Monday, December 12, 2011

Medicare and Me

Everyone who knows me knows that I'm old. I've been on Medicare since the first day I was eligible and have paid for Medigap since then. I also have saved every piece of paper that Medicare, the Medigap insurer, and the medical profession has sent. What a mess!! I have the papers filed by year and I tried to file them by doctor and/or hospital but that didn't work and I tried to file them according to the patient - me or Edgar - but that doesn't work because multiple medical people and multiple patients appear on the same papers. So much for background.

On Saturday, I received a statement from the billing service used by our doctors. It was wrong and I had the paperwork to prove it. Since they agree to take whatever Medicare pays, the charge was too high. Then, they deducted the medicare payment from the high charge, did not deduct the payment that was sent by the medigap insurance people, and billed us for the amount they said we owed. The medigap payment was considerably less than the amount they billed us.

I sat down this morning with three pieces of paper: the statement from the billing company, the statement from Medicare that outlined the approved cost and what they paid, and the statement from Medigap that outlined when they paid the difference. I called the billing company, waited on hold for about 3 minutes, gave the identification information to the polite but officious woman on the phone, and was told that the money from Medigap had not arrived when the statement to us was generated.

I was polite, and told her that the statement was wrong. She bristled. She said that they deducted the Medicare payment. I told her that the total amount was much more than Medicare approved. She tried to talk over me, but, channeling Judge Judy I told her that she could not talk over me but she had to listen to what I was saying. I asked her to please send a zero-balance statement. She launched into her prepared speech, to wait, then to call back, then, if the money was received, if I asked, the zero balance statement would be sent out. I told her that I was prepared to make copies of these 3 pieces of paper and send them to the Medicare Fraud division. She put me on hold. I waited patiently. Then she said that the correction was made on the statement concerning the approved Medicare amount and that as soon as the payment was received from Medigap, the statement would show a zero balance.

I thanked her and told her that I knew that the extra $50.00 was not going into her pocket, nor was it going into our doctor's pocket, but it was just sloppy bookkeeping. This could have cost us but, thanks to saving every piece of paper, it didn't.

In closing, I feel like I'm writing this over and over but I have to stress the importance of keeping records. They don't even have to be good records. Just keep all the papers in a carton that says - KEEP. DON'T THROW THIS AWAY. EVER.

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