Medicare / Insurance Help

[Scar]

My uncle has been receiving treatment over the last few months which has included many out patient hospital visits, different doctor and specialist visits, etc. This has resulted in many different bills, statements, Medicare statements, insurance statements, etc. He has good insurance and can afford his portion of the bills, but he has no clue how to handle the paper work and make sure insurance and Medicare are paying their share. I have volunteered to do the paperwork for him but this is a first for me and it’s a little overwhelming.

Does anyone have any advice or maybe know of a website that can give me tips on how to organize all of this. Again, my main concern is that Medicare and his secondary insurance are paying as much as they should.

[Daisy'sMom]

He should have received explanation of benefits from Medicare and his secondary insurance. If not, you can call Medicare and request these(he probably will have to call). These eobs will tell him how much they were charged, how much they paid and how much he is responsible for. Each time the physician or hospital bills Medicare, Medicare will send a copy to patient. Good luck!:blush:

[MMouse6937]

If he has Medicare and a supplemental insurance he should not be responsible for anything besides the annual deductible (which I believe is $100.) As the above poster said, look at the EOB (explanation of benefits) and check what was billed, there will be an allowable amount, then a coinsurance, the rest will have to be written off by the doctor or hospital. The coinsurance amount is what the secondary insurance should pay. Also, Medicare will normally forward the secondary claims straight on to the secondary payer, but not always. A lot of doctor's offices and hospitals have gotten out of the practice of billing secondary insurance for you (since the coinsurance is normally a small amount unless you have a major surgery) so you might have to submit copies of those EOBs to the secondary yourself. Let me know if you have any questions. :)

[princessjojo]

It is overwhelming, and I feel your pain. When our boys were hurt, we were bombarded with paperwork. Our first statement from the hospital came in a large manila envelope, and between both boys the bill was 108 pages long. Granted, I did request a detailed statement, but I was stilled shocked to say the least. Follow me and I will tell you the madness I used to keep it all straight.

First, always request a detail bill. This way, you can assure all charges are correct, and you aren't being over billed or billed for services/medications/therapies not received. I then scanned these into my computer and filed each one with the individual invoice number.

Secondly, I printed from the insurance co. each individual EOB and attached a copy of this to the invoice that it referenced. From here, you can do the same for Medicare. You may have to do this in reverse, I don't know how this really works.

After the 2nd EOB is processed, you should be able to see what your final cost is if any. I made the hospital's accounting dept. aware of the fact that I wouldn't pay anything until insurance processing was complete and I had an EOB to accompany each invoice. We were actually over billed $7800 because the insurance co. said they billing multiple times for the same services and I had to have the hospital refile claims with very specific details of the surgical services because there were so many performed.

Anyway, when the final invoice from the hospital arrives, match that invoice to the original detailed statement and all EOBs to make sure the numbers match. Once you're satisfied, pay each with an individual check, reference the invoice number on the check and file a copy of that once cleared the bank with that particular file. If you pay with a flex spending account, just file each receipt with that specific file, just as you would a check.

It really is a lot of work. I did it this way because I was afraid that if a payment was not applied as it should be, I wouldn't be able to support my case, and our bills were so great I could never pay them off if I didn't know what they were for, about, or how the insurance would/should apply payments. I also did this because I was afraid that when tax time rolled around, a red flag would be raised. We generally have minimal medical expenses, but that year, they equaled well over $800,000 so I wanted to be prepared if an audit came about. And it's easier to keep up with a computer disc than that much paper.

Good luck. I still follow this practice and have learned to watch EOBs carefully. Some say I'm obsessive, but I just don't have extra cash laying around for medical expenses. I've saved myself about $400 since just knowing what I should pay vs what the doctors charge. If I can help you at all, please let me know.

[ckaranassos]

First off great advice from everyone above. Second do not and I repeat do not pay a dime until you have spoke with all parties involved. Sometimes it takes 1, 2 and 3 times. I have recently learned that most insurance companies (I say most because I do not want to offend anyone) actually have a team of people that are formed to go over your claims and find reasons not to pay. Secondly, it is common practice in most insurance companies to lose your paper work, making resubmitting a must. I feel your pain, my step father past away 2 years ago from Lou Ghehrigs disease (ALS). He was a retired teacher with great benefits through a popular insurance company and also qualified for medicare early because he was only 60 do to an exception for people with ALS. After two years, I think, I hope everything has been staightened out. He was responsible for nothing, because he had both coverages, but it was a very long battle to get there. Keep your head up and have a lot of patience. And from me to you, you are an Angel in disguise, because it is not an easy task. :thumbsup: Good Luck!!

[Scar]

Thank you all for your advice. I jumped into it today and, well, we will not be using our dining room table for at least a few days. The main problem is that I only have all three statements on about 30% of the visits. On the rest I'm missing either the Medicare, insurance, or the actual bill itself.
First off great advice from everyone above. Second do not and I repeat do not pay a dime until you have spoke with all parties involved. Sometimes it takes 1, 2 and 3 times. I have recently learned that most insurance companies (I say most because I do not want to offend anyone) actually have a team of people that are formed to go over your claims and find reasons not to pay. Unfortunately, my uncle is old school and is insisting to pay whatever he is told he owes. I did notice that a lot of the secondary insurance is not paying on certain things. There are so many visits and statements that I guess they try to get away with as much as they can.

[tyandskyesmom]

The main problem is that I only have all three statements on about 30% of the visits. On the rest I'm missing either the Medicare, insurance, or the actual bill itself.Unfortunately, my uncle is old school and is insisting to pay whatever he is told he owes. I did notice that a lot of the secondary insurance is not paying on certain things. There are so many visits and statements that I guess they try to get away with as much as they can.

About the statements...you (or he may have to call Medicare, his other insurance and the provider of service to give his permission for them to talk to you) should be able to call each provider of service, Medicare or the other insurance and have the statements/EOBs re-sent to him/you.

About the payments...surprisingly, a lot of people are like that. Even if he paid incorrectly due to problems with charges or processing of a claim he should be able to contact the party he paid it to after you have the EOBs that say he did not owe that much and they will have to issue him a refund...yes, a lot of work but if he has indeed made a lot of payments that he did not actually owe, it will be worth it in the long run. Providers generally have no problem taking your money...whether you owe it or not.

On the secondary not paying a lot of things...you need to make sure you know what the secondary is responsible for and what the provider is responsible for and what the patient is responsible for. Read the whole EOB...not just the numbers. A lot of providers are contracted with many insurances and they in turn write off a lot of monies. BUT, it is largly done by people so there is tons of room for human error and that representative's intrepretation of the EOB. If you don't know or are unsure, call the insurance company and ask. Also, a lot of times the secondary (unless it is a purely supplemental insurance only) does not coordinate with the primary one so make sure you have checked that the secondary coordinated with the prime for the correct patient responsibility. If there are specific deniad charges, find out what they are and make sure they are denied correctly. For example, are they patient convienence charges? Or are they a coding issue that the provider of service can and should correct and re-submit? Is the diagnosis correct? I mean, if he had a Chem Panel (a blood test for many things) because he is diabetic and/or has high cholesterol (just for my example) make sure that diagnosis is not listed as a routine medical exam (the diagnosis codes on the bill and EOB would show as beginning with a V in most cases). A lot of it is going to be insurance specific. Medicare is pretty general but will make the provider of service jump through hoops to bill the claim the way they want it billed so make sure Medicare did not deny something that could and should be corrected by the provider and re-submitted. Also, the secondary will be pretty insurance specific. So make sure you have a good idea of what is covered and at what rates.

And lastly, the insurance company is a business and keeping their money is their business...so yes, they will try all kinds of things to delay a payment or to not pay at all. If you think something sounds wrong or just want a further explanation, do not hesitate to call the insurance company. They should be able to answer all your questions to your satisfaction.