By Woodrow Wilcox
A veteran came to our office in Merrillville, Indiana. He was upset about a bill from the Veterans Administration. The bill for over $300 was for visits to a doctor at a VA Clinic. He wanted to know why Medicare and his Medicare supplement policy were not paying the bill.
When the veteran got the services, the VA thought that he had a low enough income to qualify for the medical services at no charge. But, in 2002, the law was changed so that veterans who have an income over certain levels set by the VA will be charged $15 for a visit to a general doctor and $50 for a visit to a specialist doctor at a VA clinic.
The VA checked with the I.R.S. about his income level. The VA determined that our client should have paid the $15 or $50 charge to visit a doctor at a VA clinic. It sent him the bill.
The VA does not bill Medicare. If Medicare does not get a claim and rule favorably on the claim, then neither Medicare nor a Medicare supplement insurance policy will pay the bill. If the veteran client had visited private doctors instead of visiting the VA clinic, both Medicare and his Medicare supplement insurance would have paid on the bills.
Our client was upset with us about the unpaid bill. But, we don’t write the rules about how the VA and Medicare should treat his health care bills. We have a good record of helping our clients when there are mistakes in the Medicare system. But, we can’t change the results of a government policy. There is a limit to what we can do.
To help our veteran client, I typed some letters which questioned the bill and had him sign each letter. There were grounds to question the bill. I discussed the matter with our most experienced agent and thought of some ways to help the client. I phoned the client’s insurance company to discuss the VA—Medicare—insurance claims problem and got some other ideas to help the client.
The client was excited when he returned to our office to show me a letter that he received from the Veterans Administration. They admitted that they made a big mistake by not sending the revised bill through the normal claims process with a certain government contractor that connected VA claims with Medicare and supplement insurance companies.
In this case, federal government rules and regulations prevented me from helping our client to get the entire bill paid. But, I was able to help the client by nudging the VA to follow its own rules which will get part of the bill to our client paid. The point is that I helped the client to get the best possible resolution under the circumstances.
Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has helped clients of that insurance agency to save over one million dollars by finding and correcting medical bill errors that were caused by mistakes in the Medicare system. For other articles by Wilcox, visit publishing websites such as www.dakotavoice.com and www.americanclarion.com.
© 2012 Woodrow Wilcox