The Medicare Whisperer

Denise, who has a Medicare Advantage plan, recently underwent an electro-cardiogram by a cardiologist.

Returning the following week for results, she was happy to learn they were normal, and there was nothing to worry about.
Later while sorting her mail, Denise found the cardiologist’s bill had arrived.

The charges were over $400 for the electrocardiogram.

After her initial shock, Denise remembered that prior to the procedure she had called her insurance company. During that call she had confirmed what her co-pay would be for an electrocardiogram — hundreds of dollars less than what she had been billed.

What Now

Denise called the cardiologist’s billing department. She calmly explained the situation and shared her insurance company’s explanation of her co-pay.

The billing office pulled up her claim and told her, sorry, the bill was correct.

Not satisfied with this answer, Denise grabbed her insurance card and asked the billing agent to read off her plan ID number noted on the claim. Bingo. That quickly, Denise had identified the problem: the provider had mistaken an “I” in her ID number for an “L,” resulting in an inaccurate bill.

The billing agent apologized, corrected the information, and said that they would resubmit the claim to Denise’s insurance company.

A month later, Denise received an updated bill from her cardiologist’s office with the correct co-payment due, Denise happily paid it.

Denise’s story had a happy ending thanks to her diligence in questioning the bill. Mistakes can and do happen, and it’s up to the “customer” to ensure a correct outcome.

Takeaways

• Always review your medical bills. Trust your gut — if something seems wrong, question it.
• Never pay a provider bill that gives you pause or seems incorrect.
• Don’t be afraid to communicate your concerns — with your provider, insurance company, or both.

As with any transactional relationship (services rendered in exchange for payment), healthcare is “Buyer Beware.” The only way to ensure a fair and equitable exchange is to know the agreement and speak up if anything goes awry.

Sadly, too many people take a medical bill at face value and pay it.

Be like Denise: pick up the phone before picking up your wallet.

 

Julie VanDyke
50plus Magazine

Julie VanDyke is a freelance writer committed to simplifying Medicare for all.