By Woodrow Wilcox
In October 2019, I helped a senior citizen client who was being wrongfully billed by a medical firm in Illinois for $2,683 THAT OUR CLIENT DID NOT OWE.
I wrote one letter to the medical firm on October 2 after I made a brief check of the bill. Later, our client brought to me the Medicare Summary Notice forms that pertained to the bill. That allowed me to check the bill completely.
Recently, I have noticed a spike in cases where a medical firm sending a bill to a senior citizen on Medicare seems to be deliberately ignoring Medicare’s rulings on the bill in order to send a false big bill to a senior citizen directly.
On October 17, 2019, I wrote a second letter to the medical firm that sent our client a false bill for $2,683. If I had not intervened, our client would have been hounded to pay the false bill. Following is part of the letter that I sent to the medical firm that sent the false bill to our client.
On October 2, 2019, I sent to your firm a letter about several problems with your bill to our client and what I had learned in just a brief investigation of that bill. I now have the Medicare Summary Notice forms that pertain to your bill to our client.
On your bill to our client dated 09/15/2019, you claimed that our client owed $585 from service on 08/26/2019, $1,049 from service on 08/27/2019, and another $1,049 from service on 08/27/2019. That bill was completely false.
In addition to the facts that I presented in my letter dated October 2, the MSN forms disclose additional errors in your bill to our client.
For the $585 charge, Medicare ruled that the maximum balance on the account could be $38.92 and the secondary insurer paid that balance on 9/30/2019. For the first $1,049 charge for DOS 08/27/2019, Medicare ruled that the maximum balance on the account could be $32.41 and the secondary insurer paid that balance. For the second $1,049 charge for DOS 08/27/2019, Medicare ruled that your firm could not charge the client for this and that the balance for this service is ZERO.
The Medicare EOB forms that your firm received should have exactly the same information that is on the Medicare Summary Notice forms that our client received. It appears that your firm deliberately chose to ignore the rulings of Medicare and try to bill our client directly – in violation of Medicare rules.
You must send a new statement to our client showing that the correct balance on this account is ZERO. If you do not do that, or if you send another similar bill to our client, we will assist our client to file complaints against your firm with appropriate state and/or federal offices.
All the help that I gave this client was FREE OF CHARGE. Our insurance agency takes pride in “going the extra mile” for our clients to protect our clients from such bad medical billing. If your insurance agency does not give this high level of customer service, why not switch to an insurance agency that does?
Written on October 17, 2019 by Woodrow Wilcox