it back,
        but they still owe me almost $700!

        Here is the thing that you have to know...they have a pay fee
        schedule, but won't tell you what it is. As far as I can tell the
        fee schedule is a percentage of anything you pay. For example...I
        was put on a very powerful antibiotic that cost about $125 for 10
        day of the med at CVS. For this they reimbursed me about $113. I
        needed the antibiotics again, this time I went to Target and only
        paid around $85. You would think according to the fee schedule the
        entire second since it paid $113 the first time, but no, they still
        docked the reimbursement and only paid around $83.

        I also saw this one doctor 4 times for $100 each time. Two of those
        they paid the full $100, the other 2 they used their "fee schedule"
        excuse and wouldn't pay the full amount.

        Here is my advice, though it is not all that legal. Hopefully if
        you explain this to your doctor s/he will understand. See if you
        can pay one amount and then get a bill for a higher amount...then
        hopefully you will actually get the amount that you paid reimbursed.

        Reimbursements take about a month to 2 in order for you to get the
        check. That is, if you fill out the paperwork "properly." The main
        form that you need is an OWCP-915. It is a really easy form to fill
        out and then you attach your bills to that. These bills need to be
        impeccable! What I mean by that is that they need to say paid by
        patient or something to that effect and have the exact codes for the
        procedure the doctor did, even a check up has a certain code. They
        like to tell you that the codes are "wrong." Can't tell you how
        many times they have told me that. Once they even made me "prove"
        to them that I paid the bill and someone else didn't pay it for me.

        Advice #2...be patient and don't give into to their games and crap!
        I have had many tears over the crap they have put me through. I
        actually just sent more paperwork to them yesterday to still try and
        get my money back. As long as you have more patients than them, you
        will see your money again, probably not all of it, but most.

        Best of luck!
        --Lauralee


        --- In owcp@yahoogroups.com, FourDirect@a... wrote:
        > Deal all,
        >
        > I have a reimbursement question for any of you out there. As many
        of you
        > know, I've had a Peace Corps illness for about 21 years. In years
        back I used to
        > have to pay my bills up front and then attempt to get reimbursed,
        which was
        > sometimes successful and many times not.
        >
        > During intervening years I've had direct payment to practitioners
        (when that
        > has worked). However, now with ACS and the need for practitioners
        to "enroll"
        > I am finding that most of my NY physicians will not cooperate with
        this system
        > and justifiably so, as their payment is erratic and slow.
        >
        > I cannot pay out of pocket for all my needs but I need very
        particular
        > specialists and can't afford to lose them, either. When ACS first
        took over it
        > didn't seem possible to seek personal reimbursement for payments I
        had made. But
        > now the issue is again critical for my care. If I pay a
        practitioner up front I
        > wonder if I can submit a HCFA 1500 and receive payment to myself.
        Has anyone
        > had experience in the past year with ACS for obtaining retroactive
        > reimbursement to themselves (assuming I get preapproval and prior
        authorization and all of
        > that) and if so, how to do so and what forms are needed?
        >
        > Thanks for your help.
        >
        > Best,
        > Nancy T.
        > NYC
      • FourDirect@aol.com
        In a message dated 9/14/2005 12:46:38 PM Eastern Standard Time, ... Lauralee, Thanks so much. I have the fee pay schedule and all that but where do I get the
        Message 3 of 13 , Sep 14 7:06 PM
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          In a message dated 9/14/2005 12:46:38 PM Eastern Standard Time, RPCVLAJarvis@... writes:


          Reimbursements take about a month to 2 in order for you to get the
          check.  That is, if you fill out the paperwork "properly."  The main
          form that you need is an OWCP-915


          Lauralee,

          Thanks so much. I have the fee pay schedule and all that but where do I get the OWCP 915 form from? And you actually have gotten money when you've paid out of pocket?

          You don't even want to know how many tens of thousands of dollars I and my family have paid to keep me alive in those early years with marginal reimbursement. I am just trying to move ahead now.

          Nancy
        • lajarvis78
          ... do I get ... you ve paid out ... The OWCP 915 form is on the department of labor website: http://www.dol.gov/libraryforms/ Yes, you can get reimbursed...it
          Message 4 of 13 , Sep 15 10:04 AM
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            > Thanks so much. I have the fee pay schedule and all that but where
            do I get
            > the OWCP 915 form from? And you actually have gotten money when
            you've paid out
            > of pocket?

            The OWCP 915 form is on the department of labor website:
            http://www.dol.gov/libraryforms/

            Yes, you can get reimbursed...it just takes tons of patients. I got
            about $3k from them in reimbursements. Be prepared for a fight and
            know that you deserve to get that money back. They will tell you
            that you are stupid for spending your own money...they will tell you
            that you filled out this form wrong...they will tell you that the
            doctor put the wrong code on invoice...just be prepared! Shed many
            tears and have spent hours equalling many days talking to people and
            filling out the paperwork, but it has paid off. Just don't give up
            and don't give in, that is what they are expecting, so then they
            don't have to pay you!

            As for a lawyer...I talked to many about my case. I wanted to do 2
            things 1) sue PC for talking over 5 months to diagnose and treat me
            and I am still not 100% over a year later (yes, I know a lot of you
            have been dealing with your issues for much longer and you have much
            worse medical problems...I am sorry for that, but I still have my
            frustrations over my issue and how it was handled by my PCMO). 2) I
            wanted to sue to get all my reimbursements back. 3) I wanted my
            PCMO fired. Sounds harsh, but she is not a nice woman and told me I
            deserved to be sick. She should not be treating Americans or anyone
            for that matter!

            I was told a lawyer who works in workman's comp claims is the best
            to contact. I contacted a few, but none would take my case. They
            felt going against the gov't was probably a loosing cause and I did
            not stand to make enough to make it worth their time (I still have
            not found a job and could not afford to pay a lawyer).

            However, I do have a friend and she found lawyers to take her case
            and have filed a large law suite against the PC. Sounds like some
            of you might have cases that a lawyer might take, I just couldn't
            find one for mine and contacted probably about 50. If any of you
            are in California (other states too, not sure how all that
            works)...maybe we could all ban together and make one huge law suit -
            I would help with that and be willing to share my story if it helps
            and gets word out there...just a thought...

            Best of luck everyone...
            --Lauralee
          • Felicia
            What I still don t understand is why my experience is so different from everyone else s. Sounds like lots of people were medically separated from the Peace
            Message 5 of 13 , Sep 15 12:45 PM
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              What I still don't understand is why my experience is so
              different from everyone else's. Sounds like lots of
              people were medically separated from the Peace Corps.
              When that happened to me, they filled out the initial
              worker's comp forms right there. Was this just because I
              was nuttier than a fruitcake and hysterical? Once my case
              got accepted, I was assigned a nurse who has dealt with
              everything for me. Am I the only one on the list
              suffering from Peace Corps related psychiatric problems?
              There has to be a pattern here, and I'd like to know what
              it is. -- Felicia

              >> Thanks so much. I have the fee pay schedule and all that
              >> but where
              > do I get
              >> the OWCP 915 form from? And you actually have gotten
              >> money when
              > you've paid out
              >> of pocket?
              >
              > The OWCP 915 form is on the department of labor website:
              > http://www.dol.gov/libraryforms/
              >
              > Yes, you can get reimbursed...it just takes tons of
              > patients. I got
              > about $3k from them in reimbursements. Be prepared for a
              > fight and
              > know that you deserve to get that money back. They will
              > tell you
              > that you are stupid for spending your own money...they
              > will tell you
              > that you filled out this form wrong...they will tell you
              > that the
              > doctor put the wrong code on invoice...just be prepared!
              > Shed many
              > tears and have spent hours equalling many days talking to
              > people and
              > filling out the paperwork, but it has paid off. Just
              > don't give up
              > and don't give in, that is what they are expecting, so
              > then they
              > don't have to pay you!
              >
              > As for a lawyer...I talked to many about my case. I
              > wanted to do 2
              > things 1) sue PC for talking over 5 months to diagnose and
              > treat me
              > and I am still not 100% over a year later (yes, I know a
              > lot of you
              > have been dealing with your issues for much longer and you
              > have much
              > worse medical problems...I am sorry for that, but I still
              > have my
              > frustrations over my issue and how it was handled by my
              > PCMO). 2) I
              > wanted to sue to get all my reimbursements back. 3) I
              > wanted my
              > PCMO fired. Sounds harsh, but she is not a nice woman and
              > told me I
              > deserved to be sick. She should not be treating Americans
              > or anyone
              > for that matter!
              >
              > I was told a lawyer who works in workman's comp claims is
              > the best
              > to contact. I contacted a few, but none would take my
              > case. They
              > felt going against the gov't was probably a loosing cause
              > and I did
              > not stand to make enough to make it worth their time (I
              > still have
              > not found a job and could not afford to pay a lawyer).
              >
              > However, I do have a friend and she found lawyers to take
              > her case
              > and have filed a large law suite against the PC. Sounds
              > like some
              > of you might have cases that a lawyer might take, I just
              > couldn't
              > find one for mine and contacted probably about 50. If any
              > of you
              > are in California (other states too, not sure how all that
              > works)...maybe we could all ban together and make one huge
              > law suit -
              > I would help with that and be willing to share my story
              > if it helps
              > and gets word out there...just a thought...
              >
              > Best of luck everyone...
              > --Lauralee
              >
              >
              >
              >
              > ------------------------ Yahoo! Groups Sponsor
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              >
              > Yahoo! Groups Links
              >
              >
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              >
              >
              >
              >
            • Heidi Fassnacht
              Nancy, I do have experience with retroactive authorization. I started the process in 2003, and finally got paid (not everything, of course, but enough that the
              Message 6 of 13 , Sep 15 3:00 PM
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                Nancy,

                I do have experience with retroactive authorization.
                I started the process in 2003, and finally got paid
                (not everything, of course, but enough that the rest
                isn't worth the hassle to get) in 2005.

                My application was the same as would be one for
                regular authorization, but for services that happened
                in the past and I titled my application as "request
                for retroactive authorization.' I have a list at home
                of what they told me I needed on the authorization
                request, if you are interested but it is from 2003 so
                who knows if it is still valid.

                After faxing in 20 pages of request plus supporting
                documentation twice (they wouldn't accept anything but
                fax, which costs a fortune) they finally received my
                request. Months later and after many many calls, they
                said they had approved authorization first for part of
                the time, then the rest. One provider then submitted
                paperwork, and got paid fairly quickly (and paid me
                back since I'd already paid out of pocket). The other
                provider took a lot longer to have success. I made
                the mistake of putting all my providers on one
                authorization request. I guess even though everyone
                was listed under the provider section of the request,
                ACS just considered the first office to submit a
                payment request to be the one the authorization
                covered. ACS didn't tell me this was the problem for
                over a year (they had a whole list of other reasons
                for why our claims were being denied). Finally, ACS
                told me I needed to write a letter asking for the
                provider covered by the authorization to be switched,
                which I did.

                Of course I never got a letter saying anything had
                happened, so I called to check in with ACS, and they
                said they had indeed switched providers. So we
                submitted again; this time ACS denied they claim on
                grounds of untimely filing! Can you believe it?! I've
                found in a couple circumstances that denial of a claim
                for untimely filing to be ACS's last attempt when
                they've run out of other possible reasons. I called
                ACS and explained the situation, and shortly after my
                provider got paid. As with the first, since I'd
                already paid the provider out of pocket, the provider
                sent me a reimbursement check. I have not tried to be
                paid back directly.

                A side note - When I finally got someone to tell me
                that I should have had different authorization for my
                different providers the ACS person told me this
                misunderstanding on my part shows why the providers
                should really be submitting all this paperwork since
                they understand how it all should be done. Such a
                joke! The providers with whom I have been working
                have been extremely patient with this process and in
                working with me, but have no more clue than we do
                about how this process works. I was even told by one
                provider (from a different reimbursement saga) that I
                should come in and talk to their staff about how the
                system works since I knew so much more about it than
                they did. This is why I thought setting up a listserv
                would be so helpful. We seem to be our own best
                resource.

                Hope that helps some.

                Heidi


                "In the end, our society will be defined not only by what we create, but also by what we refuse to destroy." John Sawhill



                __________________________________
                Yahoo! Mail - PC Magazine Editors' Choice 2005
                http://mail.yahoo.com
              • FourDirect@aol.com
                Heidi, Thanks so much for sharing your saga. My deal is that my providers won t take reimbursement even if it is sent to them. I have some that I have
                Message 7 of 13 , Sep 15 9:12 PM
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                  Heidi,

                  Thanks so much for sharing your saga. My deal is that my providers won't take reimbursement even if it is sent to them. I have some that I have authorization for. My key question is if I still need a HCFA 1500 form and do I submit that bill completely filled out with proof of my own payment?

                  Nancy
                  PS How are you?
                • FourDirect@aol.com
                  Felicia, I m so pleased that you had a good experience. I think you are a rare and fortunate person. I was NOT medically separated and that was part of the
                  Message 8 of 13 , Sep 15 9:16 PM
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                    Felicia,

                    I'm so pleased that you had a good experience. I think you are a rare and fortunate person. I was NOT medically separated and that was part of the problem in that my illness manifested itself after I returned home - bovine tuberculosis in the lymph nodes that then spread and wasn't diagnosed for a couple of years, along with a very rare form of meningitis and encehaplitis. So, proving the correlation was a challenge. But thereafter I've had to fight for every authorization, every bill and everything else.

                    Nancy
                  • FourDirect@aol.com
                    Lauralee, Okay. I know the scenario very well. It is like a Who s on First routine only it isn t funny after all these years but that is exactly the way the
                    Message 9 of 13 , Sep 15 9:18 PM
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                      Lauralee,

                      Okay. I know the scenario very well. It is like a "Who's on First" routine only it isn't funny after all these years but that is exactly the way the conversations with all of those people go.

                      So, I will download the form and hope for the best.

                      I had the same experience with workers' comp lawyers way back when. No one wanted to touch the feds with a 10 foot pole. And we honestly do know more than anyone else can. It's just power we need.

                      Best,
                      Nancy
                    • FourDirect@aol.com
                      In a message dated 9/15/2005 1:06:05 PM Eastern Standard Time, ... Lauralee, I m in NY but I d join any lawsuit group in a New York minute! Nancy
                      Message 10 of 13 , Sep 15 9:19 PM
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                        In a message dated 9/15/2005 1:06:05 PM Eastern Standard Time, RPCVLAJarvis@... writes:


                        If any of you
                        are in California (other states too, not sure how all that
                        works)...maybe we could all ban together and make one huge law suit -
                        I would help with that and be willing to share my story if it helps
                        and gets word out there...just a thought...

                        Best of luck everyone...
                        --Lauralee


                        Lauralee,

                        I'm in NY but I'd join any lawsuit group in a New York minute!
                        Nancy
                      • Felicia
                        Oh, yes, I m very aware how lucky I have been. I almost wonder if it is because people who have had problems with Lariam occasionally kill themselves and if I
                        Message 11 of 13 , Sep 16 10:36 AM
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                          Oh, yes, I'm very aware how lucky I have been. I almost
                          wonder if it is because people who have had problems with
                          Lariam occasionally kill themselves and if I was sent home
                          from the Peace Corps with mental problems and then
                          promptly killed myself there would probably have been an
                          uproar. Don't know if that had anything to do with it or
                          not.

                          Anyway, sounds like you have had a much harder time than I
                          have. So sorry. -- Felicia

                          > I'm so pleased that you had a good experience. I think you
                          > are a rare and
                          > fortunate person. I was NOT medically separated and that
                          > was part of the problem
                          > in that my illness manifested itself after I returned home
                          > - bovine
                          > tuberculosis in the lymph nodes that then spread and
                          > wasn't diagnosed for a couple of
                          > years, along with a very rare form of meningitis and
                          > encehaplitis. So, proving
                          > the correlation was a challenge. But thereafter I've had
                          > to fight for every
                          > authorization, every bill and everything else.
                          >
                          > Nancy
                          >
                        • Kaericsson@cs.com
                          16 September 2005 Hi All: Finally I, too am writing. It has been interesting following all of your correspondense. I was also separated from the Peace Corps in
                          Message 12 of 13 , Sep 16 7:03 PM
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                            16 September 2005

                            Hi All:

                            Finally I, too am writing. It has been interesting following all of your
                            correspondense.

                            I was also separated from the Peace Corps in 1988 due to psychiatric
                            problems. Actually this did not develop from culture shock or job related difficulties
                            while on site, but due to boyfriend problems. Coulda happened anywhere -- it
                            happened while I was in training in South America. I developed a sleeping
                            disorder. Of course, day to day stresses probably did aggravate the situation.
                            Peace Corps took responsibility for all aspects of your life -- kind of them! I
                            asked for counselling through Peace Corps right away, but the infrastructure
                            was not there. They provided it for me a year and a half later, but by then it
                            was too late. I was losing so much sleep I was hallucinating. I was sent home
                            after a year and nine months of service.

                            I felt the Peace Corps did their job once I was back stateside, and my
                            expenses for psychiatric care are still handled by US Dept. of Labor OWCP. However,
                            even then OWCP was a dinosaur. I had to handle all the paper work for
                            reimbursement for medications. Finally OWCP got my pharmacy in the system, and I don't
                            have to pay much attention to that any more. However, like with the rest of
                            you, it is getting more difficult in other ways.

                            In December 2004 the psychiatrist handling my medications retired. His
                            replacement was not considered a provider under OWCP. They would not pay him for my
                            office visits. Now, I have had dozens of doctors treating my disorder since
                            1988, because I have moved a lot, and so have my doctors. This was the first
                            time OWCP had not accepted one as a provider, as far as I know. Finally he has
                            been paid for my three office visits, 10 months after I first saw him. He has
                            drummed it in to me that fewer doctors are taking OWCP patients for this very
                            reason -- it appears to be the most cumbersome health insurance agency in the US.

                            Getting reimbursement for lab work has also become screwy this past year.
                            OWCP would not accept the diagnosis codes submitted by my current doctor for my
                            lab work -- they would not accept the specific code for my disorder, only a
                            "nonspecific diagnosis" code originally submitted when I originally returned from
                            the Peace Corps, before my diagnosis was solidified. With the help of Rep.
                            James Oberstar those bills have now been paid, but I think still using that
                            "nonspecific" code. I know OWCP has codes available for my disorder -- and my
                            psychiatrist thinks it would be better to use them. Some of my doctors used them
                            successfully with OWCP earlier. (Go figure.)

                            Tomorrow Oberstar will be in my town at a fundraiser dinner and I believe
                            will be taking a moment to speak with me in person. I dropped off copies of some
                            of your letters at his area office yesterday so he'll have a chance to look
                            them over. We need to develop a unified approach to encourage US Dept. of Labor
                            OWCP to deal with its current and former employees in an equitable manner. I
                            know that their personnel are overstretched and subject to rapid burnout -- but
                            whose problem is that?!

                            This group serve is a good start. What's the next step?
                            I am open to suggestions.

                            Sincerely,

                            Kriste Ericsson
                            Paraguay 87-88
                            Minnesota
                          • FourDirect@aol.com
                            I ve heard of so many people having a terrible time with Larium. I am glad that you are still with all of us! Nancy
                            Message 13 of 13 , Sep 16 9:09 PM
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                              I've heard of so many people having a terrible time with Larium. I am glad that you are still with all of us!

                              Nancy
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