Re: hospitals treating off-label and waivers

[Guest guest]

, I can second what you are saying with regard to HBO being the

treatment of last resort. We have a chamber in our local hospital

that is, by no means, full to capacity, yet my invesitagation

indicates that it is only used as a treatment of last resort, even

for approved situations such as wound care. How frustrating it is to

have such a valuable resource here in our community and to know that

not only will it not be used to treat my son's brain injury, but it

will likely not be considered a first treatment option even for

conventional indications. Sad...

Lynn

> Dr. ston,

>

> If a patent came to your clinic with a serious fracture of the

wrist and

> elbow, so fractured that titanium bars would be needed to bring the

bones

> together, would you be able to treat that patient under present

guidelines.

>

> My daughter recently had a serious accident with such fractures as

described

> and the Hyperbaric Director at Washington Hospital

Washington D. C.

> whose name is Hymie told me he could not treat such a patient.

Only if the bones

> were diseased would he consider HBO. He told me under normal

circumstances

> the broken bones should heal and only if they don't would he

consider HBO. Dr.

> Neubauer told me Thai fractured bones would heal much faster with

HBOT and it

> seemed like a prudent therapy to prevent any onset of disease. I

was not

> requesting insurance reimbursement, only the therapy as an adjunct

to surgery. Do

> you think serious fractures should be allowed And is this something

the CMS

> should evaluate now that they have their books open for TBI

reevaluation.

> Manson

>

>

>

[Guest guest]

>Dr. Stoller: What you say is correct with not only Medicare, but

>Medicaid also. When our local hospital (St. Hospital in

>Appleton, WI) refused to treat my infant son's brain injury, the

>reason it cited was that to do so would jeopradize its status as a

>Medicaid provider. Further investigation on my part clarified the

>situation a bit. If the local hospital (a Medicaid provider) were to

>treat my son (a Medicaid recipient), it would be required to submit

>the claim to Medicaid first. Medicaid, of course, would deny

>coverage, leaning heavily on the UHMS list of approved and non-

>approved conditions as support for their denial. At that point, by

>first submitting a reimbursement request to Medicaid, the hospital

>has fulfilled its contractual obligation to Medicaid and could still

>choose to treat my son and bill me directly. The Medicaid people I

>spoke with explained to me that while Medicaid sets its policy with

>regard to what it will and will not reimburse, it has absolutely no

>authority to set hospital policy with regard to what the hospital can

>and cannot treat. The only caveat is that if a hospital chooses to

>treat a Medicaid patient for a non-Medicaid-approved condition and

>the patient agrees to pay out-of-pocket, the hospital must bill the

>patient at the same rate as it does Medicaid. If they were to bill

>the patient less than the Medicaid rate, it would constitute Medicaid

>fraud and that fraud, in and of itself, would jeopradize their status

>as a Medicare/Medicaid provider. I explained this to the hospital

>several times but they continued to claim that they were unable to

>treat my son because Medicaid forbid it. In the end, after many

>discussions, I decided that it was simply a convenient excuse on the

>part of my hospital to say it was legally *unable* to treat my son

>rather than to have to say that it is *choosing* not to treat my son.

>

>Lynn

Lynn,

Can you get this in writing?

[Guest guest]

: Which part? The fact that the hospital denied treatment

because it (falsely) claimed that it would impact its status as a

Medicaid provider or the fact that Medicaid told me that they have no

authority to dictate hospital policy with regard to what the hospital

can or cannot treat?

Lynn

> >Dr. Stoller: What you say is correct with not only Medicare, but

> >Medicaid also. When our local hospital (St. Hospital in

> >Appleton, WI) refused to treat my infant son's brain injury, the

> >reason it cited was that to do so would jeopradize its status as a

> >Medicaid provider. Further investigation on my part clarified the

> >situation a bit. If the local hospital (a Medicaid provider) were

to

> >treat my son (a Medicaid recipient), it would be required to submit

> >the claim to Medicaid first. Medicaid, of course, would deny

> >coverage, leaning heavily on the UHMS list of approved and non-

> >approved conditions as support for their denial. At that point, by

> >first submitting a reimbursement request to Medicaid, the hospital

> >has fulfilled its contractual obligation to Medicaid and could

still

> >choose to treat my son and bill me directly. The Medicaid people I

> >spoke with explained to me that while Medicaid sets its policy with

> >regard to what it will and will not reimburse, it has absolutely no

> >authority to set hospital policy with regard to what the hospital

can

> >and cannot treat. The only caveat is that if a hospital chooses to

> >treat a Medicaid patient for a non-Medicaid-approved condition and

> >the patient agrees to pay out-of-pocket, the hospital must bill the

> >patient at the same rate as it does Medicaid. If they were to bill

> >the patient less than the Medicaid rate, it would constitute

Medicaid

> >fraud and that fraud, in and of itself, would jeopradize their

status

> >as a Medicare/Medicaid provider. I explained this to the hospital

> >several times but they continued to claim that they were unable to

> >treat my son because Medicaid forbid it. In the end, after many

> >discussions, I decided that it was simply a convenient excuse on

the

> >part of my hospital to say it was legally *unable* to treat my son

> >rather than to have to say that it is *choosing* not to treat my

son.

> >

> >Lynn

>

> Lynn,

>

> Can you get this in writing?

[Guest guest]

Both. The House Government Reform Committee wants this in the record

for follow-up actions and also any follow-up hearings. You can fax to

me at 770-234-5757.

>: Which part? The fact that the hospital denied treatment

>because it (falsely) claimed that it would impact its status as a

>Medicaid provider or the fact that Medicaid told me that they have no

>authority to dictate hospital policy with regard to what the hospital

>can or cannot treat?

>

>Lynn

>

>

>> >Dr. Stoller: What you say is correct with not only Medicare, but

>> >Medicaid also. When our local hospital (St. Hospital in

>> >Appleton, WI) refused to treat my infant son's brain injury, the

>> >reason it cited was that to do so would jeopradize its status as a

>> >Medicaid provider. Further investigation on my part clarified the

>> >situation a bit. If the local hospital (a Medicaid provider) were

>to

>> >treat my son (a Medicaid recipient), it would be required to submit

>> >the claim to Medicaid first. Medicaid, of course, would deny

>> >coverage, leaning heavily on the UHMS list of approved and non-

>> >approved conditions as support for their denial. At that point, by

>> >first submitting a reimbursement request to Medicaid, the hospital

>> >has fulfilled its contractual obligation to Medicaid and could

>still

>> >choose to treat my son and bill me directly. The Medicaid people I

>> >spoke with explained to me that while Medicaid sets its policy with

>> >regard to what it will and will not reimburse, it has absolutely no

>> >authority to set hospital policy with regard to what the hospital

>can

>> >and cannot treat. The only caveat is that if a hospital chooses to

>> >treat a Medicaid patient for a non-Medicaid-approved condition and

>> >the patient agrees to pay out-of-pocket, the hospital must bill the

>> >patient at the same rate as it does Medicaid. If they were to bill

>> >the patient less than the Medicaid rate, it would constitute

>Medicaid

>> >fraud and that fraud, in and of itself, would jeopradize their

>status

>> >as a Medicare/Medicaid provider. I explained this to the hospital

>> >several times but they continued to claim that they were unable to

>> >treat my son because Medicaid forbid it. In the end, after many

>> >discussions, I decided that it was simply a convenient excuse on

>the

>> >part of my hospital to say it was legally *unable* to treat my son

>> >rather than to have to say that it is *choosing* not to treat my

>son.

>> >

>> >Lynn

>>

>> Lynn,

>>

>> Can you get this in writing?

>

>

>

>

>_._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

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