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What would you do? (questionable Medicare/supplemental charges)

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I'm going through all the paperwork for my MIL. It is a job in and of itself, especially when you get a collection notice one day, and the next day an EOB from part B supplemental insurance saying you don't owe a thing! What a ridiculous papertrail and huge headache!

Anyway, I came across something that bugs me. On the EOBs for part B supplemental, there are a whole bunch of charges for when she was hospitalized. However, there is a large charge for surgery from an orthopedic provider. Yes, she did break a bone and was hospitalized, but no, she never had surgery for it or anything else during that entire hospitalization.

Medicare and her part B supplemental picked up the entire cost, and she didn't have to pay anything out of pocket. However, it just seems wrong to me.

What would you do--investigate it, report it, leave it alone, what? If you would do something about it, what exactly would you do?

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If it was me, I'd investigate and, if the hospital billing dept can't explain the charge then report to Medicare.

The Justice Dept. just released a report about something over 3 billion dollars being recovered from investigations of fraud and overpayment ... it's not a rare, "once-in-a-while" phenomenon.

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If it was me, I'd investigate and, if the hospital billing dept can't explain the charge then report to Medicare.

I agree, but would also be surprised if Medicare did anything about it, although the supplemental company might.

We've seen some questionable charges for Hubby's Auntie and my Dad over the years. Medicare takes soooo long to process claims that it is hard to remember events clearly once the statement arrives. And it seems to take even longer to get a response from Medicare as to the follow up on questionable claims.

But I do think it's our responsibility to ask these questions.

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Well, I did call. The CMS paperwork is more descriptive, while the BCBS supplemental paperwork is correct but with an inaccurate description that, apparently, confuses many. For her particular injury, the standard treatment is to have a doctor look at you, order an xray (billed separately) to confirm, then order bedrest and possibly assistive devices, and follow up. The billing was legit, but the "surgery" descriptor on the supplemental paperwork really threw me.

For a $1746 billing, the provider got paid $500.20.

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Always check. Remember, the insured is the ultimate responsible party for any balance due and noticing anything out of the ordinary. I worked in medical billing for years before I went to nursing school and I always tell people to pay attention and call. Call the insurance company first because they can explain more thoroughly than the EOB. Call the provider and/or facility. Stay in touch with all parties for big cases.

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In my experience, the insurance company won't really care that they are being over billed.

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