On May 27, 2015, I helped a senior citizen client from Saint John, Indiana. She got a bill for medical services rendered on July 28, 2014. The bill was dated May 7, 2015. The medical service provider waited almost a year before filing the claim with Medicare.
The bill was for $131. But, the client had both Medicare and a Medicare supplement insurance policy through this insurance agency. So, why did she get a bill?
First, I phoned her Medicare supplement insurance company to learn what it knew of this bill. It reported that Medicare ruled that the medical services that our senior citizen client received WERE NOT COVERED BY MEDICARE. If that ruling remained unaltered, our client would have to pay the bill.
But, I phoned Medicare with our client and asked why the medical services were denied by Medicare. Always ask why.
The reason was that the claim was filed as an annual wellness visit with less than twelve months passing since the last annual wellness visit. The client was a regular patient of the medical service provider that filed the claim. It knew or should have known that Medicare would not pay under those circumstances. The medical services should have been filed under different coding and with different notes to fit the Medicare guidelines.
To help our client, I wrote a polite but exact letter to the medical service provider and explained what errors were made. I asked that the claim be corrected and refiled with Medicare. If the medical service provider cooperates, I believe that will fix the problem and eliminate the $131 bill for our senior citizen client.
All the help that I gave this client was FREE OF CHARGE. The people at this insurance agency really do care about our senior citizen clients and we “go the extra mile” to protect them from financial harm when a mistake is made in the Medicare system. Does your insurance agency give this high standard of service to its senior citizen clients? If not, why not?
Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has saved clients of that insurance agency over one million dollars by correcting mistakes in the Medicare system. Also, he wrote the book SOLVING MEDICARE PROBLEM$ (www.solvingmedicareproblems.com).
© 2015 Woodrow Wilcox