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I had heart surgery February 9, 2011. I received a bill for $10,810 from Bay Medical Physicians Group yesterday. I don't owe Bay Medical; Medicare and Blue Cross do. What should I do?
By Lawrence from Panama City Beach, FL
Call the people that billed you, and tell them to contact your medicare. You shouldn't have to pay. Hope you get that straighten out. Medical bills are so frustrating.
Does the bill say if it has been turned over to medicare and your supplemental insurance. It could say that, or does it say this is the balance. Call they billing office and ask these questions.
First, you have Medicare part A but do you have Medicare part B? Part A pays the hospital and part B pays the doctors. Some folks opt out of part B to save money or believe they don't need it.
Second, you should have received Medicare Summary Notices that explained what the Amount Charged was, Non Covered Charges, Deductible and Coinsurance and what you may be billed. You would have received several of these notices for all the costs and procedures involved.
Third, you want to call the people that are charging you $10,000 and ask why and what payments have Medicare and Blue Cross paid. Call Blue Cross and ask why or what portion of the bill are they to pay and of course Medicare.
You may also want to read the information on the back of the Medicare Summary Notice that explains what you may be billed for part A and part B and the appeal process should you choose to appeal the bills.
It is a complicated process but in the long run you may very well owe the $10,000. Good luck.
I don't have Medicare yet, just Blue Cross, but the way they pay bills now is: The doctor bills you but you must wait for the EOB (explanation of benefits) form from the insurance company.
When you get the EOB, it will probably say something like, doctor billed $10,000, but we're paying $1,500 and your responsibility is $0. Or your responsibility may be a small co-pay. Wait until you hear from all involved, don't pay a penny until it's resolved or then you're responsible for the full amount.
My husband had a stroke this past February and I had to retire from my job just to take care of paperwork like this. I have gotten bills for $40,000 and $192,000; the $40,000 is still up in the air as they say the surgery he received was experimental (the neurologist says otherwise and they are investigating) but after I resubmitted the $192,000 it changed to $6.46 for non prescription drugs.
I feel sorry for the healthcare world, they finally get paid a year after they treat you, but that is the way it is now.
I should have also added the following.You have mentioned you have Blue Cross as a supplement plan but did not disclose what type of plan you have. Plan A is the least expensive and you get the least amount in benefits. All Supplement insurance companies are required to offer Plan A. As you travel up the alphabet, plan F, plan M, for example the insurance cost goes up but the benefits increase. If you do not know what Plan you have Blue Cross will help you and explain what your benefits are.
Don't expect Medicare and the supplemental insurance company to pay 100% of all the bills. There is a lot more than what I can explain here. You have to start with the Bay Medical Group to find out why the $10,000 invoice and then to Blue Cross to find out what plan you have and what they pay and what you have to pay. On the back of the Medical Summary Notice I mentioned in an earlier post it states Medicare claims may be assigned or unassigned. Providers who accept assignment agree to accept Medicare approved amount as total payment fo rcovered services. Medicare pays its SHARE of the approved amount directly to the provider. You may be billed for unmet portions of the annual deductible and the coinsurance.
Doctors who submit UNASSIGNED claims have not agreed to accept Medicare's approved amount as payment in full. A doctor who does NOT accept assignment may charge you up to 115% of the Medicare approved amount.
So you have to understand that just because you have Medicare and a supplemental insurance plan is no insurance they will pay the entire bill. You have to contact Bay Medical Physicans group, Blue Cross and Medical and have all of this explained to you. This to complicated an issued to fully explain in an online post. I am afraid if you do not resolve the issue Bay Medical Physicans MAY well put the amount they claim you owe out to collection.
Can a Medicare doctor charge a statement fee of $5.00 because you waited for Medicare to see what was paid. It is not a late fee, but a statement fee.
As far as I know they can. However, I would report it to Medicare (CMS) and ask if they will contact him to rescind it. Their number is: 1-800-MEDICARE (1-800-633-4227
Or if you get your Medicare thru a private insurer like a Blue Cross or other advantage plan, call the number on the back of that card and ask to file a grievance against the doctor. You have rights to do this.
They may make you file in writing. I can offer tips to draft the letter if you get to this point.
Post back with an update.
Yes, I think they can since they were entitled to their money and you made them wait.
Yes, this is legal but they should have provided you notice the doctor would charge this fee under those circumstances.
You probably signed a statement in their office stating something about this fee but some doctors also have a sign posted in their office.
Medicare takes several weeks to pay a doctor and usually, if Medicare is the primary insurance, that claim is filed first and any delay is due to Medicare and not due to the patient.
You can file a complaint and they may refund your money but you should not feel they have done anything illegal or even wrong for that matter.
You do have the right to find another doctor.
That is not nice of the doctor to charge you told them you would like to see what Medicare would cover to proceed.
You can contact Medicare and ask them the process.
Does anyone know if the code 99397 is the correct code to use for a pelvic/breast exam done by a gynecologist when on Medicare, covering the office vist/doctor's time? It appears that Medicare pays for the code G0101 which is for the actual test and is an approved benefit. Medicare reps tell me that they no longer use 99397 and the OB/GYN needs to call the provider help line for the correct code in order to be paid.
Medicare insists it is an approved benefit, GYN says Medicare never pays on 99397 (that is correct, but should they have submitted another code?). Researching online shows that we have the option of having a physical done by an internist, opting to have the well woman cancer screening done by a GYN. The quarterly summary from Medicare shows the code used by the provider when submitting the claim. It is my first year onboard and I'm trying to figure out if the GYN is correct or the Medicare reps. I would appreciate the answer.
This is a well visit code for an established patient. It should be covered