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Re: [owcp] group question

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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 1 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



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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 2 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 3 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 4 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 5 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 6 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 7 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 8 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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