Va. Beach man fights Medicare months after wife's death

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by Janet Roach

WVEC.com

Posted on February 10, 2011 at 7:31 PM

Updated Thursday, Oct 17 at 2:33 PM

VIRGINIA BEACH -- Joe Grande's long fight with Medicare to cover costs of his wife's medical care shortly before her death in August, is finally over.

He's thanking the 13 News Troubleshooters for help resolving the case.

The couple was on a cruise ship when Barbara Grande got very sick and had severe back pain.

"She jumped out of bed because of the pain and she had one foot on the bed and one foot on the floor and she leaned over and I think she died on me at that moment," Grande recalled.

Barbara was treated in the ship's infirmary before being transported to a Long Island hospital.

The treatment aboard the Princess cruise liner cost $1,034. When papers were filed with Medicare, the claim was rejected, stating Medicare can make payment only if "the services are furnished while the ship is within the territorial waters of the United States."

The ship was docked in Brooklyn, still hours from leaving. "Medicare says the ship was in international waters," Grande was stunned to learn.

The cruise line even sent a letter to Medicare stating it was in port at the time Mrs. Grande got treatment, but still his claim was turned down.

In all, Medicare turned down the claim three times.

Lisa Walker, a Medicare expert for Bay Aging, says it's not uncommon to be rejected two or three times before a decision is reversed. She says there is an automated system that can kick out a claim based on a few key words without a person ever laying eyes on the claim. In Grande's case, she believes the words "cruise ship" would have triggered the rejection.

"I don't even think he's even appealed yet. You can easily get frustrated and give up, so it is important to stick with it," explained Walker.

Grande didn’t give up but turned to the 13News Troubleshooters to cut through the red tape.

After contacting Medicare and the office of Rep. Scott Rigell (R-2 D), Medicare put Grande in touch with a Medicare Health Insurance Specialist to expedite his case. Rigell's spokesperson, Crystal Cameron says the congressman's office also took immediate action to help resolve the claim.

Centers for Medicare & Medicaid Services public affairs officer Lorraine Ryan said some rules on Medicare coverage on cruise ships have changed, although she wouldn’t say what those rules are. She suggests that Medicare recipients who have questions to contact the Virginia Insurance Counseling and Assistance Program, which is designed to help beneficiaries.

After fighting with Medicare for more than five months, Grande received a phone call Thursday from Medicare stating the check would be in the mail in the next few days and the situation was resolved. Relieved, Grande says what he's been trying to do for months, 13 News helped him do in less than two weeks.

"I'm happy channel 13 could help so much. I could not have done it without them," he added.

His wife's death certificate lists aortic aneurysm as a possible cause of death.

It would have been their 20th cruise together.  Although, it was a trip they never got to make, Grande feels she can finally rest in peace.

 

 

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