When Medicare states the Max you may be billed is ZERO why am I being billed by Stanford?

[spanishdancerab]

On my Medicare Claims and Medicare Summary, a service is not covered and Medicare States I may be billed / am responsible for $0. This is with a Medicare Contractrated Provider.

Stanford is taking the amount I am not responsible per Medicare and billing my Medicare Supplement Plan  - AARP UHC, which I was told by a Medicare rep is a violation of Medicare, and an investigation is supposedly being opened.

Of course, UHC wont pay it since Medicare isnt covering it. UHC states on their statement I may be responsible for charges unpaid. So Stanford says I must pay.

I have tried everything you can think of to remedy this. 

Any Ideas?

[GailL1]

@spanishdancerab 

There are a couple of things it could be - I have to guess cause you give few details.  Look also for codes beside the amount and then reference what Medicare says the codes mean.  

1.  The provider may not accept Medicare assignment but maybe a “non-participating” provider that is billing Medicare to see what they pay.

Here is Medicare’s description of the different categories of providers.

Medicare.gov - Does your provider accept Medicare as full payment? 

2.  Or it might be the service that Medicare is not covering - If the provider had you sign a ABN (Advanced Beneficiary Notice) - then depending on you choice on the form, the liability might be yours for the service.

Here is description of an ABN from Medicare.

Medicare.gov - Advanced Beneficiary Notice of Non-Coverage - Your Protections 

My money is on #2 if you signed an Advanced Beneficiary Notice of Non-coverage and you selected that you want the service even if Medicare does not cover it.

[spanishdancerab]

Stanford and the provider are participating providers. 

I never signed an Advanced Beneficiary Notice.

This service/procedure, which I have to get every 3 - 4 weeks, has been covered since 2018. 

I first tried to chat with Medicare, then called Medicare, only to get a person who had no idea what I was talking about. I was finally able to get through to a Supervisor that told me I was not responsible for an amount where the service was not covered , where Medicare states I owe $0, and where the provide is contracted with Medicare. Yet I keep getting billed with the threat of collections. The interesting thing is the Medicare Supervisor told me the procedure is covered with no limits on the number of times a year that I can receive the injecitons. 

I really dont want to be put into collections I owe Stanford $0. Im at wits end. 

[GailL1]

@spanishdancerab 

If you get this service often and never have any payment problems with them, then what is different about this particular claim in coding / provider, etc.  

It could be just a billing error.  Does the MSN claim processing by Medicare agree with the provider billing?  Any footnotes on the MSN?

It seems to be a problem between the provider billing and the Medicare claim - is there a difference.  

Without added details, there is no general info that I can give you on this problem.  

Medicare.gov - Part B Medicare Summary Notice Explained 

Maybe it is time to put your complaint in writing to the parties - provider and Medicare.

Good Luck 

[shamit]

Have you tried calling Medicare?  I have one claim right now that Medicare did not approve the bill but says I am not responsible to pay it.  My medigap plan says I may be billed for it.  I talked to someone at Medicare and they said if the facility tries to bill me for it I should contact Medicare and they will contact them and tell them they can't bill me for it.  It will be escalated by Medicare.

[BLS99880]

Okay, sorry if this is a stupid comment on my part, but are you taking the deductible into consideration? I just paid close to $180 to my oncology clinic, but that is part of my 2025 $257 deductible.

[spanishdancerab]

Good question. I have Medicare "F" which does not have a deductible, so that isnt the issue. I wish it was....