A client called because he had a billing problem. He claimed the insurance company with his Medicare Supplement policy would not pay his medical bills. Your Medicare Online Account
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“Chris Grimmond is awesome! His expertise in the field of Medicare for a variety of states is unprecedented. He gave me all the facts and options that I had with respect to my situation,
I tend not to react anymore until I have the whole story from all the sources. I said, “Okay, let’s call the insurance company.”
We got a customer service representative on a three-way phone call. The rep said they had received bills from the hospital, but the bills didn’t have Medicare approval and coding. The insurance company requested the hospital send the proper codes, but the hospital didn’t reply. The customer service rep said the insurance company was not refusing to pay; instead, they couldn’t pay until Medicare sent the approval with the proper codes. Then the insurance company would happily pay its portion.
and I am happy to have the right choices for me due to Chris. Thank you so much; you and your staff are wonderful!” —Kim S.
policy because your bills are sent directly to Medicare, and you can view them on your MyMedicare.gov online account.
After we got off the phone with the insurance rep, I translated what happened to my client.
For those on Medicare Advantage (Part C) plans, you can see your bills on your online account with your specific insurance company. On MyMedicare.gov , you can see the claims sent to Medicare, print out your Medicare card, and pay your Medicare Part B premium online if you are NOT getting a Social Security check. It is an excellent tool for everyone on Medicare. Everyone should be on their MyMedicare.gov account. For the client who thought his Medicare Supplement company was not paying, if he had viewed his MyMedicare.gov online account, he could have quickly seen the bills were never sent to Medicare. Please call us to speak with a licensed agent if you need help setting up your MyMedicare.gov online account. We are here to make sure you have the best Medicare insurance experience.
The hospital is supposed to send the claims to Medicare first, not the insurance company. Medicare determines everything. Medicare already has a schedule of payments for specific procedures. Medicare determines whether the procedure is “medically necessary.” If it is medically necessary, Medicare pays the predetermined fee, which also has a procedural code. Then Medicare forwards the claims to the insurance company with the necessary coding. The insurance company receives the claim and knows precisely what to pay based on the code. The insurance company sends the money to the provider within 48 hours of receiving the claim from Medicare.
The system is beautifully flawless — usually.
Instead, it sounded like someone at the hospital must have been new, been poorly trained, or mistakenly sent the bill to the wrong place.
When the hospital did not receive payment, they did the easy thing and blamed the insurance company and sent the bill to the patient rather than looking at what they did wrong.
Unfortunately, I had to send my client back to the hospital to have them forward the seven-month-old bills to Medicare.
BILL PROBLEM SOLUTION Something I am doing now when I meet with clients for the last time is enrolling them in their MyMedicare.gov online account. You have an online account with Medicare.
MyMedicare.gov is especially important for clients on Original Medicare (Part A & B only) and a Medicare Supplement/Medigap
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