NeuroTalk Support Groups - Alan just had his hearing re: His custom molded Orthotics

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- - Alan just had his hearing re: His custom molded Orthotics (https://www.neurotalk.org/peripheral-neuropathy/115726-alan-hearing-re-custom-molded-orthotics.html)

Quote:

Originally Posted by MelodyL (Post 628311)

HI.

Yes, I'm aware of the information that was stated in these two links. As a matter of fact, I'm going through it myself because I'm a diabetic and I also have neuropathy (although I was extremely lucky and got a handle on it because I take Methylcobalimin every single morning.

In MY case, I am entitled to orthopedic shoes,(I'm not in Alan's category, so I don't need custom molded anything), but diabetic shoes (let's just call them fancy sneakers with big toe boxes), well they are costly. But the HMO will only contribute $88 towards my shoes and my shoes cost much more than $88.00. Other HMO's pay as little as $40 towards the cost of the shoes.

That's why many shoe companies refuse to take the $88.00 and the $40.00 (unless the patient provides the rest of the money).

I'm on Social Security Disability and I grow my own food in my kitchen. If they think I can come up with a co-pay of $100 or more, they are kidding themselves. I mean, what's the use of having insurance if they don't cover SHOES for goodness sake.

Thank god, I don't need custom orthotics like Alan does. I DID need them over 5 years ago because I had a double heel spur (but surprisingly, I have had no problem with this condition for YEARS)

Okay, I just found out who takes care of all these things.

THE CMS
Centers for Medicare Services.

Here's the website

http://www.cms.hhs.gov/

Now THERE'S A LOT OF INFO AND LINKS AND THINGS TO CLICK ON, and there is even a contact link, but after doing that, I have no idea what to do next. I want to contact the people who make the policy, who make the guidelines, and request that they CHANGE the status on not allowing non-diabetics to get shoes and orthotics.

So any of you creative people out there, click on this website, scroll around and if you find a place that I send an email or call (about changing policy), kindly let me know.

I couldn't find it.

Thanks, Melody

Hi Melody,

I am very aware of the situation you and your husband are going thru as I have been following the posts. I should have realized that you more than likely have seen every site there is to see and then some. I should not have included those sites. I am sorry that I did.

I, myself, need custom orthotics, at least to start with, BUT they will not be paid for. I will have to pay out of pocket when I do get them. And they are expensive as we know. I have had to pay out of pocket for needed medical equipment for quite some time.

If I had diabetes, orthotics would be paid for. But I do not have diabetes. I have peripheral neuropathy due to CMT. My feet are VERY sensitive and with the way I walk I could use orthotics but yet orthotics are not paid for. Any kind of shoe is not paid for either.

When the time may come for AFO's for me, and it probably will happen, I believe they do pay something for them. I certainly hope that there is some help for them.

So with all due respect Melody, I do realize that you have been going thru a lot of stressful stuff. I hope you do get a favorable answer soon.

Quote:

Originally Posted by MelodyL (Post 628258)

I agree, so it has to be UP TO US to do DO THE WRITING AND EMAILING.

Anyone know who writes the medicare guidelines and who I can write to?

Thanks much

Melody

Melody,

Have you looked into this medicare advocacy org?
http://www.medicarerights.org/

May be worth a shot.

Quote:

Originally Posted by JoanB (Post 628325)

Hey Mel, this might be a longshot, but have you considered contacting your congressman/woman's office? I've heard of people getting help that way when it's a problem that involves the government. Just a thought.

I never thought that a congressperson could have any effect on an insurance company, but HEY!! It's worth a shot.

That is if Alan gets turned down!!

Will update.

thanks much
:hug:

its not that the congressman would have an effect directly on the insurance company but that the congressman could have an effect on medicare rules which the insurance company hides behind.

Quote:

Originally Posted by Kitt (Post 628368)

Wow, with all the stuff you are dealing with, and because you are NOT diabetic, they won't cover your orthotics. Stinks, doesn't it? How they rationalize what they rationalize, well, I don't see it getting any better any time soon. I guess we all have to suck it in and do whatever we can, HOWEVER we can.

I handle stress by sprouting my own food in my kitchen. You have no idea how soothing it is, how comforting and how calming, when you go into the kitchen and you see your little garden all abloom with sprouting sprouts.

They just SPROUT all the time, even when I put them in the fridge, they STILL SPROUT. They make me smile, so my body feels better.

I learned a cool hobby. A great de-stressor.

I hope I can find an organization, or someone who can change those medicare guidelines.

I'm going to give it my best shot. I can deal with regular shoes, but people like you and Alan, well, it's just not fair. You guys should get all the foot gear you need and you should have it paid by insurance.

So keeping fingers crossed.

You take care,

Melody

Quote:

Originally Posted by antonina (Post 628381)

Melody,

Have you looked into this medicare advocacy org?
http://www.medicarerights.org/

May be worth a shot.

Antonina:

WHAT AN EXCELLENT WEBSITE. I just clicked on the "contact us" link and I wrote them the whole story.

Here's hoping someone reads it and gets back to me.

I'll update.

You guys are the greatest.

Melody

Quote:

Originally Posted by echoes long ago (Post 628502)

its not that the congressman would have an effect directly on the insurance company but that the congressman could have an effect on medicare rules which the insurance company hides behind.

Yes, that's exactly what I meant...but since insurance has an astonishinng amout of influence on congresspeople and since it's a quid pro quo kind of relationship, I'd think it's not that rare that a congressperson might sometimes give them a poke to change some behavior too.

I took my Ambien about an hour ago--so I hope that :Scratch-Head:made sense.:Hum:

Quote:

Originally Posted by JoanB (Post 628560)

I think of the relationship between insurance companies and congresspeople as more of a puppeteer- puppet relationship.

Quote:

Originally Posted by echoes long ago (Post 628635)

I think of the relationship between insurance companies and congresspeople as more of a puppeteer- puppet relationship.

So true!!

Don't get me started on our bought & paid for Congress. I'll save that rant for posting on leftie blogs. What would be so bad about a health care system like that in France?

Melody,
I hope that site can help. I forgot to mention that I've gotten the best results from a letter. How about writing directly to Medicare?

I concur on the power imbalance; was just suggesting that sometimes the back scratching goes both ways among The Masters of the Universe.

Anyway, picking up the phone to try couldn't hurt. They'd probably be happy that it isn't me (I have senators' and reps' offices on speed dial).