Can Dr. bill patient what Medicare did not pay?
Hi all, have a question about Medicare. Just received a bill from a local hospital for some lab work my late MIL had in July 2017. They billed Medicare part A/B $345.58. Medicare paid $33.77. They made an adjustment of -$150.81 and are demanding payment of $170. This hospital is in network if that makes a difference. We also have not received a statement from Medicare stating MIL could expect to pay this bill. My question is, aren’t they only allowed to bill the patient a maximum of 20%? Isn’t $170 more than 20%? All this Medicare stuff is confusing, I don’t know if it’s 20% of the entire bill or what Medicare paid. I don’t think she had medigap insurance (I’ve seen no evidence of it and unfortunately her box of important paperwork was pilfered by her partner before it was given to us and her insurance paperwork wasn’t there). Do we need to pay the entire $170 or can we fight this? Thank you!
The billing department is the place to start.
Normally if doctor accepts Medicare and your supplimental this is how it works.
Charge 345.58, Medicare approves 42.21, 80% is 33.77.
Difference between approved and 80% is 8.44 this is what ur supplimental should pick up. If the doctor is a Medicare doctor he cannot charge you more than the 8.44.
Trying to figure out how they got to 170. 00 due. This is how I got close.
Charged 345.58
Medicare 33.77-
_______
Total 311.81
150.81- adjustment
______
161.00
8.44 20%
_______
169.44 being billed.
Without seeing your paperwork this where I got. If he excepts Medicare the most he can charge you is the 8.44. He has to except the 33.77 because of his contract. If he feels Medicare has made an error he needs to resubmit. His office may have coded the billing wrong.
Like I said, without seeing your paperwork its hard but I think I have given you and idea how it should work.
I think if you Google Medicare specialist you should find something.
I will PM u with the guy I used, maybe he knows someone in your area or can help.
20% is not based on the amount charged but the approved amount by Medicare. I think someone in the billing department has made a mistake. If the estate has no money, the bill can't be paid. You r not personally responsible for it.
I would look at her EOB, co-pays are such that you may or may not meet the deductible. It is a screwy system.
Can you contact a Medicare specialist insurance agent, they could look at the paperwork and help you understand.
Another avenue would be to file a Medicare fraud complaint, with your local office on aging helping you, that would get answers and resolutions.
I hope you can get this sorted out, I can feel your frustration. These scummy little vultures get off on making people crazy.
Remember it’s her debt not yours.
Is hubs opening probate? Or that boy friend of hers? Personally I’d kick this bill and any others that show up......and it can take years for the billing cycle to run its course..... to the ”unfortunately Jane Smith Jones, whose bill this is, died on xbxncnc and its anticipated that her heirs will be opening probate in the future. Your bill will need to file according to CA probate code as a debt against her estate. And remember - insert name of debtor here - there will be a NOC (Notice to creditors) in the newspaper of record for her probate court as to where that claim is to be filed”
Then hang up.
Really after the first couple of these, you’ll have this response down pat.
Signing a paper saying Mom would be responsible for any balance refers to the 8.44 if her suppliment doesn't pick it up or her deductable not satified. The lab has excepted the $33 (80%) they are entitled to 8,34 the 20%. That is all.
Since it seems like boyfriend has taken over, give him the bills. He needs to have a list of debts. He also should be figuring this all out. Give him my breakdown. If he took all the paperwork, then he may have the Medicare and supplimental paperwork. The supplimental will show the breakdown. What Medicare paid and what they paid or didn't pay. Always use the supplimental to determine what balances are left.
I just went thru something similar.
and thank you, I assumed the paper she signed was in reference to the same thing, not that she would be responsible for the rest of the original amount.
laboratory charges $354.58
medicare O/P contr adj -$150.81
medicare A/B payment -$33.71
amount MIL owes. $170.00
that is the only information on the statement.
and again this was sent by the hospital. They have their own labs. This wasn’t an outside lab. And they take Medicare (aspire health plan). So when I call, it is correct they should have only billed 20% of $33.71?
also the lab services were actually 6/13/17. Medicare paid $33 in July 2017. I wish I could call and tell them they are 6 months too late and that if they want to get paid, they should bill their patients in a timely manner!
They can only charge what Medicare approved for the services.
If your MIL has died, send them a copy of the death certificate and that should be the end of it. I believe they only have 6 months after death to file a bill against her estate, after that they are out of luck.
If she ever had a supplemental insurance, you would have seen a bill or auto-withdrawal for premiums.
I would contact Medicare and ask them to help you understand how it works.