JLTraveling
DIS Veteran
- Joined
- Apr 3, 2005
- Messages
- 2,693
If you're on Medicare, just a PSA to find out if anything in your standard care plan is being affected by the new guidelines that went into effect on July 1.
My dad has severe arthritis in his spine, and for years the gold standard of treatment has been radiofrequency ablations (basically burning off the affected nerves). He gets them every 2-3 years, depending on how long it takes the nerve to regrow.
So on June 30, he had ablations in his lower lumbar spine for the first time in 3 years. No problems, no Medicare issues, worked like a charm. But they also went ahead and scheduled him for ablations in the next higher spinal level for tomorrow (left side) and 2 weeks from now (right side).
He just got a call from the Medicare coordinator at the hospital. Medicare denied, because under their new guidelines, if it's more than a year between procedures, you have to start the whole process over. New MRI, followed by new diagnostic nerve blocks, and only then can you get the ablations. She recommends from here on out, getting all the ablations every year even if the pain hasn't significantly returned yet.
So now, instead of paying for left side and right side ablations and nothing else for 2-3 years, Medicare's paying for:
1. Steroid injections to get Dad through our upcoming month of travel.
2. Steroid injections again when those wear off.
3. New MRI
4. Nerve blocks at every level of his spine
5. Annual ablations at every level of his spine
Talk about wasteful government spending! But for anyone who relies on Medicare to pay for your standard disability management plan, double check if you've been affected by the new guidelines. They're kind of awful right now.
My dad has severe arthritis in his spine, and for years the gold standard of treatment has been radiofrequency ablations (basically burning off the affected nerves). He gets them every 2-3 years, depending on how long it takes the nerve to regrow.
So on June 30, he had ablations in his lower lumbar spine for the first time in 3 years. No problems, no Medicare issues, worked like a charm. But they also went ahead and scheduled him for ablations in the next higher spinal level for tomorrow (left side) and 2 weeks from now (right side).
He just got a call from the Medicare coordinator at the hospital. Medicare denied, because under their new guidelines, if it's more than a year between procedures, you have to start the whole process over. New MRI, followed by new diagnostic nerve blocks, and only then can you get the ablations. She recommends from here on out, getting all the ablations every year even if the pain hasn't significantly returned yet.
So now, instead of paying for left side and right side ablations and nothing else for 2-3 years, Medicare's paying for:
1. Steroid injections to get Dad through our upcoming month of travel.
2. Steroid injections again when those wear off.
3. New MRI
4. Nerve blocks at every level of his spine
5. Annual ablations at every level of his spine
Talk about wasteful government spending! But for anyone who relies on Medicare to pay for your standard disability management plan, double check if you've been affected by the new guidelines. They're kind of awful right now.
