Has this happened to you? Here’s a situation encountered by some of my clients recently.
What HappensYou receive a bill from a hospital or medical service you’ve already paid. Mistakes happen—this is not to imply that the biller is doing the wrong thing. The bill may be recent or several months old, and the bill shows you paid your share of cost at the time of service. You search your plan’s or Medicare’s Explanation of Benefit statements, and confirm your payment, but do you owe this bill?
Don’t hesitate to question a bill you receive. Receiving a bill does not mean you owe it.
Your Action PlanContact your agent for assistance or call your plan. Agents and insurance plans do their best to provide good customer service. Having your agent initiate a three-way call to the plan with you on the line can help. The plan will contact the provider and clarify if payment is needed. There’s generally a favorable outcome, and in the cases of my clients, each matter was successfully and promptly resolved. Not one client owed a penny.
Medicare Protects
Its BeneficiariesWhen providers agree to treat Medicare beneficiaries, they must follow strict billing rules. For Medicare Advantage members, this protection is found in your plan’s Evidence of Coverage. Your responsibility is to satisfy your plan’s deductible, if any, and pay your copays or coinsurance for care. You pay nothing more, even if the payment amount is in dispute, or if the carrier did not pay the full amount the provider charged.
For Medicare Supplement members, your provider bills Medicare first for Medicare to pay its share of Medicare approved expenses, and after the part B deductible has been met, if required by your plan, the remainder is paid by the supplemental plan. Depending on the provider and whether the provider accepts Medicare’s payment as payment in full (called “assignment”) or not, there are maximum rates in place for services and rules on how much Medicare will pay. If you receive a bill, contact your agent, the supplemental carrier, or the billing office listed on the statement you’ve received. You’ll have resolution with no additional payment from you as the member.
One client, on a very limited income, received a large and unexpected bill. He reluctantly concluded that this must be the cost of the services received and dutifully paid the $1,500 bill. I’d called to see how his plan was working for him, learned of the bill and his payment. Our immediate three-way call to the plan proved he owed nothing, and the client stopped payment on his check he’d mailed the day before. Stop before you mail that payment—you may not owe that bill!
Leah Kari, AMR, FHIAS, specializes in showing Medicare eligible people their insurance options. Reach Leah for comments by phone at (520) 827-2460 (TTY users dial 711) or send an email to leah@leahkarisolutions.com.
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