A new client asked us for help with a bill that he got under Obamacare before he became a client of our agency. We helped him. The client is from the Miller Beach area of Gary, Indiana.
The client had been careful to read the details of the Obamacare “On Exchange” plan from an insurance company. He learned that certain “preventative services” were free under the plan. So, he got the Obamacare plan and then went to a local hospital for preventative services that he thought would be free. The surprise he got almost made him sick.
He got a bill for what he thought the Obamacare “On Exchange” policy would cover for free. He brought the evidence to our office. We helped him to file a complaint with the Indiana Attorney General. The Attorney General forwarded the complaint to the Indiana Department of Insurance. The Indiana Department of Insurance questioned the insurance company that issued the policy.
The answer of the insurance company for the failure of the Obamacare “On Exchange” policy to cover “preventative” services was very clear and to the point. The hospital was using wrong codes and notes for services rendered which classified the services as NOT PREVENTATIVE. Since the services were not preventative, the services were not covered by the “preventative services” promises of the insurance policy.
In fact, the hospital refiled several times changing the codes and descriptions. But, the hospital personnel never filed the claim with the correct wording and coding. So, our client got stuck with a bill for $611.14.
I suggested to the client that he take all the papers to the hospital billing department and ask them to either file the claim correctly so that the filing would comply with the “preventative services” rules of the Obamacare policy or compromise and discount the bill so that he could pay a reduced amount and be done with it. I believe that the client was disappointed with his Obamacare policy, but not disappointed with all the work that our agency did to help him with a problem that happened before he became our client.
This case was very difficult because the client did not buy the problem policy through this agency. Therefore, I helped him by listening to him, reading the documents, and typing letters for him to sign because I could do no more than that.
In this case, the Obamacare “On Exchange” policy did not help the patient. It hurt the patient financially.
Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has saved clients of that insurance agency over one million dollars by fighting fraud and mistakes in the Medicare system. He wrote the book SOLVING MEDICARE PROBLEM$.
© 2016 Woodrow Wilcox