Beneficiary Saves Close to $6,000 ~ an SMP Success Story

Beneficiary Saves Close to $6,000 ~ an SMP Success Story

Sometimes what appears to be fraud, may just be a billing issue or mistake. Yet it is always good to report suspected fraud so we can help resolve the situation at hand. Last month an elderly couple contacted our Senior Medicare Patrol regarding almost $6,000 of ambulance bills for 2 ambulance trips in May and June of 2016. These ambulance services were for the wife and at the time of each service, the husband supplied her Medicare info and supplementary insurance info to the ambulance company so they could bill Medicare. Yet for some reason, Medicare was never billed and in August, this couple received a combined bill of $5,771.31 for both ambulance trips.

The husband contacted our Senior Medicare Patrol as he had been told Medicare would cover the transport. Our SMP contacted the ambulance company and found out they had only billed their supplement insurance first, and not Medicare. A supplement insurance will only pay if Medicare pays. And since Medicare did not pay (because it wasn’t billed), their supplemental insurance denied the claim and the company sent the large bill to this couple. Once the ambulance company saw their error, however, they submitted their bill to Medicare in December and Medicare paid both claims.

This couple avoided almost $6,000 in charges, and are grateful for SMP’s services. The husband said, “Your services were fantastic. And my concern is that they [this and other ambulance companies] are doing this to other people who are overwhelmed and unable to deal with these bills.” This is definitely a shared concern and is one reason we’re sharing this story. If you or someone you know is facing a large ambulance bill that Medicare should cover, contact our Senior Medicare Patrol (SMP) at 1-855-613-7080. You can also contact your local Health Insurance Counseling and Advocacy Program (HICAP).

Karen Fletcher
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.

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