Forget about getting the Administrators fromthe Associatio there.

That's the first thing I did when Alan initially got denied. I called them, I emailed them. I got a very polite email response indicating that they don't do advocacy (I initially asked them to be a witness at the hearing (over the phone), or could they write a letter or SOMETHING. The answer was, regretfully NO, Then I contacted ANOTHER Neuropathy Organization, and asked the same thing. Same response.

So no help in THAT Department.

I AM WONDERING if the ACLU would get involved, (in case we get turned down again).

I asked Alan, "Is this as far as we can go, (the hearing with the ALJ I mean)? And Alan said "No, the next step is to go to an actual Court, but I'm not up to that". So I said 'So this is it?" And he said "I guess so".

Alan is on Social Security, and the foot company (A very very nice Foot Orthotic Company) knows this and probably won't pursue payment.

Immediately after I got off the phone with the ALJ, I phoned the Foot company and got on the phone with their billing department (we're old phone friends because of all these shenigans). I had her laughing on the other end. She said "You know, you should go to Court when I go to Court".

I told her "I'm just letting you know that we did do a good job of why your company should get paid, that my HMO did pay previously".

She said "Yeah, I know, but HMO's lie all the time and the judge's know this"

I didn't know that.

So we fought the good fight, and in a few weeks, we'll find out if we won the good fight.

Oh, on another note, I AM ENTITLED TO A PAIR OF SHOES EACH YEAR because I'M A DIABETIC RIGHT?

Wrong!! Same HMO as Alan.

Seems that when my podiatrist put in my prescription for my shoes (as he does every year), well this time, they only will pay $88.00 and that' NOT ENOUGH TO COVER THE COST OF THE SHOES. So we are finding out if my doctor's office will accept this payment. He is part of a practice and lately he said the HMO's only pay something like $40 for a pair of shoes. (I must be lucky, they paid $88.00 for mine).

I called up the girl who handles all the insurance (at my podiatrist, I mean). I asked her "If your office got paid the $88.00 and you are not satisifed with that amount, what happens next?"

Her reply was "Oh, we refund the money to the insurance company". This happens all the time.

So as soon as I heard that, I went to Payless and got a $20.00 pair of nice white sneakers (with a wide toe box).

That will work fine for now, but I guess I'm facing MY OWN FIGHT for my own pair of shoes.

But you see, I'm not complaining. I can go into any shoe store and buy a pair of shoes. Alan CANNOT DO THIS.

So if anyone knows who I can write to to have them re-think their medicare guidelines rule, let me know okay?

Oh, and this is interesting, when I was on the phone with the Foot Company representative I asked her if the judge has the discretion to side with us against the HMO, or if he had to follow the medicare guidelines as well.

Her reply: "Of course he has discretion, HE'S THE JUDGE, if he didn't have discretion, there would have been no hearing over the phone".

So she thinks we just might have a shot.

time will tell

lol

Melody