Medicare Billing Mistakes

I have spent the last week in freezing Connecticut helping my 87-year old friend figure out her medical bills.  I wrote about Julie in December when I discovered her retiree Medicare supplement plan had been changed to a Medicare Advantage plan.

Julie’s family have provided her new UnitedHealthcare id card to every doctor, lab and medical provider – but most of them seem to have problems processing the new information.

MEDICARE BILLING MISTAKES

Julie has been getting bills saying her insurance denied payment – and that’s because they billed Medicare (!!).  They all got Julie’s new insurance information – but they did not put it into her record.  How inefficient!

Julie’s family was ready to pay the bills and I said to hold off until I could look at them.  I called some providers and I also called UnitedHealthcare (UHC).  The UHC Customer Service rep I talked to was very helpful and she even put me on hold while she called one doctor’s office.

The UHC Customer Service rep talked to me because Julie was sitting with me and gave permission for me to represent her.  I asked the UHC rep to send Julie a form that will put me in her record as being able to talk to UHC on her behalf in the future. Without that info in Julie’s record, UHC won’t talk to anyone but Julie.

Every Medicare Advantage plan application package should have this HIPAA form – but they don’t.  They have to be requested by the plan member while the plan member is able to sign the form.  Otherwise, the plan won’t talk to anybody but the member – which is a problem for people like Julie who are unable to handle these kinds of details.

ANOTHER PERSON NEEDS HELP

I also I spent a good deal of time last week trying to help a woman who is losing her special needs Medicare Advantage plan because she lost her AHCCCS (Arizona Medicaid). Karen was referred to me and asked for help understanding why she had lost her AHCCCS and why she is soon to lose her UnitedHealthCare Dual Complete Medicare Advantage plan (also known as the Community Plan).

Karen and I made a (three-way) call to AHCCCS (Arizona Health Care Cost Containment System) and spoke to a very helpful woman in the SSI-MAO office (Supplemental Security Income Medical Assistance Only).  This is the office that handles help for people who have Medicare and low income.

It turned out that Karen’s income is $31 over the limit for getting help with her medical bills, and the Dual Complete Medicare Advantage plan is only for people who get this help.  Karen was allowed by the plan to keep it for six months to see if she could re-qualify for AHCCCS help.  However, the Dual Complete plan changed as of January 1st and stopped covering her 20% co-insurance.  Normally, AHCCCS would pay that – but she lost AHCCCS back in October.

Karen was wondering why she was getting medical bills she had never seen before – and she cannot pay them when she lives on $1,032 per month from Social Security.  Karen says she had a stroke and has other heart problems and she needs to be hospitalized for a specific treatment – but she can’t afford the co-pays that come with Medicare or Medicare Advantage plans.

WHAT TO TELL A PERSON WHO CAN’T AFFORD CARE?

I don’t know what to tell Karen about paying for the treatment she needs.  If she has an emergency and is admitted to the hospital, she won’t be asked to pay her co-pay up front.  But if she arranges a treatment that involves a good-size co-pay…… she might be asked to pay that in advance – and she doesn’t have the money.

THE HAVES AND HAVE-NOTS

My friend in Connecticut has plenty of money and can write checks for bills she doesn’t understand.  And then there is Karen, who lives in fear that she won’t get the care she needs because she has just a little too much income to get help with co-pays and co-insurance.

What a country!