Hi Amy and everyone else,
I hope I'm posting this properly. My mom's oral surgeon offered to send a claim to Medicare. Because the biopsy came back positive for SCC, the excision was deemed medically necessary. However, unknown to my mom, the oral surgeon is not a Medicare participating provider. Therefore, Medicare doesn't want to pay the claim. I intend to appeal the claim because there's no argument of necessity, the problem is bureauacracy. Do you have any thoughts on how to structure this claim? Do I complain to the oral surgeon? Any thoughts would be appreciated.
Thanks.
D
Mom's caregvr. DDS failed to dx 01/03. Dx Stg IV SCC 05/03. Induct. chemo, IMRT, 5FU, H, Iressa, Neck disect, radiation. Dad's caregvr. Dx 01/04 Ext. Stg SCLC. Mets to liver/bone 08/04. Died 11/12/04. Mom tongue CA dx 06/13, hemiglossectomy (80% removed) 08/13. Clean margins and nodes, but PNI. 6/15/15: Tongue CA at base of remnant tongue. Declined further tx; hospice.
Died 10/13/15. What a long and difficult journey.
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