From: Herbert Stein [mailto:firstname.lastname@example.org]
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,
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.
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.
Joyce and Herbert Stein
1008 Trailmore Lane
Weston, FL 33326-2816
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