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Back from SCS trial



  • Dave, I agree that Medicare pays less than the going rate. Not just for SCS implant, but for everything. It is embarrassing.

    I do not have a problem with finding a local pain doctor or a local hospital that will perform the SCS implant for Medicare patients, but I don't trust the local doctors and hospitals to do it right. So while this (Julie's) thread was unfolding, I was traveling 150 miles by train (since pain prevents me from driving) to one of the best hospitals in the region to arrange for my SCS trial.

    After my first visit to my Pain Center earlier this year, the hospital billed my insurance company $878. Medicare allowed $77. Neither the hospital nor anyone at the Pain Center said anything about the bill. However, I was so embarrassed that I called Medicare to complain. I told the Medicare agent that two doctors at the Pain Center had spent more than an hour with me on an initial visit. How could Medicare allow only $77? The agent sounded somewhat sympathetic, but she said the only thing I could do would be to file an appeal with Medicare. I have gotten into so many hassles with Medicare before. They over billed me for my premiums and then took many months to review their calculations at three different sites in three different states and finally gave me $65 refund. I don't want to go through the hassle of another appeal.

    Julie, I know this thread is about your trial experience, but since you have revealed that you work for Medicare, perhaps you could advise me how to deal with the Medicare bureaucracy.

    According to the web site of one of the manufacturers (I suppose I may not give the URL here), Medicare 2009 allowed charges are:

    $8412 for implantation of two percutaneous leads;
    $15567 for implantation of spinal neurostimulator;
    $109 for electronic analysis of spinal neurostimulator (first hour)

    Hardware charges are higher, but the Medicare allowed charges were not given. I suppose they are higher for Boston Scientific than for St. Jude.

    Does anyone know whether these are the actual Medicare allowed doctor charges?

    If they are correct, then maybe the low initial allowed charges may be offset by the implantation allowed charges.

  • I actually solely work on Medicare Part D and Medicare Advantage (Part C) so I really don't know much about Medicare Part A and B rates. I can try to do a little research this weekend on it. But, the biggest thing I would say to do is if you are not happy with your Medicare rates you should write your Congressmen. The biggest problem is that Medicare and Medicaid have become such a huge (and growing) portion of our Federal budget that there have to be some measures to control expenditures. This is one of the reasons that health reform is needed. (But please, I don't want to go there. With trying to keep up with work and my back pain I haven't paid attention to the health reform debate.)

    I do know that if you are in a Medicare Advantage plan (Part C) and if a plan can't provide a service within a reasonable distance in network a beneficiary can request an exception to go to an out of network provider for coverage of the service.
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