By Woodrow Wilcox
There is a big, thick file in my office with the name of a client from Gary, Indiana. Her Medicare claims were gummed up because of some attorneys and an insurance company.
When she came to my office over a month ago, she wanted to know why Medicare and her Medicare supplement insurance policy were not paying anything on her medical claims.
I studied the bills and papers that she brought and then started making phone calls with her. We phoned her Medicare supplement insurance company. It told us that Medicare ruled that neither Medicare nor her Medicare supplement insurance company should pay anything on the denied claims.
Then, we phoned Medicare and requested documents about how and why Medicare ruled that way. We waited two weeks to get those documents. Then, I compared the Medicare documents with the bills. We phoned two different offices of Medicare. In each phone call, the client gave permission for me to speak and question on her behalf.
I found the problem. Some attorneys and an insurance company caused it. Our client had been in a car accident on March 31, 2010. The car accident case was settled. But, neither the attorneys nor the insurance company involved notified Medicare that the matter was settled. They failed to follow professional standards.
When this happens, Medicare believes that another insurance company may first be responsible for medical service claims and then Medicare secondarily. If a doctor or hospital does not specifically mark a claim form as being for a service that is unrelated to an accident, then the form defaults to being related to the accident and the other insurance company’s responsibility. Our client had seven claims that were processed incorrectly by Medicare. The doctors and hospitals wanted their money – from our client.
I helped the client send letters to the attorneys and insurance company to ask them to help fix the problem by filing the proper papers with Medicare. The law firm had closed its office in Indianapolis. I tracked down their chief office in another state. All this took a lot of work.
Our client did not get any response from either the attorneys or the insurance company. So, I helped the client to bring this matter to the attention of the Indiana Attorney General, the Indiana Department of Insurance, and the Indiana Supreme Court attorney disciplinary commission. The Medicare records got fixed fast. Now, all our client’s claims will be reprocessed – correctly this time. We saved our client a lot of money.
All the help that I gave this client was FREE OF CHARGE. This insurance agency distinguishes itself by “going the extra mile” to protect our senior citizen clients from financial harm when mistakes or fraud in the Medicare system threatens them. Does your insurance agent or agency deliver this high standard of service to 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 fighting mistakes and fraud in Medicare claims. Wilcox wrote the book SOLVING MEDICARE PROBLEM$.
© 2016 Woodrow Wilcox