I used #ChatGPT4 to appeal #Medicare claims to a judge. Here’s how a 🧵 Step one ask “As you are knowledgeable in medical billing, with your expert opinion give me the step by step process to appeal a Medicare claim at all levels”

A story about @Optum owned by $UNH @UHC So a patient received a lab order, without the doctor being involved in the order. Tech Bros at work.

A lovely little $CI @Cigna thread. Just when you think they can’t get more mafia. Read this little gem. At appeal is a COVID-19 test #COVID19 was mandated to be covered during the pandemic by Congress. Watch @michaelcburgess and @FrankPallone clarify this. @FrankPallone confirms NO COST FOR COVID TEST AND SERVICE TO THE PATIENT. So, why charge the patient when the law says no cost? Well apparently, if a patient can receive services at NO COST, CIGNA won’t pay. Despite the law mandating coverage for COVID-19 tests during the pandemic. Read closely

Oh @ConnectiCare Why are you breaking the law? Again and Again. In this case you literally denied due to timely filing. I talked about this since I discovered it in May. So @USDOL are you ever going to enforce these? They literally responded today on the… https://t.co/obVO4gEdAs https://t.co/nZdl19Od9a

https://twitter.com/takeweightoffmd/status/1653073929156608002?s=46

twitter.com/i/web/status/1…
It’s not only them $UNH getting in on the game. Responding July 8th but dating it July 10th. We see your games. Does @USDOL @UHC ? @DGlaucomflecken ? Either I travelled to the future or you dated this 7/10/23 to try and game the rules.

Hey @propublica here’s a story about a company named $CI using #AI DENIAL BOTS TO DENY COVID 19 TESTS. Mind you FFCRA & CARES ACT mandated covid test payments. I won’t review the law here but suffice it to say @Cigna has violated federal law here. Patients have sued $CI and we… twitter.com/i/web/status/1… But here is where the plot gets interesting @Cigna uses medical management decision to deny a federally mandated and @US_FDA APPROVED COVID-19 test called @BioFireDX using Medical Coverage Policy 0530. Yes, Yes insurer violating Federal law while @USDOL or @HHSGov doesn’t hold… twitter.com/i/web/status/1…

Given the huge amount of traction this post gave. I want to dive into what it means for you, as a patient who may have gotten their medical claim denied by insurance. You can read the thread.

https://twitter.com/takeweightoffmd/status/1660028788623671296

But TLDR; if your medical care claim was denied due to timely filing it was a violation of federal law and YOU HAVE LIMITED TIME AND MUST DO THIS NOW. What’s this?

How insurance policies Break the law in 7 tweets, by Dr Murphy. Step one: FFCRA mandates COVID-19 testing be paid for. One type of covid test is called 0202U a cpt code for a biofire covid test. FDA approved even. Step 2. Given the chaos of the pandemic, CARES Act allowed delayed billing and requires insurers to suspend denials for timely filing. The wording is 60 days past the end of the national Health emergency. Which ended May 11th 2023. So last day to file claims is July 10th 2023.

So @Aetna has decided to tell all their staff that they will not pay for #COVID19 testing for asymptomatic people or for people who aren’t certain they had COVID19 contact. twitter.com/i/web/status/1… Despite clear guidance from @USDOL FAQ 44 Q1 can insurers use medical screening (medical management) to deny claims on covid 19 tests to asymptomatic with no contact? @USDOL ANSWER: NO. So why aren’t they doing anything? #regulatorycapture

tiktok.com/t/ZTR4t6doT/ Watch this. The government and insurance CEOs conveniently forgot the law demands they pay for multiplex panels that test COVID19. What’s most despicable is that elderly and underserved low SES need fair the worst with these diseases. Medicaid & Medicare Have refused to cover these tests despite the law crystal clearly preventing coverage decisions OTHER THAN THE FFCRA LAW. tiktok.com/t/ZTR4tacuY/

CDC: You must rule out other viruses including #influenza #RSV during pandemic when testing #COVID19 OIG: if you do that, U should be investigated for fraud and abuse. 😵‍💫😵‍💫😵‍💫 @BioFireDX & @QIAGEN are the best #covidtests for patients who feel sick. FULL STOP. Despite JDs advice cdc.gov/flu/profession… GEEZ WHY CAN’T WE FIND COVID TESTING ANYWHERE??? Despite best medical practice, OIG wants to investigate you for doing what’s right for the patient, then the lawyers will decide. Who will offer tests with that Damocletian risk.

@alexmeshkin Ok, @alexmeshkin I don’t have a small sample size. I’ve been testing this since April 2020. Nearly, nearly 100% of people I have a pre & post on have significant drops. Including several pro athletes. This is not uncommon. There will be an epidemic of hypogonadism. Politics aside @alexmeshkin It’s funny. Insurers refused to pay for this bloodwork & @Labcorp sent patients to collections for it! They charge 100 bucks for this test, at my lab it’s 30 bucks. Fools.

So it begins. We can’t afford to pay for citizen testing for the uninsured & @RepMcKinley @BillPascrell @HouseGOP @HouseDemocrats WON’T ENFORCE THE #CARESACT #FFCRA so Insurers will continue to stiff bills & premium paying patients will be used as human shields for COVID19 bills. What country do we live in where those who can afford to pay stick the bill to those who can afford least to pay? So what happens to the test to treat debacle? It appears the uninsured are left to fend for themselves. And $CI wants to doctors to sue the patients! #caresAct #FFCRA

Thank you

Is anyone checking Turquoise Health? I think I know how hospitals can afford to buy doctors. My payment for a 99204 new visit is 200-ish dollars. What is it at local hospitals? I wonder what they get paid? Imagine if Everytime you buy a doctor’s practice you can 8x their revenue! That’s insane @wendellpotter @johncraven1 @misterchambo @AGWilliamTong @ComptrolLembo @GovNedLamont @nytimes @WSJ @POTUS @DutchRojas

$UNH United sued last week acknowledged they HAVE TO PAY FOR COVID TESTING PERFORMED BY PHYSICIANS. UNITED refused to pay physician labs for YEARS. Now they recognize that the FFCRA and CARES mandate they pay these physicians and their labs! @EdGainesIII modernhealthcare.com/insurance/unit… This is precisely the problem. The lawsuit is about demanding proof of each & every test done. Then you submit this and they deny for “improper physician order” This letter is meant to stave off thousands of lawsuits from work in 2020. IT WONT WORK. Providers are getting lawyers.