--you did an excellent job on this, Mel.

Basically, as far as I can see, you caught them in a mistake at the very least and in a deceptive practive at worst.

The question is how far the judge's authority actually extends in these cases--and I admit I have no idea what the political considerations are. I couldn't even speculate whether the judge is compelled to follow the regulations to the letter, can bend them in certain cases, or is independent (and ornery) enough to want to make an example/teach a lesson to the other side and make them pay for their incompetence and/or deceit.

But Echoes is right; this is PRECISELY the type of thing that an advocacy organization should be lobbying abround, and bringing it up at the next neuropathy support meeting can only help. Wonder if you could get some of the administrators from the Association there . . .

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

i can see a neuropathy organization not wanting to come to a specific hearing because of lack of time or manpower but you would think that they could write up a standard brief that a person could submit as to why some non diabetic PNers have the medical necessity of orthotics and shoes. That California organization talks a good ball game but that appears to be all they do. Both organizations are absolutely useless. They should be working on getting the medicare rules changed at the federal level. What is it exactly that they do?

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

Found these two sites from Medicare concerning shoes, etc. Interesting.

http://www.medicare.com/equipment-an...-footwear.html

http://www.medicare.com/equipment-an...tic-shoes.html

Government writes the rules???

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.

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