Boomer Bits: A Big Bad Medicare Policy

On Nov. 11, 2022, I met with a client from Griffith, Indiana. We phoned Medicare together to try to resolve a medical bill problem.

We spoke to four Medicare representatives including a senior Medicare claims representative. After the phone call, I helped the client to file a complaint against Medicare for a really bad policy that could cost many seniors substantial amounts of money. Here is the problem.

When a claim is filed with Medicare, Medicare is supposed to rule on that claim and send a Medicare Explanation of Benefits to the doctor or hospital and to the Medicare supplement insurance company. The same information is supposed to be sent to the senior citizen patient in a Medicare Summary Notice.

If Medicare makes a ruling on a claim and then changes that ruling, it will not send an Adjusted Medicare Explanation of Benefits to the insurance company. It will send an Adjusted Medicare Summary Notice to the senior citizen after 30 to 90 days.

Medicare representatives told me that Medicare does not send a revised ruling to the Medicare supplement insurance company of the senior because THE LAW DOES NOT REQUIRE MEDICARE TO DO THAT. Instead, Medicare imagines that the senior citizen will somehow know to send a copy of the revised claim report to the senior’s insurance company. How many seniors do you know that know and understand that? Not many if any!

This means that Medicare supplement insurance companies don’t get the information so that they can work on fixing the problems caused by Medicare’s revised rulings. That would be easier for seniors. Instead, the insurance companies never get notified and the senior citizens get hounded to pay medical bills that their insurance companies would pay if only Medicare had notified the insurance companies about the revised rulings. So, seniors get hounded to pay bills that they really don’t owe as a direct and proximate result of this BIG BAD MEDICARE POLICY.

I hope you’ll join me in urging Congress to fix this problem that probably costs innocent seniors millions of dollars per year.

Woodrow Wilcox is the senior medical bill case worker at Senior Care Insurance Services in Merrillville, Indiana.  He has saved clients of that firm over three million dollars by fighting mistakes and fraud in the Medicare system.  Also, Wilcox wrote the book SOLVING MEDICARE PROBLEM$ which is available from book stores and online.