“In January, my doctor sent a claim to Medicare for a walking boot which I needed for a medical condition. Medicare denied the claim even though the boot was a covered item. Since the doctor was not paid, he insisted that I pay $284.85 out of pocket, which I paid, however I was sure this was not a fair practice.
I brought my case to the California Senior Medicare Patrol and Sandy Morales, Complex Case Manager, worked on the issue for several months. She was an intermediary between Medicare and my doctor and after several conversations, she was able to convince the doctor to re-submit the claim for the boot, along with the appropriate documentation indicating medical necessity.
Bottom line: in September, Medicare paid the doctor for the valid claim and the doctor reimbursed me for the full $284.85.
Thank you Sandy and Senior Medicare Patrol for being such a strong advocate for a grateful Medicare beneficiary.”