Out of state hospital issue

[dresdenron]

Last year i ended up in a GA hospital while visiting family. I live in New York State and had Blue Cross Medicare Supplemental Insurance at the time. The original hospital ER sent a bill to Medicare and Blue Cross. The hospital for the last 11 months has said the secondary payer has not paid the bill and want me to pay it. After numerous hour long conference calls in the spring I discovered the problem. The hospital (or Medicare) had sent the wrong hospital name and address for the bill. The hospital had been taken over by a large regional hospital, but this had happened 2 years before I was there. For the first few months the hospital claimed they had not received the original Blue Cross check but later they admitted they had it. It was decided among all parties that a corrected form would be sent by the hospital to Blue Cross and then Blue Cross would send a new check and void the old one. I am now told, months later, that form was never sent and my account has not been fully paid. I have tried Office of the Ageing and a Federal Senator but haven't found any one to get involved yet. Blue Cross has been very helpful at their end, but their hands are tied. Does AARP have an advocacy department that can help in these matters?    

[CarolynBI]

You might want to see if the hospital has a patient advocacy department (also can be called things like the omsbud  office, patient experience, etc.) and call them to have them help untangle the problem. On more than one occasion I have found that works. Of course that also depends on whether or not that office actually does what they are supposed to do. 

[GailL1]

@dresdenron 

Hard to keep up with what happened here so let me just go over how a Medigap plan works with Traditional Medicare.

A Medigap plan (Medicare Supplemental plans) is NOT health insurance, they are financial protection insurance that works with Traditional Medicare to pay some or all of a beneficiary’s out of pocket cost since there is no limit to this out of pocket cost in Traditional Medicare.  They do not approve any claims and all claims have to go thru Medicare 1st for payment of their share and then to the Medigap plan to pay their share.  

A medical bill will always go to Traditional Medicare for processing and then IF a Medigap policies is listed on your Medicare file, as it must be for the system to work properly, the claim is then sent on to the Medigap insurer for further processing and claim payment based on the Medigap plan that the beneficiary has.

REPEAT:  A provider does NOT bill a Medigap plan, they bill Medicare, the claim is processed and then Medicare sends their finished claim onto the Medigap plan insurer that is on a beneficiary’s Medicare file.  In fact, a provider doesn’t even have to have the Medigap card or account number.  The card that your Medigap issues is needed only for any auxiliary benefits that might be on the plan.  The only criteria for a Medigap plan to pay for a covered service is that Traditional Medicare has paid their part of the claim - that means Medicare has approved the claim and paid their share of the cost.  If Medicare ok’s the claim and pays their part, the Medigap plan will pay their part of the claim.  If the claim is denied or rejected for some reason by Traditional Medicare, the Medigap plan does not pay.

Now in your case, you need to register for and look at your Medicare file.  Then go to this claim - the MSN (Medicare Summary Notices) will say what was paid or not on the claim and there will be a notation that it was sent on to the Medigap insurer. 

Medicare.gov - Create An Account  

You should have gotten these claims forms in paper form - both from Traditional Medicare and then from the Medigap plan.  But if you don’t have them now, you can look them up on your Medicare file.

Look at the Medicare claim form (MSN) and see when they sent it on to the Medigap provider - Most likely what has happened is it never got processed by the Medigap insurer (BCBS) because they Medigap insurer does not pay from a provider bill, they pay from claim the info sent to them from Medicare.  So you may have to start over with getting a copy of the MSN from Medicare that indicates that it was went on to the Medigap insurer, then find out what the BCBS Medigap plan paid - you may have an account with them as well, but if not call them and if they never paid it then as what is the best course to get it paid - it might have to be resubmitted to Medicare and they will make it as a duplicate claim and then send it on to the BCBS Medigap plan.

If the Medigap claim was paid, then the Medicare claim + the BCBS Medigap claim payment form is all you need to rectify the situation - checks not cashed for whatever the reason would still have to checked out by the initiating payer and follow thru to resolve it.

As long as the hospital or any other providers participate in Medicare either under assignment or even as a “non-participating” provider, all the claims go to Traditonal Medicare for processing 1st because the ONLY thing that a Medigap policy (Medicare Supplemental) does is pay their share of the remaining bill if Medicare approves the service.  

[papawofboo]

  Does your state government have a Department of Insurance? Also you might want to try you Rep. in the House, they are closer to you than the senator. Don't forget rule #1, never, never pay anything until you have the correct EOB's in front of you.

[dresdenron]

Thanks all of you. Just an update. My wife and daughter went in person at different times last year to the hospital I was in and no one there in several different departments could get a hold of the billing dept (large out of state hospital took over smaller hospital a few years ago). 

I contacted my state's Dept of Financial Services and although they couldn't help me directly they gave me a few connections to non profits which help with Health Insurance issues. They have been very responsive and I will be talking with someone in their Washington office this afternoon.

I have also contacted our US Rep's office and will see how they do also. That office did want my SS number which bothered me since they have copies of the bill with my patient ID number and Insurance carrier number. Usually AARP tells you to not give out SS number, even to doctors. 

[CarolynBI]

By law you are not required to give any medical facility your SS number. Health care is the biggest source of identity theft in this country. Make sure that they didn't put that in your medical record account. If they did ask it to be removed. When I am asked for it I remind them of the law. EPIC (mychart) has a fake number they put in for everyone who refuses to give them their number (it is either 999-99-9999 or 888-88-8888 - one system I use does one and one does the other). Glad you found resources.

[dresdenron]

I didn't say the hospital asked for my SS number. I said the congressman's office asked for it to investigate my hospital bill issue. 

[CarolynBI]

You are right. Your bill should have been enough. If, in fact, your SS isn't in the health care system he isn't going to find that useful anyway. Hopefully the medical system won't try to claim HIPPA prevents him from helping you without you signing something. He may have been reminded that health care can't require your SS number and so you giving it to him wouldn't have helped (yes I realize too late now, my post is more in case others need that kind of information).

[dresdenron]

I downloaded the consent form from the Congress Rep's web site and took it to their district office.  As I was leaving they came out and had me come back in. They said it was a 2 page form so they gave me another consent form to sign. On the back of that form i had to sign and date again and put in my social security number. I questioned that but was told that I could give them other ID such as driver's license number, etc.  in addition to the SSN but the Social Security number had to be on the form first for them to agree to work on the issue.