Eli Kamara MD

139 posts

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Eli Kamara MD

Eli Kamara MD

@EliKamaraMD

Orthopedic Surgeon, specialized in adult reconstructive orthopedic surgery, hip & knee replacements, joint replacement, hip & knee arthroplasty, fracture care.

The Bronx NY Katılım Şubat 2021
160 Takip Edilen283 Takipçiler
Eli Kamara MD
Eli Kamara MD@EliKamaraMD·
This is a well documented problem not only with @aetna but all Medicare advantage plans. oig.hhs.gov/reports/all/20… I hope @LeaderJohnThune and @SpeakerJohnson will take action to move forward and address these issues with Medicare advantage and reintroduce S.4532 - Improving Seniors’ Timely Access to Care Act. As a result of this behavior, patients are suffering.
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Eli Kamara MD
Eli Kamara MD@EliKamaraMD·
Hey @Aetna @AetnaHelp Shared with patient permission We submitted prior authorization on 1/2 for a total knee replacement on 1/22 for a Aetna Medicare advantage patient. It was denied on Saturday 1/18 over the holiday weekend. Now your representatives are saying that since we didn’t appeal on Saturday, the surgery is denied and we need to restart the entire approval process. Additionally, no option was given to appeal the decision. We have spent 2+ hours talking to your staff with no recourse given. This is inappropriate. Saturday was a holiday weekend. The patient’s family took off work and flew in to support her during the surgery. The patient has failed multiple documented rounds of non-operative treatment, and has a successful knee replacement on her opposite leg. Her X-ray below clearly demonstrates bone on bone arthritis. This is a clear violation of Medicare guidelines. Another example of the need for the passage of S.4532 Improving Seniors’ Timely Access to Care Act @AAOS1 @AAHKS @CMSGov @cmaorg @HHSGov @MedicareGov @AmerMedicalAssn #claimdenied #respectmyprescription
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Eli Kamara MD
Eli Kamara MD@EliKamaraMD·
Todd, Thanks for the message. From your email: “If a provider can supply records in regard to completed physical therapy or an evaluation from a physical therapist stating that they feel the therapy would be ineffective, we would be happy to submit that information on the providers behalf.” I am happy to submit any requested clinical information regarding the patient’s history. Unfortunately on the phone today for 3+ hours with @Aetna the representative did not give us the option to submit any data, perform a peer to peer, speak to a doctor, or appeal. As a result the patient’s surgery for tomorrow is canceled. It’s inappropriate that it takes a tweet to get an answer from @aetna.
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Eli Kamara MD
Eli Kamara MD@EliKamaraMD·
@AetnaHelp Thanks we will email you But an email is not as helpful as a phone call. The surgery is scheduled for tomorrow.
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Aetna
Aetna@AetnaHelp·
@EliKamaraMD Hi, We sent you a direct message with our contact information. Thank you, Todd, AetnaHelp
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Keşfet

@aetna @LeaderJohnThune @SpeakerJohnson @MikeKellyPA @RepDelBene @RepLarryBucshon @RepBera @RogerMarshallMD