Does anyone know of any websites or other resources that can help caregivers learn more about Medicare, Secondary Health Insurance and reviewing and/or disputing Hospital and other medical bills for the relative they are caring for???
I am a 38-year old man and, rather ironically, I am a licensed Independent Insurance Agent in the state of Georgia. But I am a Property & Casualty Agent (Home, Auto, Commercial, Workers Comp, etc.) and have very little knowledge about Health-related Insurance! I am fortunate to have a great PPO plan and haven’t had a single claim problem or denial in the seven years I’ve had the policy!
But I have been helping my mom (an only child) take care of my grandmother for the last few years. She is now 93-years old and started having more and more recurring health issues just in the past year. She has been hospitalized twice this year, in mid-Feb and again earlier this month, each time for 3-4 days.
She has Medicare A & B coverage, like most seniors. She also has supplemental coverage and Part D (Rx) coverage from Blue Cross/Blue Shield of Michigan as the surviving spouse of my step-grandfather. He was a Chrysler retiree and BCBS administers the UAW Retiree Medical Plan…
The hosptial bills are $21-$25k for each 3-4 day stay. Medicare rejected over $5k of the first $21k bill and BCBS refused to pay anything at all. Everyone tries to put the blame off on the other guy, Medicare said the hospital needs to call BCBS, and so on…
I spent most of today reading that damn booklet that Medicare sends each year with coverage details. I also read at lest 60 or 70 pages of similar crap on the BCBS website. The hospital is actually at the root of this particular issue! Even though she was in the hospital for over 72 hours in a private room, they are calling it OBSERVATION which makes it Outpatient! Medicare only pays 80% on Outpatient and won’t pay for most drugs administered at the hospital because she has Part D coverage for drugs from BCBS. BCBS doesn’t cover any Outpatient services, but would pay 90% of what Medicare didn’t if she had been Inpatient! It’s in-fucking-sane!
I paged her doctor last night and, even on a Saturday evening at 7pm, he called me back within 30 minutes. The man is truly a saint, so at least I’ve got one ally. I asked him if he specifically admitted her and he said YES! that he always does so with Medicare patients for this very reason. He also told me that the doctor on duty at the hospital could reverse his order, but legally he is required to inform her doctor that he is doing so and why AND inform us of the status change and give us paperwork explaining the possible impact on Medicare and other insurance benefits as a result, including having the patient of POA (me) sign off on it. None of that happened…he is drafting a letter to the Hosptial Administrator and Billing Dept tomorrow morning reiterating that he ADMITTED her for INPATIENT care and, if anyone changed that, they didn’t follow the legally required procedures! He is instructing them to re-code the bill as INPATIENT treatment and resubmit to Medicare and BCBS or he will file a formal complaint with the Insurance Commissioner and all other relevant entities.
Damn, shit, hell fire…I hate freakin’ health insurance, I hate hospitals and I hate dealing with all this shit!!!
Does anyone have any advice, input or even just a little encouragement if you’ve ever dealt with this stuff before?
Going forward, I will know to INSIST that she be admitted and page her doctor immediately if they don’t. We also may consider using a different hospital that is located the same distance from her home, but in the opposite direction. The only down side to that is that her doctor does not have priveleges at the other hospital, but even he said it may be worth considering if the billing issues persist unresolved. The other hospital is rated much higher by patients on all the various rating sites and even on Medicare’s website.
As it stands, the Feb hospital bills has a balance of almost $6k outstanding and they have been calling my grandmother’s home number every day and upsetting her! I’ve called them back every day to demand that they erase her phone number from their files and ONLY call me or my mom (both have POA). I’ve told them that she has dementia and can’t legally agree to pay them a single cent or anything else…I finally hand-delivered a demand letter CEASE all communication with her immediately and stating the laws that require them to follow my instructions to the letter. I walked it in to the hospital administrators office Friday afternoon and refused to leave until he personally signed that he received it!!!
As Whitney Houston would often say after she had to take care of business the hard way, “Yeah, I can be Ghetto! You KNOW that now!” I’ve also been thinking of her other favorite phrase, “Uh uh, Oh HELL to the NAWWW!” White boy can be Ghetto as well!!!