I am just sharing an experience that worked out well for me. Follow it to the end..the morale of the story is at the end.
its regarding to 2 recent billing errors. I have medicare with a supplimental insurance. first medicare covers 80% then my supplemental gets a bill and they cover the last 20%
FIRST ERROR HAPPENED IN FEBRUARY OF THIS YEAR...after covering my infusions for over 2 years, problem free. medicare suddenly refuses to pay. i receive a bill from the infusion center that i owed over a $2,500 for the infusion.
I was pretty panicked, thought maybe i reached a lifetime limit? and was thinking i needed to stop the infusions, because i don't buy what i can't pay for & that's it! if i can't pay for tysabri because i have reached some kind of lifetime limit...tysabri is OVER FOR ME!!!
so i called MEDICARE first and asked directly if i have reached a limit. the person says no i need to get the infusion center to resubmit.
so i do---and this has taken a lot of phone calls to different buildings ect. can't talk to the person that does the submission only someone else who can talk to that person and i can talk to someone who can talk to SS ect. Denied again!
this time i call medicare and i talk to someone willing to listen..FIRST IT IS ILLEGAL FOR ME TO GET A BILL FOR THE INFUSION AS THE INFUSION CENTER AGREES TO ACCEPT ASSIGNMENT-WHATEVER MEDICARE IS WILLING TO PAY THEY MUST ACCEPT AND NOT BILL IN EXCESS.
AT FIRST THE MEDICARE REP THOUGHT THAT THE INFUSION CENTER HAD VIOLATED THEIR CONTRACT WITH MEDICARE AND WOULD LOSE ALL MEDICARE Patients.
Then we communicated further and established that the infusion center was not sending me a bill because they wanted more than what medicare reimbursed, but medicare refused to pay at all for the treatment and it had to be discovered why medicare was refusing to pay at all, after paying for 2 years?
it is legal for a healthcare provider to bill for services that medicare refuses to pay, the patient can still get the treatment if they pay for it & that's legal.
Well going back to the medicare rep, she said we need to find out why medicare all of the sudden refused to pay for something that it had been paying for 2 years?
THEN SHE TOLD ME ITS NOT MY PROBLEM ANY MORE! SHE SAID MEDICARE HAS BILLING RESOLUTION REPESENTATIVES LOCATED REGIONALLY AND THAT PERSON WITH THE INFUSION CENTER WOULD RESOLVE THE PROBLEM.
Turns out a data entry error of a factor of 10 had been entered into my claim, so medare denied it as its not an approved dosage. the dosage was corrected on the claim, medicare paid and i heard no more about it.
THEN IN JULY I GET ANOTHER BILL, THIS TIME MEDICARE PAID BUT THEY HAD RECEIVED NO RESPONSE FROM MY INSURANCE.
I had learned alot from febuary, how frustrating it was to be on the phone with people who couldn't resolve the issue. but i was responsible for paying.
I remembered what the medicare rep had told me in febuary, this is not your problem. i thought yes this is not my problem--this is a problem between the infusion billing department & my insurance company. i'm just stuck in the middle.
So wrote 2 letters--1 to the infusion center billing dept and requested a copy of what had been submitted to my insurance that hadn't been paid & the month before & after which had been paid. I wrote i suspect a data entry error and i would like to review all three submissions for differences.
Then i wrote a letter to my insurance company and requested a copy of my statement for July as i had received a bill after 2 problem free insurance payments years.
I suspect a data entry error and i have also requested what was submitted to insurance from the infusion center at that time.
Then i copied both letters to each other and mailed.
Yesterday i got this response from my insurance company--i wasn't sure this letter writing was gonna work, but it did. My insurance company and the infusion center found the problem and corrected it!
Here is the note I got back from my insurance company:
12/21/11 Dear Ms...,
I contacted "P" and spoke with "L", she was able to fax over the claim since we did not have it.
It has been processed, check will be issued to your provider on 12/23/11.
Thank you,
"S"- Claims Depart Team Leader.
I think this is such a great resolution to the issue and am so glad of the way i handled it--which i learned from a Medicare Representative, but it could not have had such a fantastic resolution from my view point without the extra effort by "S" & i was so lucky that she was the one who got my letter. there is a thank you note to her from me that will be in the mail soon!
its regarding to 2 recent billing errors. I have medicare with a supplimental insurance. first medicare covers 80% then my supplemental gets a bill and they cover the last 20%
FIRST ERROR HAPPENED IN FEBRUARY OF THIS YEAR...after covering my infusions for over 2 years, problem free. medicare suddenly refuses to pay. i receive a bill from the infusion center that i owed over a $2,500 for the infusion.
I was pretty panicked, thought maybe i reached a lifetime limit? and was thinking i needed to stop the infusions, because i don't buy what i can't pay for & that's it! if i can't pay for tysabri because i have reached some kind of lifetime limit...tysabri is OVER FOR ME!!!
so i called MEDICARE first and asked directly if i have reached a limit. the person says no i need to get the infusion center to resubmit.
so i do---and this has taken a lot of phone calls to different buildings ect. can't talk to the person that does the submission only someone else who can talk to that person and i can talk to someone who can talk to SS ect. Denied again!
this time i call medicare and i talk to someone willing to listen..FIRST IT IS ILLEGAL FOR ME TO GET A BILL FOR THE INFUSION AS THE INFUSION CENTER AGREES TO ACCEPT ASSIGNMENT-WHATEVER MEDICARE IS WILLING TO PAY THEY MUST ACCEPT AND NOT BILL IN EXCESS.
AT FIRST THE MEDICARE REP THOUGHT THAT THE INFUSION CENTER HAD VIOLATED THEIR CONTRACT WITH MEDICARE AND WOULD LOSE ALL MEDICARE Patients.
Then we communicated further and established that the infusion center was not sending me a bill because they wanted more than what medicare reimbursed, but medicare refused to pay at all for the treatment and it had to be discovered why medicare was refusing to pay at all, after paying for 2 years?
it is legal for a healthcare provider to bill for services that medicare refuses to pay, the patient can still get the treatment if they pay for it & that's legal.
Well going back to the medicare rep, she said we need to find out why medicare all of the sudden refused to pay for something that it had been paying for 2 years?
THEN SHE TOLD ME ITS NOT MY PROBLEM ANY MORE! SHE SAID MEDICARE HAS BILLING RESOLUTION REPESENTATIVES LOCATED REGIONALLY AND THAT PERSON WITH THE INFUSION CENTER WOULD RESOLVE THE PROBLEM.
Turns out a data entry error of a factor of 10 had been entered into my claim, so medare denied it as its not an approved dosage. the dosage was corrected on the claim, medicare paid and i heard no more about it.
THEN IN JULY I GET ANOTHER BILL, THIS TIME MEDICARE PAID BUT THEY HAD RECEIVED NO RESPONSE FROM MY INSURANCE.
I had learned alot from febuary, how frustrating it was to be on the phone with people who couldn't resolve the issue. but i was responsible for paying.
I remembered what the medicare rep had told me in febuary, this is not your problem. i thought yes this is not my problem--this is a problem between the infusion billing department & my insurance company. i'm just stuck in the middle.
So wrote 2 letters--1 to the infusion center billing dept and requested a copy of what had been submitted to my insurance that hadn't been paid & the month before & after which had been paid. I wrote i suspect a data entry error and i would like to review all three submissions for differences.
Then i wrote a letter to my insurance company and requested a copy of my statement for July as i had received a bill after 2 problem free insurance payments years.
I suspect a data entry error and i have also requested what was submitted to insurance from the infusion center at that time.
Then i copied both letters to each other and mailed.
Yesterday i got this response from my insurance company--i wasn't sure this letter writing was gonna work, but it did. My insurance company and the infusion center found the problem and corrected it!
Here is the note I got back from my insurance company:
12/21/11 Dear Ms...,
I contacted "P" and spoke with "L", she was able to fax over the claim since we did not have it.
It has been processed, check will be issued to your provider on 12/23/11.
Thank you,
"S"- Claims Depart Team Leader.
I think this is such a great resolution to the issue and am so glad of the way i handled it--which i learned from a Medicare Representative, but it could not have had such a fantastic resolution from my view point without the extra effort by "S" & i was so lucky that she was the one who got my letter. there is a thank you note to her from me that will be in the mail soon!
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