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Re: group question

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  • 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 1 of 13 , Sep 14, 2005
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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 2 of 13 , Sep 14, 2005
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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 3 of 13 , Sep 15, 2005
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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 4 of 13 , Sep 15, 2005
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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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          • 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 5 of 13 , Sep 15, 2005
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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
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            • 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 6 of 13 , Sep 15, 2005
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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 7 of 13 , Sep 15, 2005
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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 8 of 13 , Sep 15, 2005
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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 9 of 13 , Sep 15, 2005
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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 10 of 13 , Sep 16, 2005
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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 11 of 13 , Sep 16, 2005
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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 12 of 13 , Sep 16, 2005
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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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