I am on straight Medicare with a supplement. Last October I had to visit the ER and spend one night in the hospital. I haven't received billing yet for the hospital or ER so I'm assuming that was covered. But I AM receiving bills from a private medical group and a private lab facility which again I assume are over and above the hospital and ER expenses. I have heard talking heads on TV rail about this clearly unfair practice, but am wondering (a) if it is still legal and legit and (b) if so, what options if any beyond just not honoring these bills I might have. Thanks in advance.
Medicare Information and Discussions
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Double Billing?
- Thread starter Barry
- Start date
After a hospital visit, Medicare receives a bill from the hospital for use of the facility. Medicare receives a series of bills for the professional services provided (surgeon, anesthesia, radiology, lab, etc.). The supplement then pays second. The supplement sends you an Explanation of Benefits (EOB) stating how much you owe. If the bills you are receiving are for the same amount as the supplement says you owe, then you are responsible for paying the amount the supplement says you owe.
If the bills are for more than the supplement EOBs say you owe, you need to let the biller know you have Medicare and a supplement and they need to wait until the supplement has processed the claims and determined the amount owed before sending you a bill.
If the bills are for more than the supplement EOBs say you owe, you need to let the biller know you have Medicare and a supplement and they need to wait until the supplement has processed the claims and determined the amount owed before sending you a bill.
JC
Well-Known Member
I have never heard this happening. The only thing I can think of that could be going on is if the different drs or testing facilities do not accept medicare in which case they are sending you the bill to be paid instead. If they are Billing Medicare first then you would only be responsible for what your supp says you owe. If you have a plan F for example you wouldn't be responsible for anything. I would be curious to know what they say about this.
The provider billed me a few dollars more than Medicare identified as my maximum payment. I contacted the provider and the rep had to do the old "I'll ask my manager" routine before they agreed to accept what Medicare said they were due. But they wanted me to pay first, THEN they'd do the adjustment. No way Jose', I've been there done that in which they never do the adjustment, then continue to hassle over the balance...major headache. I insisted that they send me a correct invoice which I would then pay, but would not honor an incorrect invoice as a matter of personal policy. The rep said that was not their policy, but I said too bad b/c it was MY policy. The rep promised to get a resolution and call me back, which was two days ago and I haven't heard anything yet. My feeling is, I'm more than willing to pay the correct amount, but if they insist on gouging then they'll end up with nothing. Just another small example of the fraud that is rampant in our healthcare system.