A VERY UNUSUAL REPORT

An elderly couple brought some papers to our office and asked me what the papers meant. The couple visited our office on December 6, 2011. The senior citizens were from Munster, Indiana.

“One of these documents has thirteen pages and I can’t understand any of it,” the woman said to me.

I reviewed the papers. I asked them if they were getting any medical bills with balances due. They assured me that they were not.

“Well, then you don’t have any problem,” I told them.

“That’s what I wanted to hear,” the woman replied.

The couple brought three Medicare Summary Notice forms to me. They told me that they never had gotten Medicare Summary Notices until now. They should have been getting these forms since 1992 – almost twenty years ago – when the husband first went on Medicare.

The Medicare system is supposed to send a Medicare Summary Notice (M.S.N.) about every two or three months to the senior citizen who received medical services. It is supposed to happen automatically. But, this couple could not remember ever getting one until now.

There was one M.S.N. which was very unusual. I never had seen one exactly like it in the almost nine years that I have helped senior citizens with Medicare related medical bills. Every footnote on the bill had the same basic entry and then cited the specific Medicare rule regarding Medicare’s ruling on the medical service. Below here is the initial paragraph of every footnote on the M.S.N.

A local medical review policy (LMRP) or local coverage determination (LCD) was used when we made this decision. An LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered by Medicare. A copy of this policy is available from your local intermediary or carrier by calling the number in the customer service information box on page one. You can compare the facts in your case to the guidelines set out in the LMRP/LCD to see whether additional information from your physician would change our decision.

As I have stated in previous articles, Medicare does not pay for everything. In laws and government bureaucracy language, “what the big print giveth, the fine print taketh away.”

Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has helped the clients of that agency to save over one million dollars by correcting medical bill errors that were caused by mistakes in the Medicare system. For other articles by Woodrow Wilcox, visit www.dakotavoice.com and search “Woodrow Wilcox”.

© 2011 Woodrow Wilcox

www.WoodrowWilcox.com