By Woodrow Wilcox
On October 10, 2017, I received an inquiry from a client in Michigan City. He wanted to know why he got a bill for $228 when the original amount of the bill was $354.
I reviewed the papers and phoned the client’s insurance company at the same time. What was the problem? Medicare refused to cover a vaccination for the senior citizen client. So, a government policy prevented coverage of that medical service. The insurance company had nothing to do with that decision.
Medicare supplement policies pay only when Medicare approves the medical service. Medicare supplement insurance companies do not use their own claims adjusters to review the merits of a medical service or device. They rely entirely on Medicare claims representatives. Whether a claim is or is not covered by Medicare, the insurance company never argues about it.
If a medical service or device is not covered by Medicare, neither Medicare nor a Medicare supplement insurance company will pay on a claim. The bill – all of it – belongs to the senior citizen.
I don’t do miracles. I don’t have a magic wand. I work hard to protect our clients from mistakes and fraud in the Medicare system. I do that job very well. As of last fall (2016), I have saved clients of this agency over two million dollars. I have a good record of finding and fixing mistakes or fraud in medical billing. But, I can’t change a government policy. Only elected politicians and bureaucrats can do that.