On March 9, 2015, I received a phone call from a very happy senior citizen client from De Motte, Indiana. She reported to me that my letter to a hospital on her behalf had worked to reduce a bill by over $120.
When she first met with me and brought the hospital bill to my office, I reviewed it and then phoned both her insurance company and Medicare with her to discuss the problem. I learned that the bill was for “Self-Administered Drugs” and it was for $148.26. Neither Medicare nor her Medicare supplement insurance would pay for these drugs because of rather new Medicare rules written in 2009 by President Obama’s then new Attorney General Eric Holder.
Holder wrote new definitions for “in-patient” and “out-patient” for seniors who visit a hospital. Both doctors and hospitals must use these definitions or Medicare will pay nothing. Under the new definitions, it is possible for a senior citizen on Medicare to stay overnight in a hospital, but be considered and out-patient. If a medical service is given to a senior in a hospital who is legally defined as an out-patient, Medicare won’t help to pay for medicines taken while in a hospital. Out-patients are covered by Medicare Part B which does not pay for prescription or non-prescription drugs. In-patients are covered by Medicare Part A and do get help with prescription and non-prescription drugs while in a hospital.
This forces the hospitals to charge senior citizens for medicine taken while in a hospital and under the out-patient definition as written by Eric Holder under authority of Barack Obama.
The bottom line is that the rules written by Eric Holder hurt hospitals and senior citizen patients on Medicare but help drug manufacturing companies to make billions of dollars more at the expense of senior citizens.
To reduce the bill for our client, I simply acknowledged that the hospital did not cause this problem. But, it would be nice if the hospital reduced the costs of the medication to the same amount it would have received if the old rules had still been in place and Medicare would pay for the medicines. The hospital liked this proposal to resolve the problem and save our senior citizen client over $120. Neither our client nor the hospital caused this problem. Eric Holder did.
Note: Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana. He has saved clients of that insurance agency over one million dollars by correcting medical bill errors that were caused by mistakes in the Medicare system. He wrote the book SOLVING MEDICARE PROBLEM$ (www.solvingmedicareproblems.com).
© 2015 Woodrow Wilcox