Cigna Govt services: The DAB case - M09-1406 affirmed that Linda's oxygen claims were OWCP's yet MSPRC has not listed them on the conditional list on mymedciare.gov that you paid and did send to them and they sent out a letter to ACS, the US dept of labor contractor, jsut as they had on the claims they could locate using the national health ins data base for claims paid by other intermediaries such as Trailblazers who have refused for over a decade to code as a conditional pay for recovery. The DAB affirmed that you have claims back to 8/1/00 still pending with you to process and pay conditionally as ACS has still not set my computer file, nor input 11 years if oxygen claims because: they would be paid as they were previously for life. When ILL Blues, who had been paying and duplicating some still being paid to the company Lincare bought, took over OK and TX, NM at the same time ACS did for US dept of labor they proceeded to post false info that there was no owcp and convinced, in collusion with trailblazers, to ignore owcp and have Medicare pay. Your people stated that when you took over for palmetto GBA in our area they refused to forward all pending claims and appeals,etc to you . The initial start date for you should be 8/1/00 for oxygen, the date of my entitlement to Part B and Lincare needs to be paid conditionally from then through 5/06, when acs lied to them making them think I'd gotten some huge settlement monies that included their back pay and they stopped service. Rhema came and Lincare refused to turn over the owcp contract which they found out they still had and then All about mobility took over until Lincare became the monopoly due to a discriminatory CMS regulation, etc. Since then my son hauls tanks, and pays out of pocket and I've asked you for reimbursement but the " death panel' rules say that isn't possible and I need an answer as to why patients are left to die who have years of life in them with medical care?
Other supplies that have been paid by Palmetto GBA and others since you took over are for secondary/tertiary issues to the original accepted conditions at OWCP. Due to ACS refusing to set up my computer file and bring on line with the official US dept of labor one, these have yet to have an initial decision even though 6 judges and a hearing office pointed out they were in the paper file which has disappeared.
Until Linda's 1996 pending request for permanent disability at owcp is processed, Doyle's and our daughter's primary payer is Federal blue cross.blue shield as one in considered an active employee until owcp decides place them on permanent disability. There are claims on Doyle that are bing appealed and need to be sent to MSPRC for recovery from Federal Blues. Any claims on our daughter should be treated as such, too.
We are asking for a letter of waiver of any overpayment liability against us and our estates as its against equity and good conscience for such violations of laws, judges and govt contracts.
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This is page 25
Cigna has had unprocessed claims and appeals pending now for almost 2 years or more in some cases and will not respond. HR 1063 being violated since they were bought by SC Blues parent company of Trailblazers and also over Wisconsin claims and appeals still pending since 2007 HR 1063, they get fined big time, too. Linda joy Adams
UPDATE; Cigna Govt Services is now Celerian Group..
THIS IS AN INJURY CASE from 1/10/89 HHS-SSA from Jersey City NJ. ACCEPTED CONDITIONS OCCUPATIONAL ASTHMA, CHEMICALLY INDUCED PNEUMONITIS, INHALATIAN OF TOXIC FUMES WITH BRONCIOSPASMS as well as issues fROM THESE FOR HEART, UPPER RESPIRATORY, ETC APPROVED ALSO FOR PAYMENT lIQUID OXYGEN APPROVED FOR LIFE. . NONE BEING PAID SINCE ACS (gvt contractor) TOOK OVER in 2002 AND REFUSES TO POST FILE. Other issues timely filed and pending but ACS will not permit these to be seen by claims examiner. Every claims of mine needs to be coded conditonal payment for this reason.
Third party suit still pending to repay taxpayers currenlty obstructed by US Dept of Labor contracor ACS-Xerox defying Labor judges orders of 2/09 to post / process/ pay items. And reconstrufct files from my records. and ASK ME FOR THE FACTS OF THE CASE as none else knows. WE ARE ABLE TO RECONSTRUCT FILES FOR THE JUDGES, THEN THEY SEND THEM TO ACS TO POST AND ' GONE.' In there is the over a decAde of oxygen CLAIMS UP TO THE CURRENT FILINGS
ALL OF FAMILY'S CLAIMS HAVE fED BLUES AS PRIMARY PER THE LAW AND m09-1406 MEDICARE DECISION AS BLUES IS MY EMPLOYER GROUP HEALTH FAMILY PLAN.
With famliy members,now also having a medicre card, they are affected, too.
Hr 1063 shoud 'fix' problems in the new Health Law when implemented, too. as same entities.
.MSPRC has no means to force recovery except the implementation of HR 1063. This needs to happen yesterday, as the law was passed and signed on 1/11/2013.
I am asking for a protective filing on O2 until a Medciare Heairng is held to see if regualiton can be overturned to pay when no supplier for patient. No break in O2 useage for 18 years.
Blues has been haing ther coverage delted every other oweek afterpsoted at Medciare Coordingaiton of buiefts for some time noww. and My prior oxygen sulier only got the oc ays after I sent the Medciare paymets reocrds on over tothem, myself. it psotf form Us dpt of albor bi weekly and the oxygen clims you paid in the past as pirmary, did not get paid by Fed Ble unitl I sent in the clims my self and they suppier got paid. NOW OUT OF THE LIQUIDOYGEN BUISNESS DO N TO THE REGULAITON THAT MAKES NO COMMON SENSE EXPET TO ELIEMANTE THE OCMPTETION FOR COEMPETTIVETE BID> . > Thats in mulptile ageines, e t which ACS=Xerox has control of now. lal oenidng items process.paid and this has not been allowed to 'offiially ' be seen by my clism eximenr ,there nor ha smy fiel been reconstructedform my records, nor has anyting been doen but ignore all. Its the very behaviors that casued the orignal conditional pay law be passed back j the ealy 1980's. now we haveone with penalties. It alws the govt to stop such bad behavior. I can only ask for conditonal payments form Medciare to etmedcial care, in the meantiome. A my other Pirary Fed Boue, whic dos reimburse 60% now for xygen, as the Heaing filed wehre you woudl not pay since 1/08 die to my not haing a sulierand get my oxygen directly form the manufacturer. Conngress or HHS needs to address all of this as lives are at stake, mine nor one.
Attsaced are more new appeals and redeterminations,etc + reopenings. Cigna Govt services did approve me for life for liquid oxygen due to oife treateing inflmaamiton fomr the conentrators. whihc has not improved over the 18 years since OWCP put me o liquid for lfe,.. This is for PUlmonary Hypertenios whihc is the eson for permnet approval by you before back in 1/ 2004 tests done at Univeristy Of Texas. Before that, was 5/2000 when oxygen got pulled and had the pw saturation rate. altugh the 2005 guidliens idnicated the sat rate was not a determing actor due to dignosis f pulmonary hypertenion, etc.
Please feel free to call me about any thing you wish to know or additl info please et me know. G= Form 1697 has been on file for you to be able to speak to my husband Doyle Adams. Linda Joy Adams Doyle Adams and DOyle for M.. 1/6/14 ( spell check not working)
I have filed oxygen claims with them last year and they have yet to respond, I am aware that Medicare will not pay for oxygen if there is no supplier as being medically ABANDONED IN 1/08 DUE TO AN UNCONSTITUTIONAL REGULATION THAT REQUIRED ALL SUPPLIERS TO HIRE A RESPIRATORY TECH TO DELIVER LIQUID OXYGEN WHICH MAKES NO MEDICAL OR LOGICAL SENSE. So I get it directly from the manufacturer and pay. BUT FEDERAL BLUES REQUIRES ME TO GET A WRITTEN RESPONSE FROM MEDICARE FIRST BEFORE THEY PAY UNDER A PROVISION TO PAY WHEN MEDICARE DOES NOT FOR DME WHICH HAS NOTHING TO DO WITH MEDICAL NECESSITY. ITS BEEN A HORRIFIC FINANCIAL HARDSHIP NOT TO GET ANY REIMBURSEMENT AT ALL. OF COURSE THIS IS FEDERAL WORKERS COMP BILL AND AFFILIATED COMPUTER SERVICES HAS NOT INPUT ANY IMS PER THEIR ORDERS TO LET ME DIE SINCE THEY TOOK OVER IN 2002.tHERE IS AN APPEAL PENDING FOR A HEARING WITH MEDICARE AND ITS BEEN OBSTRUCTED BY ACS ALSO AS THEY CONTROL ACCESS TO THE JUDGES . ITS UNCONSTITUTIONAL FOR THE GOVT TO SET UP THESE DEATH PANELS. ALTHOUGH APPROVE FOR LIFE FOR LIQUID OXYGEN FROM MEDICARE, NO SUPPLIER HAS TO TAKE ME EVEN THOUGH THERE IS A MONOPOLY SET UP UNDER COMPETITIVE BID IN MY AREA.THAT TOOK OVER IN 1/08 BY THE OTHER REGULATION PASSED TO FORE AL SMALL COMPANIES OUT OF THE BUSINESS OF THE CHEAPER METHOD OF JUST EXCHANGING FILLED TANKS BY THE MANUFACTURER. LINDA JOY ADAMS
UPDATE: Cigna Government Services, was the only intermediary (government contractor of Medicare that ever filed claims legally and sent them to the recovery unit contractor to get the money back from FECA*Federal workers comp. which enabled me to go to appeals and get the judge's orders to enforce the conditional pay laws. But found out Congress overthrew the entire government back in the COUP OF 2002 and the government contractors now in control of the nearly the entire government. Cigns is no longer involved with Medicare and sold off their sub division to South Carolina Blue Cross Blue Shield who had the multiple mediocre number scam going that ended with a $4 million dollar theft on my records alone and still no way to recover that or get a waiver of overpayment which is easy as I had no part in it and did everything I could to get the government to stop it but no funding from Congress to do so. The same entity controls all of it. They are now called Celerian group and they have refused to process oxygen invoices on me for over 2 years now. Since there is no supplier, it would be a denial and then I could go on up and add these to the pending hearing as the regulation that forced all small medical supply places out of a side line liquid oxygen business inn 108 is unconstitutional and was passed illegally without due process notices to all the parties involved to have input back in 2007. Undue and probably illegal influence by the 2 big companies to get rid of the small places who could deliver cheaper because the just exchanged filled tanks before the competitive bid program began and routes were bidded on. ending the FAIR MARKET COMPETITION IN HEALTH CARE Congress never stepped in on this either as they kept spewing out political speeches how FAIR MARKET LOWERED COSTS AND stopped FAIR MARKET COMPETITION IN HEALTH CARE IN 1/08. There are more than enough patients and in rural areas we need those small suppliers to work with the system and figure out how to get the care to the patients the most efficient way possible and they had done so. Congresses unconstitutional gag order not to mentin contact or have a contractor testify means nothing can be done to make things better for patients and taxpayers and lives endangered over it and lost in some cases. Linda Joy Adams 8/21/16
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