Sunday, March 20, 2011

Difficulty of Providers Getting into Medicare


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?
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  1. I had the same difficulties. Wrote to the insurance commissioner in CA and SC along with Palmetto upper level management. Problem was resolved in a week.