#1 ·
🤣
So, I was in a car wreck a while back. Went through all the doctors and tests, and eventually, an orthopedic surgeon told me I absolutely needed Physical Therapy. I went to my primary care doctor to get the referral, and since my local clinic offers Physical Therapy, I headed there with all my specialist reports in hand. But after looking at everything, the Dr. Physical Therapist there basically looked at the surgeon's recommendation and said, "Nah, you don't need this," and flat-out refused to treat me. So, what do I do? I drive about 25 miles to the next specialized clinic that actually does the work, and that's where I'm getting my treatment. After finishing my sessions, I submitted my travel reimbursement claim to Medicare. Instead of paying out from the Medicare fund, they’re making my primary doctor pay for it out of her own pocket! She's losing money on my travel costs even though Section 53 of the Health Insurance Act clearly states:
THE LAW
REGARDING MANDATORY HEALTH INSURANCE
I. GENERAL PROVISIONS
TRANSPORTATION COST REIMBURSEMENT WHEN EXERCISING RIGHTS TO HEALTHCARE UNDER MANDATORY HEALTH INSURANCE
Article 53.
An insured person exercising their right to healthcare under mandatory health insurance is entitled to transportation reimbursement if they are referred outside their place of residence or stay to receive healthcare.
An insured person under paragraph 1 of this article is entitled to transportation reimbursement if they utilized healthcare at a contracted healthcare institution, or at a contracted private practice physician's office, in a location more than 30 miles away from their place of residence or stay, because they could not obtain the necessary healthcare at a closer contracted healthcare institution or private practice office providing that specific type of service.
Regardless of distance, the right to transportation reimbursement applies to persons under 18, those referred abroad according to official agency acts, organ/tissue/cell donors, and chronic kidney patients undergoing hemodialysis.
In accordance with paragraph 3 of this article, the right to transportation reimbursement also applies to insured persons residing on islands or in areas designated by the Mountainous and Highland Areas Act and the Special State Concern Act.
Basically, I want to know: am I legally entitled to have Medicare cover these costs directly? And is Medicare violating Section 53 by forcing my doctor to foot the bill?
So, I was in a car wreck a while back. Went through all the doctors and tests, and eventually, an orthopedic surgeon told me I absolutely needed Physical Therapy. I went to my primary care doctor to get the referral, and since my local clinic offers Physical Therapy, I headed there with all my specialist reports in hand. But after looking at everything, the Dr. Physical Therapist there basically looked at the surgeon's recommendation and said, "Nah, you don't need this," and flat-out refused to treat me. So, what do I do? I drive about 25 miles to the next specialized clinic that actually does the work, and that's where I'm getting my treatment. After finishing my sessions, I submitted my travel reimbursement claim to Medicare. Instead of paying out from the Medicare fund, they’re making my primary doctor pay for it out of her own pocket! She's losing money on my travel costs even though Section 53 of the Health Insurance Act clearly states:
THE LAW
REGARDING MANDATORY HEALTH INSURANCE
I. GENERAL PROVISIONS
TRANSPORTATION COST REIMBURSEMENT WHEN EXERCISING RIGHTS TO HEALTHCARE UNDER MANDATORY HEALTH INSURANCE
Article 53.
An insured person exercising their right to healthcare under mandatory health insurance is entitled to transportation reimbursement if they are referred outside their place of residence or stay to receive healthcare.
An insured person under paragraph 1 of this article is entitled to transportation reimbursement if they utilized healthcare at a contracted healthcare institution, or at a contracted private practice physician's office, in a location more than 30 miles away from their place of residence or stay, because they could not obtain the necessary healthcare at a closer contracted healthcare institution or private practice office providing that specific type of service.
Regardless of distance, the right to transportation reimbursement applies to persons under 18, those referred abroad according to official agency acts, organ/tissue/cell donors, and chronic kidney patients undergoing hemodialysis.
In accordance with paragraph 3 of this article, the right to transportation reimbursement also applies to insured persons residing on islands or in areas designated by the Mountainous and Highland Areas Act and the Special State Concern Act.
Basically, I want to know: am I legally entitled to have Medicare cover these costs directly? And is Medicare violating Section 53 by forcing my doctor to foot the bill?