Medicare Advantage problems? Speak up!

I recently wrote about a client of mine who got a $715 bill for durable medical equipment (DME). She was shocked to learn that she owed $715 for a machine she assumed she was renting – but she did not fight the charge.  She arranged with the DME company to pay them $20 per month for as long as it would take to cover the bill.

At this time of year, I check in with my Medicare Advantage clients to see how their plan is working for them.  When I called Alana, she said she likes her plan, but she had received a big bill for DME.  I went to her house and got copies of the bill and the contract she signed – and then I contacted her Medicare Advantage plan as well as the DME company.

After a week of exchanging emails with her Medicare Advantage plan, and my discovery of the Medicare “Patient Bill of Rights and Responsibilities”, Alana is no longer responsible for the $715 bill.  Wahoo!  I have to admit it gives me great pleasure to win one for a client – and I have a feeling this blog gives me some leverage when I am talking to insurance companies. Read the full story here.

But besides bragging about my victory, the  point of this post is to advise people that they can and they should dispute bills they don’t think they should have to pay.  People on Medicare Advantage plans have the right to appeal decisions if their plan says they cannot get tests or procedures – or if they get a bill they don’t think they should have to pay.   As well, they can make complaints if they think they are not being treated fairly by their plan.

For more on your Medicare rights see past posts: http://tucsoncitizen.com/medicare/tag/medicare-appeals/  and http://tucsoncitizen.com/medicare/2012/08/22/medicare-advantage-complaint/

When I help a person enroll in a Medicare Advantage plan, I tell them to call me if they have any issues with their plan. They can handle the problem themselves, but I know whom to call and what to say to the company.  It’s not surprising that many seniors are hesitant to stand up to an insurance company – and many are afraid they will lose their plan if they make complaints.  I can assure people that this does not happen.  I can’t assure my clients that I can fix their problem, but together we can give it a try.

So if a person is enrolling in a Medicare Advantage plan and they are working with an insurance agent, they should ask that agent if he or she will be available to help with any issues that might arise.  There are agents from Mesa who come to Tucson, sign people up, collect their commission, and disappear. I’d recommend going with a local agent or someone who is recommended by a friend or relative.

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I just got a call from a client who had a car accident last week. She and her husband were transported in the same ambulance and they each got a bill for $1,000. They are in different Advantage plans, so their co-pays will be different.  But Nancy’s question to me was, “Why are there two bills when we were in one ambulance with one attendant taking care of the both of us?”

That’s a very good question, and I told Nancy to talk to the ambulance company and  tell them she will dispute the two bills. We need to find out if this double billing is allowed by Medicare.  It seems like a rip-off to me. But we will figure out what Nancy and her husband’s rights are in this situation.

Don’t get pushed around! Ask questions. And let me know if you have similar stories I should write about.

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