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Sunday, March 20, 2011 12:57 AM


Medicare Provider Bureaucratic Nightmare


John Peters, a practicing psychologist, just sent me an email regarding a complete bureaucratic nightmare that has prevented his firm from obtaining a Medicare Provider Number.

John writes ...

Hi Mish,

I'm writing at the request of Customer Service at Palmetto GBA, the firm which handles all our Medicare processing.

As a practicing psychologist with offices in Fairfield and Albany, California, I have been attempting to obtain a Medicare Provider number.

I applied despite horror stories from doctors who informed me that just the enrollment process takes a few years and I may need to hire a professional to assist me.

Being a geek by nature, and already on the panels of five insurance companies and workman's comp, it seemed like a trivial matter to get one additional certification.

The first problem involved needing to complete a mandatory electronic payment form that I found via a Google search since the provider analyst never responded to any of my inquiries.

Months later I received a notice telling me that my application had been rejected with no reason given. By phone, I found out that they needed a canceled check which hadn't been included. However, I had received no request for a canceled check.

The provider analyst then said I needed to seek permission to re-enroll, a process that takes up to three months.

Persevering, I went through the process, getting “permission” to re-apply. After carefully seeking help going through exactly what would be needed in the new application, resubmitted it.

Months later I received another rejection. This time it was because they wanted a specific contact person's name from the bank on the electronic payment form instead of the general customer service name and number.

I was told that the provider analyst had sent me a request for the needed information, but that she had sent it to the wrong email address. Still, there was “nothing that they could do,” since my application number no longer existed and I needed to once again seek permission to re-apply with another three month wait.

Persevering, I noted the reasons for the rejection, and reapplied for permission to re-apply. Months later my request was rejected on the grounds that I had exceeded the 60 day period for requesting reconsideration.

It turns out the provider enrollment analyst used the initial versus current request number, despite my including the current request number in bold letters at the top of my letter.

Next, I send a letter which noted the error, and enclosed a copy of the rejection letter which confirmed that my response had been the following week. A month later, I received another rejection letter from the same analyst that merely copied her original reason for rejection. Clearly, the analyst had not even looked at the letter.

Since the customer service representative has no access to records, she can only direct me to a number for “complex cases.” I have tried for a month at various times of day, and have never been able to get through to anyone. Generally, after an extended message, the call is disconnected, or I am put on hold for about an hour before it disconnects. I was told that the reason for this is that they are “busy.”

In a period where the issue of government involvement in healthcare is being considered, I ask myself why there is absolutely no accountability for the worse than horrible management of Medicare?

The customer service representative at Palmetto noted that she deals with phone calls similar to mine all day, every day, that involve pure incompetency and the unwillingness of provider enrollment analysts to do their jobs. The representative went on to say that she is helpless to do anything, because they do not give her access to any records, and that contacting a congressman is about the only option available.

I've sent this email out to several California congressional representatives.

Sincerely,

John Peters, PhD
If anyone out there can help John, please shoot me an email. I will pass it on.

Mike "Mish" Shedlock
http://globaleconomicanalysis.blogspot.com
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