S. O. S. – Speaking of Seniors: Medicare Mistake Threatened Stroke or Heart Attack

Both a husband and wife who are clients of this insurance agency visited our office and each seemed so excited and upset that either of them could have had a heart attack or stroke right in our office. The elderly couple live in Crown Point, Indiana.

After calming them enough to talk, I listened to their problem. They got what they believed was a medical bill for $6,128.42. It was a bit unexpected.

The husband has cancer. The wife has a heart problem. Each has Medicare and a good Medicare supplemental insurance policy.

The woman was told by her doctor to go to a hospital immediately whenever she has a certain paid in a certain area of her body. The next time that she had that pain, she went to a hospital. The hospital kept her overnight.

Then, the couple got what they thought was a bill. Actually, it was the “explanation of benefits” from their insurance company. That is a form that every Medicare supplement insurance company sends to the client/patient once the insurance company gets the Medicare “explanation of benefits” for instructions on how to treat and pay the claims.

The insurance company “explanation of benefits” listed “actual charges” as $6,128.42 and “MEDICARE APPROVED” charges of $0! So, it is easy to understand that the couple thought that they owed over $6,000 to the hospital for the woman’s one night stay. The coding of the unpaid charges caught my attention. The coding related to the statement “Medicare has left no supplemental or patient liability for this charge.”

That did not make sense to me. How could Medicare approve none of the charges, but leave no supplement or patient liability for the charges?

I contacted the client’s insurance company and got great help from Jean Wilkerson who is a supervisor in the claims/customer service department of the insurance company which is headquartered near Nashville, Tennessee. She listened to my questions about the bill and the explanation of benefits. She cared that the company’s explanation of benefits had alarmed the elderly couple. She asked for a few hours to investigate the matter. Then, she phoned me with the results.

Medicare sent a bad/erroneous explanation of benefits to the insurance company on the first time. A corrected explanation of benefits was sent later. The insurance company paid according to the corrected document and the elderly couple owed nothing.

I phoned the clients right away to give them the good news.

“Thank you! Oh, thank you so much! God bless you,” the woman said to me.

I did not need to do much work to help these clients. But, I really had to work to calm them and allow me a chance to investigate the problem and the documentation. So, the service that I gave them helped them to relax. They will sleep better now.

All this service to these clients was provided at no charge. This insurance agency cares about our senior citizen clients. We know that problems can arise. We provide this level of service to demonstrate that we really care about our senior citizen clients. Maybe that is why this insurance agency has become the largest senior citizen oriented insurance agency in the Midwest.

Woodrow Wilcox is the senior medical bill problem solver at Senior Care Insurance Services in Merrillville, Indiana. That is the largest senior citizen oriented insurance agency in the Midwest. For over six years, Woodrow Wilcox has helped senior citizens with medical bill problems with Medicare and VA clinics. He has saved senior citizens over $600,000 in wrongful charges. For more health care articles by Wilcox, visit www.medicareproblems.net or www.woodrowwilcox.com.  Wilcox is also a Democratic candidate for U.S. Congress.

© 2010 Woodrow Wilcox. Re-published here with the permission of the author.

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