Another $500+ Saved for a Medicare Beneficiary ~ SMP Success Story

Another $500+ Saved for a Medicare Beneficiary ~ SMP Success Story

Knowing where and who to turn to when presented with a Medicare question, billing issue, or potential fraud can make a huge difference in one’s peace of mind and in-pocket savings! One recent example is with a beneficiary facing a $511.45 bill for a covered Medicare service. The beneficiary’s husband contacted our Senior Medicare Patrol (SMP) in May 2016 about a claim submitted to Medicare on 02/08/2016 where Medicare was billed for a covered patient office visit, but denied the claim due to “Medicare does not cover routine examinations”. The denied claim on the Medicare Summary Notice showed the beneficiary may be billed $511.45. And later on, she did indeed receive such a bill from her doctor’s office.

Yet this visit was a covered Medicare service. She shouldn’t be billed. The beneficiary and her husband repeatedly called the doctor’s billing department requesting multiple times that they correct the coding on the claim and resubmit it to Medicare. But they got nowhere, which is why they contacted SMP for help.

After our SMP worked for 5 months on the case, staying in touch with the billing department and advocating for the beneficiary and her husband, the billing department finally reviewed the coding and agreed to re-submit the claim to Medicare with appropriate code. Our SMP recently got news that Medicare payed $118.63 for the claim, and the beneficiary no longer has any looming bill! This is just one example of the thousands of dollars SMP programs nationwide save beneficiaries each year. See our Senior Medicare Patrol section for more info on SMP.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.