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Another MSA compiled - Printable Version

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Another MSA compiled - freebird - 08-21-2010

I just Received my 3rd MSA proposal by the IC since March 2009. The IC felt the first two were way to high. This MSA misses many issues. This one will be sent to CMS for approval even though it is obviously built to take advantage of a GHP or The Gov. prematurely.

I will be shocked if this MSA gets past CMS without being corrected.


RE: Another MSA compiled - Bummer Knees - 08-21-2010

freebird keep us posted.

My insurance company proposed a MSA of $10,000.00 for the knee replacement and mesicus/pica surgery on the other knee.

The insurance company sent a letter to the attorney last week wanting to talk settlement again, and again they will try and low dollar the MSA.


RE: Another MSA compiled - freebird - 08-21-2010

The Question is will CMS see the intentional low ball MSA and change it? For instance, They have me down for 9 visits a year instead of 12 over a 26 year period to my PM Doctor. It is mandatory I see my pain management doctor every month when I am being prescribed a Sch II narcotics. That is 78 visits not included in my MSA. They also took away 2 of my prescription drugs I have been taking for over 3 years faithfully. These 2 add up to over $70000.

My thoughts are the IC is trying to screw the Federal Gov by low balling a MSA and "getting" it sneaked by Medicare.

That is wrong IMO. IF CMS has tightened up there screening, there is NO WAY this MSA will ever be accepted.

BUT IF CMS tries to change it, The IC will not accept it and we are still at square 1.


RE: Another MSA compiled - Bad Boy Bad Boy - 08-22-2010

I have read some articles in the past that talked facts on what CMS will do and approve for a MSA. It was clear, they rush through these things, and mostly do approve them. But, only in a slight chance they get denied. If it were up to me, a game plan should have been worked on way back. A full detail list made and showing proof what the MSA should be close to, medication and cost, medical visits outlined in full, and medical detail cost. Then some how figure out on how to get that list to CMS. But, other then that, from those articles, stating, many do just get approved without a proper review. So, how does one force a proper review is beyond what I would know.


RE: Another MSA compiled - freebird - 08-22-2010

Bad Boy Bad Boy Wrote:I have read some articles in the past that talked facts on what CMS will do and approve for a MSA. It was clear, they rush through these things, and mostly do approve them. But, only in a slight chance they get denied. If it were up to me, a game plan should have been worked on way back. A full detail list made and showing proof what the MSA should be close to, medication and cost, medical visits outlined in full, and medical detail cost. Then some how figure out on how to get that list to CMS. But, other then that, from those articles, stating, many do just get approved without a proper review. So, how does one force a proper review is beyond what I would know.

One would think a MSA is non-negotiable BUT.... This IC has had 3 different MSA's constructed in a little over a year, The errors have been pointed out but they just ignore the actual data to get a MSA at there price.

Another "biggie" they have left out every time is my Ablation nerve burnings for Pain Management. They write in the MSA report that I can have 1 nerve burning in 26 years total instead of 1 every 2 years.Actually they give me 2 nerve burnings (each in a different area) in 26 years. That is 24 nerve burnings left off!

My Attorney has showed this IC time and time again the BIG INTENTIONAL Errors of this MSA BUT THEY JUST IGNORE THE ACTUAL DATA AND FACTS EVERYTIME.

A MSA should be fairly "cut and dry" based on past years of documentation which I have concerning my Meds, Procedures, PM Visits etc.

All of this BS you hear about fines for trying to screw Medicare seems to not be to damn serious. If Medicare does not catch erroneous errors such as this, they are failing on the job horribly.

I am going to send this one through and see if CMS has "tightened up" in the last few years. My MSA is a intentional low ball figure set up to have the GHP/ AND OR Federal Gov. pay prematurely for my work related injury COVERED by a IC.

It sucks but I have exhausted all efforts short of calling CMS myself when they receive this MSA.


RE: Another MSA compiled - Bad Boy Bad Boy - 08-22-2010

Freebird, I want to see your MSA be the right, correct and most fair Fund possible.

My problem is, as we have been learning over all these years about the MSA Fund (Medicare Set-Aside Fund) is just how in the heck, can we as injured workers, and injured workers attorney's, correct a major fault as in your situation. You would think it is a form of out an out Fraud, as the Employers IC and Attorney have been provided as you have said very important and true facts, even pointing out errors. So, as a learning group here once again, I say, how are we going to stop this Fault? Is there a way to show the IC's and their Attorney are Low Balling this?


RE: Another MSA compiled - freebird - 08-22-2010

Actually I feel the IC's, There Attorney's and the third party vendors they use to constuct a MSA KNOW they are low balling. They get away with it because CMS does not overlook the facts. Seemingly, Most MSA's are approved with minimal rejections.

My life span was reduced by 4 years on this 3rd MSA! I look on the Social Security website and I have a 30 year projected life span for my age. This third party vendor Gould and lamb say my life span is 26 years! WTF?

I have worked very hard with my Attorney to resolve this MSA with the IC BUT they have refused to budge acting like this is a bargaining chip instead of a MSA built around 2-3 years of solid medical records and data. My MSA is at least $100,000 dollars short and that is being conservative. They also refuse to include Lyrica which I have been taking for 4 years every day. It was replaced with NOTHING!

I feel CMS will have to start levying heavy fines for any IC allowing such extreme erroneous MSA's even built based on a life care plan and projections made by individuals who are no more than a glorified RN.

How can a third party vendor such as Gould and Lamb put there stamp of approval on such false information and get away with it by causing US the tax payers to pay for something prematurely?

When I know my MSA has been sent to CMS, I will be on the phone to talk with someone from CMS. Will it matter? I am open for any suggestion


RE: Another MSA compiled - Bummer Knees - 08-22-2010

Question?

Does the ALJ have any say in the MSA or the amount?


RE: Another MSA compiled - freebird - 08-22-2010

Bummer Knees Wrote:Question?

Does the ALJ have any say in the MSA or the amount?

I believe the answer to that is no. If CMS approves it, it is a done deal and the Judge will sign off on it. Really out of his/her "food chain" to determine a MSA amount IMO. Now, I could be wrong......


RE: Another MSA compiled - Bad Boy Bad Boy - 08-22-2010

Well, heck ya I would be calling CMS as fast as you could on this.

Also here is a good read for you;
http://www.riskandinsurance.com/story.jsp?storyId=120820473

If you ask me though, I do think it is something your attorney should try a handle through CMS though. So, where is your attorney stands on this?