Author Topic: new sockets allready  (Read 5229 times)

Offline herb

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Re: new sockets allready
« Reply #15 on: March 22, 2010, 08:51:46 AM »


Happy Spring everyone. Great weather to go outside and be active.
Here a few links to some Bach music

http://www.youtube.com/watch?v=pVadl4ocX0M
http://www.youtube.com/watch?v=ipzR9bhei_o

Offline chrysochloridae

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Re: new sockets allready
« Reply #16 on: March 22, 2010, 05:11:09 PM »
it does seem to be the time of year for re-socketing!


I've noticed an increase in demand for appointments at our centre - must be everyone getting their prostheses sorted before the summer hits!

Offline pegleg jack

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Re: new sockets allready
« Reply #17 on: April 01, 2010, 06:33:41 PM »
just got back from my first static fitting on my new sockets, and quess what they fit like a sock going on, but the bad new is that MEDICARE AND MY SENIOR ADVANTAGE coverage, they are saying that they are not going to cover all of it for me like my last pair, and have stated that due to the cuts by the goverment, i could easily wind up paying for the whole shooting match, that is pay for both legs total this time around, for my test legs i am having to go back to and old pair of feet from two sets ago and use them, THANK GOD that i have kept my old legs and not given them away like i was going to do. All of this i got from my prosthetist today, he is going to see if he can get around it, but told me not to get my hopes up to high. He also stated that he is running into this with his other patients also, and especially the new amputees, not being able to get what they need in the line of equipment.

So to all of you here in the STATES, all i can say is look out cause it is coming down the pike, and we are going to have one heck of time getting anything done, thanks to the 135 billion cut from SENIOR ADVANTAGE and the 400 billion getting cut from MEDICARE.
you-all have a great day.

Offline herb

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Re: new sockets allready
« Reply #18 on: April 01, 2010, 08:08:55 PM »
Hello Jack - My prosthetist always gets pre-approval on all my charges and I know to the penny what my copayments will be before they start fabrication of my prosthetics.  Did you have a prescription for the new sockets? Your advantage program is sold by a private insurance company. Those policies are subsidized by the government exactly the same this year but the subsidy will be smaller next year. Your insurance company can not change  your current policy coverage in the middle of the year. It may be different when you renew it for next year. Herb

Offline pegleg jack

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Re: new sockets allready
« Reply #19 on: April 01, 2010, 08:32:45 PM »
It was thier insurance dept that gave us the word on it and yes we had a prescription for my new legs and they were attempting to get approval for everything and that was the answer they got from the insurance company that handles my SENIOR ADVANTAGE and from the MEDICARE representive.
you-all have a great day.

Offline Dick Stevens

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Re: new sockets allready
« Reply #20 on: April 02, 2010, 01:11:16 AM »
Jack:

That sure is not good news.  According to my Medicare Advantage policy, my pros and other DME products are covered 80%, leaving me 20% to co-pay.  This is good for 2010.  Who knows what future years might bring.
Dick Stevens, DBKA in PA

Offline pegleg jack

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Re: new sockets allready
« Reply #21 on: April 02, 2010, 10:08:42 AM »
Dick, the last i saw and read was that the cuts to SENIOR ADVANTAGE, became effective the day the bill was signed, now i havent seen anything saying it is beiing delayed. And what i posted came from the company that i am having the work done and thier dept that handles all of thier insurance claims.
you-all have a great day.

Offline herb

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Re: new sockets allready
« Reply #22 on: April 02, 2010, 10:48:07 AM »
Hello Jack - many of the insurance companies routinely deny claims hoping you will not appeal. Demand that they cover it. You paid your premium and they can not change the rules in the middle of your contract. good luck herb

Offline Mitchee

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Re: new sockets allready
« Reply #23 on: April 02, 2010, 04:31:25 PM »
I'm pretty sure that Medicare has specific guidelines for getting a new socket.  I thought it was every few years or if you had a certain amount of change in volume then you could get a new socket.  Your prosthetist should know the Medicare guidelines regarding how much volume loss is required for a new socket and he/she should be able to get it pre-approved.  Otherwise, I would suggest calling Medicare and ask to speak to someone who knows what they are talking about and can answer your specific questions.  It's worth a shot to see if you can at least get Medicare to pay for your new sockets. 

I can't offer much advice in regards to your supplemental policy.  Your supplemental policy may have a yearly cap or a lifetime cap.  As stated by Herb, file an appeal.  Make them review your case and thoroughly explain why they are denying it. 

Whenever you call Medicare or your insurance company, always document who you talk to, and the date and the time of the call.  Be persistant and thorough.  It's the best way to get an insurance company's attention.

Good luck.
Initial injury:  July 1985
Amputation:  December 2006 - Ertl LBKA

"The journey of a thousand miles must begin with a single step."
 -Lao Tzu

Offline Dick Stevens

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Re: new sockets allready
« Reply #24 on: April 03, 2010, 03:18:59 AM »
Jack:

Before you assume that all these drastic cuts are for real, double-check the source of the info.  There's alot of vocal opponents of the Healthcare Bill throwing out a ton of misinformation, hoping to pit more and more people against it.

But, remember that they have a  VESTED INTEREST in opposing it -- namely to protect their very fat profits under the existing system.

There's a boatload of lobbyists spending many millions of $$ fighting Healthcare Reform.  They are NOT spending all that money for your benefit or mine.  They're spending to protect their OWN Bottom Line.

Simply put, it's an INVESTMENT made in hopes of reaping very handsome PROFITS, that is Return-on-Investment.

The Bottom-Line is not Healthcare, it's Money.

So, please, please check the sources of your info.
Dick Stevens, DBKA in PA

Offline pegleg jack

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Re: new sockets allready
« Reply #25 on: April 03, 2010, 09:46:05 AM »
Dick, this infromation came right from the companies dept that handles the insurance claim, and that is what they got from my SENIOR ADVANTAGE CO. and MEDICARE. THEY called both of them and that is what they were told. Dont know how much clearer i can be  with out getting it in writting  and noterized for you. And also the last i heard and read that when OBAMA signed the bill the cut became effective then not next year or year 2014.
you-all have a great day.

Offline Dick Stevens

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Re: new sockets allready
« Reply #26 on: April 03, 2010, 04:13:22 PM »
Jack:

Of course, each insurance plan has its own quirks.  So far, mine has not announced any changes since the Health Bill was signed.  The services I have been using haven't changed - - yet.
Dick Stevens, DBKA in PA

Offline snowbear

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Re: new sockets allready
« Reply #27 on: April 08, 2010, 11:31:45 AM »
Jack:

Of course, each insurance plan has its own quirks.  So far, mine has not announced any changes since the Health Bill was signed.  The services I have been using haven't changed - - yet.


Offline snowbear

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Re: new sockets allready
« Reply #28 on: April 08, 2010, 11:34:44 AM »
Dick, this infromation came right from the companies dept that handles the insurance claim, and that is what they got from my SENIOR ADVANTAGE CO. and MEDICARE. THEY called both of them and that is what they were told. Dont know how much clearer i can be  with out getting it in writting  and noterized for you. And also the last i heard and read that when OBAMA signed the bill the cut became effective then not next year or year 2014.

By that time OB wil not be president...Thank God..Absoultely the worse president in US history. People ge what they voted for..A idiot.

Offline Dick Stevens

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Re: new sockets allready
« Reply #29 on: April 08, 2010, 11:52:40 AM »
No, Snowbear:

The WORST one just left office last year!

With a little luck, Obama (or at least his party) will still be in office in 2014.  Better to spend billions for healthcare  :) than trillions for killing and maiming  :(.  (Altho some say that, in the long run, healthcare reform may actually SAVE money.)  (Wars NEVER save money.)
Dick Stevens, DBKA in PA