Medicare/Medicaid coverage for VNS Therapy depression patients implanted prior to May 4, 2007.

From: Herbert Stein [mailto:fabrik@bellsouth.net]
Sent: Monday, May 11, 2015 2:14 PM
To: Madam Secretary Sylvia Matthews Burwell, United States Secretary of Health and Human Services; Sean Cavanaugh, CMS – Deputy Administrator & Director; Dr. Patrick Conway – Acting Deputy Administrator for Innovation and Quality, CMS Chief Medical Officer; Courtney Turner; Nancy Conn – DMOA Acting Deputy Director
Subject: Medicare/Medicaid coverage for VNS Therapy depression patients implanted prior to May 4, 2007.

Dear Madam Secretary Burwell,

clip_image001

http://www.hhs.gov/about/

So exactly when does your agency/bureaucracy actually do something helpful and effective “for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves”?

It has been two (2) years now that I’ve been on this project advocating and writing to former Secretary Kathleen Sebelius and you.  My original pleas were for “Compassionate Use” only to learn all along your CMS agency incorporates the doctrine of “Continuity of care” which rightfully should have insured medical coverage for this unique population of patients implanted with a medical device being denied care and/or replacement by your various contractors. 

The decision of December 30, 2014 reiterates this fact of “Continuity of care”.

What does it take to get any of you people to understand that it is rightfully your responsibility to care for these patients (read you’re agencies statement at the beginning of this communication) and you folks are failing?  Why can’t you add an addendum to the NCD of May 4, 2007 noting the fact that all VNS Therapy depression patients implanted prior to that date are rightfully to be covered?  Why can’t any formal message, document or piece of paper be sent to all your Medicare/Medicaid contractors to inform them what should have properly been included in the original decision but was egregiously or negligently and/or intentionally overlooked and/or omitted?

Why can’t anyone in the multitude of your agencies personnel get the message out to all your contractors?  Why must the patient, “least able to help themselves” be forced to appeal? 

“Please note, that if a particular Medicare claim is not paid, the Medicare beneficiary has the right to appeal.” — Dr. Patrick Conway, CMS Chief Medical Officer.

Why it is your own people don’t understand the true realities of life/procedures from the patient viewpoint?  The hospitals will not proceed unless they get the okay from MAC.  The hospitals will not perform surgery for replacement of the prosthesis for a depression patient although they will perform the exact same surgery for an epilepsy patient.  Obviously your own people don’t know it is not a question of appealing non-payment but first obtaining approval for the surgery and/or care in the first place.

It is truly, truly sad and maddening situation as I sit here writing to you for the umpteenth time to tell you, in my opinion, of the ineptness and what I consider the incredible incompetence within your agency based upon some of the answers and/or communications that I receive based upon patient pleas asking for my assistance to overcome your contractor’s denials.

Why can’t you in writing or one of your subordinates inform all your Medicare/Medicaid contractors in one document submission that these VNS Therapy depression patients are to be covered and treated exactly the same as the VNS Therapy epilepsy patient?  Is that too difficult for anyone to comprehend?

I no longer have to beg for “Compassionate use”.  I now ask that you only do what are rightfully your job and that of all your subordinates and that which has been adjudicated within your own agency. 

Medicare/Medicaid coverage is rightfully to be covered for all VNS Therapy depression patients implanted prior to May 4, 2007.

The next letter I would truly hope to receive from either you or any of your subordinates is one informing me that all the Medicare/Medicaid contractors have rightfully been informed and acknowledge that all VNS Therapy depression patients implanted prior to May 4, 2007 are to be covered for both care and replacement of their medical devices without any further need or discussion for any appeals.

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

—————————————————————

NOTICE OF CONFIDENTIALITY / Disclaimer

—————————————————————

Disclaimer: This E-Mail is covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521 and is legally privileged. The information contained in this E-Mail is intended only for use of the individual or entity named above. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you receive this E-Mail in error, please notify the sender immediately at the email address and/or phone number above and delete the information from your computer. Please do not copy or use it for any purpose nor disclose its contents to any other person.

CONFIDENTIALITY NOTICE: This e-mail message including attachments, if any, is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail, destroy all copies of the original message, and do not disseminate it further. If you are the intended recipient but do not wish to receive communications through this medium, please advise the sender immediately.

Advertisements

About vnstherapy

I'm a very, very long-time support person and health care and mental health advocate/activist for my spouse Joyce as well as to others. I'm also a retired business executive and former Board Member, President and facilitator of a local chapter of DBSA as well as a Florida State appointment as a Guardian Advocate. I do not endorse, promote or advertise for any therapy, product or company. I do share our personal experiences, my research and knowledge in the hope it might benefit someone or do I give advice as to what one should or shouldn't do. I extend my best wishes for wellness to one and all and all the good you’d wish for yourselves.
This entry was posted in VNS Therapy and tagged , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s