By Woodrow Wilcox

On April 30, 2012, I helped a client who was a senior citizen from Dyer, Indiana. The client was upset that a medical bill was not completely paid and that there was a $575 balance. He wanted me to explain why Medicare and his Medicare supplement insurance policy had not paid all the bill. He was not happy when the visit started.

Whenever such a problem occurs, I first gather and review as many documents as the client can provide to me. Also, I compare our records of what kind of policy our client bought through this insurance agency, from which insurance company, and which type of policy.

From the information that I had, I believed that the claim should have been paid if there were no missing pieces of the puzzle. So, I talked with the client to learn if there were some key information that was missing. There was.

The client had retired and started on Medicare and a Medicare supplement policy. But, the client had an ongoing worker compensation claim. That was messing up his Medicare and Medicare supplement claim payments.

When someone is in a car accident or has a worker compensation claim, Medicare wants other insurance to pay first before it will pay on the claim of a senior citizen. If Medicare has a record that a senior citizen has been in a car accident or has a worker compensation claim, a doctor or hospital must mark on the claim form that the services rendered are not related to the accident or worker comp claim if that is the case. If there is no such marking on the claim, Medicare assumes that the claim is related to the accident or worker comp claim. And, that changes the Medicare calculations about what Medicare should pay.

The client did not know that his worker comp claim would affect his other medical service claims. So, he did not tell his doctor, hospital, or other medical service provider to be sure to mark the claim for their services as either related or unrelated to his worker comp claim, depending on the facts.

Because the medical service provider did not mark the claim either way, Medicare defaulted to assuming that the medical service was related to the worker comp claim and made its calculations based on that assumption. But, in fact, for the claim in question, that was not the case.

To help the client, I sent a friendly letter to the medical service provider to explain what I had learned when I made some phone calls with our client to Medicare and his insurance company. I requested that the medical service provider re-file the claim with the information that Medicare required. When this is done, I am confident that our client’s claim with be properly paid and the $575 balance will disappear.

The help that I gave to this senior citizen client was provided FREE OF CHARGE. The owners and managers of this insurance agency know that the Medicare system is not perfect. Whenever one of our clients has a problem with getting a bill paid, we do our best to help the client to get the problem corrected. Does your insurance agency give this high level of extra 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. Wilcox has saved clients of that agency over one million dollars by finding and correcting medical bill errors that were caused by mistakes in the Medicare system. To read other articles by Wilcox, visit publishing websites like and

© 2012 Woodrow Wilcox