SOS: Speaking of Seniors – Medicare Took Nearly 2 Yrs to Process Claim

An elderly Hispanic woman and her daughter visited our agency office and asked for help with a medical bill and Medicare problem. The elderly Hispanic woman is from the west side of Gary, Indiana. Her daughter is from Hobart.

The elderly woman went to a local hospital emergency room and was admitted and stayed in the hospital for five days. But the hospital charged the senior citizen as an outpatient. Medicare processes claims differently for inpatient and outpatient medical services. The hospital’s charging the senior citizen as an outpatient when she was in the hospital as an inpatient for five days skewed the Medicare benefits calculations.

With her mother next to her, the daughter phoned Medicare. A Medicare representative advised that the senior citizen should appeal the unpaid charges. So, the daughter helped her mother to appeal. Medicare denied the benefits on appeal. The Medicare appeal order did not even acknowledge the fact that the hospital had misfiled portions of the claim as outpatient when inpatient was more accurate.

The daughter brought her mother and all the papers to our office. I reviewed the papers and contacted the elderly Hispanic woman’s insurance company. I learned that the portions of the medical bill that were not paid and that were denied by Medicare had never reached the client’s insurance company for processing. Medicare sent other claims for the same date of service, but not the claims that related to the unpaid bill.

To help the client, I helped them to mail copies of essential information to the insurance company for processing. But, the dates of service were in March 2008. The hospital has only 15 months to file the claim. That would mean that the hospital was required to file the claim with Medicare no later than July 2009. But, the claim was first processed by Medicare on February 16, 2010.

Can you understand why I have no confidence in the current Medicare system nor any other future federal health care system?

It took the hospital and Medicare from March 2008 to February 2010 to process a claim. That is almost two years. For the entire two years plus, the elderly Hispanic woman has gotten bills that should have been paid by Medicare and her insurance company. The insurance company can’t be blamed because Medicare never sent the claim to it in the over two years since the client was in the hospital.

Just think about all the medical bill problems the federal health care system will start to cause for everyone in the not too distant future!

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 or

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

Comments are closed.