Dr. Ronald L. Stram's medical care "did not meet the professionally recognized standard of care," according to Livanta, Quality Improvement Organizations, in a June 24, 2016 official assessment for Medicare. This was in response to a complaint we filed with Medicare about our unpleasant and unhelpful treatment by Dr. Stram and the Stram Center for Integrative Medicine.
Shortly after moving to Delmar, NY, last year to live with our daughter, son-in-law and grandchildren, my wife, Maria, (then 76) and I (then 70) visited Dr. Ronald Stram thinking that he might become our new physician in the area. It turned out to be an unfortunate choice.
Summary: Dr. Stram prescribed over one thousand dollars in lab tests not covered by Medicare, despite our specific request to the contrary. When we appealed Medicare's non-payment of our claim, he refused to provide a letter explaining the medical necessity for his prescription. He also overcharged us for the visit. His prescription and care for us were subsequently assessed to be below "professionally recognized standards of care."
1. Lab Tests: I specifically requested that Dr. Stram prescribe lab tests covered by Medicare. I explained to him before he examined us that my wife and I live only on Social Security plus her small pension, that we were heavily in debt, and that we thus needed to be quite careful with our medical expenses. Our request was explicit. I believe it was reasonable to have trusted that Dr. Stram would honor our request and only prescribe covered tests, or at least warn us if some tests were not covered.
It appears, however, that Dr. Stram did not take our concern and request seriously and evidently ignored it altogether. (In retrospect, he did seem indifferent to our financial situation and eager to hurry up our appointment. But he cannot in good conscience deny that we made this specific request of him and that he did not warn us to the contrary.) As a result, we were billed $1,378.62 in lab costs that Medicare did not pay. It took us many hours of work and nearly a year to appeal these costs through three levels of appeal. This long and difficult process - without Dr. Stram's documented justification of his prescription (see below) - caused us quite a bit of unnecessary worry and distress.
2. Refusal to Provide Letter of Medical Necessity: Despite numerous requests to his office Dr. Stram refused to help us in our Medicare appeal by providing a written explanation of medical necessity for the tests. He said through a staff member that his office does not have a "policy" of issuing such statements because "Medicare never reverses its decisions about claims." (Medicare eventually did, in fact, reverse its decisions after months of effort on our part, but not with his needed assistance.) Not only did Dr. Stram fail to honor our request for covered tests, but he was unwilling to substantiate the medical need for the tests he prescribed either in writing or verbally. After Livanta's negative assessment of his care, we now understand his reluctance to provide such justification. There apparently was none. So in our appeals, we had no way to establish medical necessity. All we had in hand was his brief prescription before the tests. He was unwilling even to talk with Medicare about the claims. Why did Dr. Stram refuse to substantiate his prescription? Was he concerned that he was unable to medically justify the financial stress he caused us and wanted to somehow distance himself from it - and us? Did he not, in fact, have sound medical reasons for his prescription? The Livanta assessment suggests he did not.
Dr. Stram's refusal to support the medical necessity of his prescription made our appeal extremely and unnecessarily challenging. That refusal to justify his unilateral action simply added insult to injury. The first mistake may have been unintentional because of his apparent indifference to our situation, but the second action seemed thoroughly intentional. His office was aware of our dilemma because we called them a number of times requesting the letter, yet refused to help -- even when it seemed incumbent on them to do so. Dr. Stram refused speak with us directly, but the office person with whom we did speak said she consulted him before refusing to help us.We believe Dr. Stram's mindful refusal is unconscionable, given our expressed dilemma & need and Medicare's request for the letter.
3. Overcharged: Additionally, Dr. Stram charged us more than the 15% limiting charge allowed by Medicare for our first visit according to our Medicare Summary Notices for 3/19/15. His office refused to reimburse us the difference.
4. I cannot tell if Dr. Stram's expensive treatment, or simply time, cured my cough, but Livanta said it "did not meet the professionally recognized standard of care." It surely cost us a lot of subsequent headaches.
I share this in the hope that others may avoid our unpleasant experience. Caveat emptor! read more