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Old 01-18-2008, 11:26 AM
lisa_tos lisa_tos is offline
Junior Member
 
Join Date: Jun 2007
Posts: 91
15 yr Member
lisa_tos lisa_tos is offline
Junior Member
 
Join Date: Jun 2007
Posts: 91
15 yr Member
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A few further comments on how to check an MSA estimate. I agree with Tshadow that it's really best if you have an attorney who is working with you to make sure it's correct. I'm sure I don't know enough to tell if one is done correctly so my comments above what Medicare will cover do need to be evaluated in light of your specific situation with an attorney and an experienced reputable firm that does MSA estimates.

However here are some red flags that the estimate is not correct. you would probably need someone with out TOS to help you do this because it's too much paperwork.

1) you can find out from Medicare what diagnosis codes your injury is reported to be. You can find out from your treating physician what diagnosis codes he or she thinks you injury corresponds to. You can look at the MSA estimate to see what diagnosis codes for your injury are included. Everything according to Medicare is keyed off of what they think the diagnosis codes for your injury is, so if there are discrepancies you might want to ask about. It takes a professional to figure out how best to summarize your injury in terms of diagnosis codes to report to Medicare so there may be reasons for the discrepancies you find, but the professionals should be able to explain it to you.

2) if you know somebody who is getting similar treatment under Medicare, you can see what procedure codes are typically used for the services your doctors say you need. It's really common for a service to have a number of procedure codes. The firm that did my estimate would only put one code for procedures that had multiple codes. This resulted in gross underestimate of some procedures-one procedure had only 1% of the actual typical cost estimated because all of the expensive codes were excluded.

3) You can check if all of the prescriptions for medical services were served to the estimator. Medicare looks at all the things you're treating physician has been recommending in the last several years for the diagnosis codes it believes your injury consists of. So if your doctor recommended something expensive like surgery for one of the diagnosis codes Medicare has and the estimator has not reviewed the current prescription for that expensive medical service, you can have problems.
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"Thanks for this!" says:
tshadow (01-19-2008)