Question
QUESTION: I am 78 years (diabetic) old and I am having cataracts removed. The surgeon recommended that I have a Crystalens put in. It did not work. I now find out from others that I am a poor candidate for a multifunctional lens. I was charged $1,950 for the lens which will be removed in 2 more days. In addition, the Dr. has had me in 9 times(before and after surgery) to take measurements ($30 co pay each visit). Should I have to pay these co pays EVERYTIME and should I be able to get the $1,950 reimbursed? I have Medicare (Secure Horizons). Thank you!!
ANSWER: Hi Jim
Those Advantage plans look good and cheaper than original Medicare. They are if you are in good health and like them. But. if you have a lot of office visits, the co-pays are expensive. You are stuck with them.
Do not understand the $1,950. Did you pay that? If so, what reason was given to deny payment by the advantage plan???
John
---------- FOLLOW-UP ----------
QUESTION: Hi John,
Thanks for the response. I was told (by the Drs. office) that my insurance does not cover the multifunctional (Chrystalens) implants and that I must pay the additional $1950. They said only the "standard" lens is covered. I go back in tomorrow to have the Crystalens removed and the "standard" lens put in. Something just doesn't seem right here. So far it looks like I will be paying $1950 for something that didn't work and will be removed.
Jim
Answer
Hi again
The question is when you were told they were not covered.
With Medicare the doctor is required to know what is covered and what is not and to apply the correct code when billing. If something is not covered, they are required to advise you of this and are supposed to have you sign an ADVANCE BENEFICIARY NOTICE(ABN), where you agree to pay if it is not covered.
Look through your Medicare Summery Notices and find the one pertaining to those implants. The one that denied payments. On the back, it will tell you how to make and appeal. Do so and include the following statements on your written appeal.
I did not know they were not covered.
I was not told they were not covered until after the procedures was done.
I was never given an ABN and never signed one.
Hope this helps.
John
