Medicare Part B Screw Up
September 13, 2015 9:15 AM Subscribe
A beloved relative of mine neglected to sign up for medicare part b during her enrollment window. Before the window reopened for her to register she fell ill and has had two emergency surgeries in the last two weeks. So what now? She otherwise is uninsured, although does have part a.
Further details: retiree with a good pension, plenty of cash in the bank but not so much that paying list to the doctors won't dramatically alter the retirement she had planned.
So what do we do? If there is no way to solve the medicare issue can someone point me to a resource on how best to approach negotiating the medical bills down - I assume common and customary should a minimum be the starting point but perhaps I'm wrong?
Further details: retiree with a good pension, plenty of cash in the bank but not so much that paying list to the doctors won't dramatically alter the retirement she had planned.
So what do we do? If there is no way to solve the medicare issue can someone point me to a resource on how best to approach negotiating the medical bills down - I assume common and customary should a minimum be the starting point but perhaps I'm wrong?
The hospital may have access to a social worker as well, who might be able to answer better about any governmental options (including what, if anything, part a will cover).
posted by nat at 11:36 AM on September 13, 2015
posted by nat at 11:36 AM on September 13, 2015
I assume that she did sign up for Part A? Part A will pay for a big portion of hospitalization costs, but not for physician services such as the surgeon.
First, don't be in a big rush to settle the bills as there generally are no late fees. It can take six months for all the bills to trickle in as they bounce back and forth between Medicare and the various providers involved. You will probably want to negotiate the whole mess at one time, not piecemeal. Some bills will be bundled by the hospital and others will be from individual physicians.
Then you need to talk to someone in the billing department, asking for someone who can negotiate terms of settlement for the uninsured. They will probably offer an installment plan for the full amount, but you can sometimes get as much as a 50% discount off list prices if you ask what they would accept if you send them a check the same day for the entire agreed amount. People tend to procrastinate on paying medical bills forever, so offering instant payment carries a lot of weight, being a bird in the hand.
I also second contacting a social worker at the hospital. Their job is knowing all the ends and outs of various programs for the uninsured that may be available to your relative.
posted by JackFlash at 11:49 AM on September 13, 2015
First, don't be in a big rush to settle the bills as there generally are no late fees. It can take six months for all the bills to trickle in as they bounce back and forth between Medicare and the various providers involved. You will probably want to negotiate the whole mess at one time, not piecemeal. Some bills will be bundled by the hospital and others will be from individual physicians.
Then you need to talk to someone in the billing department, asking for someone who can negotiate terms of settlement for the uninsured. They will probably offer an installment plan for the full amount, but you can sometimes get as much as a 50% discount off list prices if you ask what they would accept if you send them a check the same day for the entire agreed amount. People tend to procrastinate on paying medical bills forever, so offering instant payment carries a lot of weight, being a bird in the hand.
I also second contacting a social worker at the hospital. Their job is knowing all the ends and outs of various programs for the uninsured that may be available to your relative.
posted by JackFlash at 11:49 AM on September 13, 2015
I don't think there's any way to get Medicare Part B coverage retroactively. If the services were not Part A (inpatient) services but were hospital outpatient services, the list prices will be much higher than what Medicare Part B would have paid, so you are right to want to negotiate them down.
Here are some resources for negotiating the bills. These are designed to get past the “list” price to the actual payment rates or ranges for common procedures. Price information for emergency procedures will probably be harder to find.
Guroo, from the nonprofit Health Care Cost Institute
Healthcare Bluebook, which offers some negotiating advice
FAIR Health
For physician services, the Medicare physician fee schedule seems like the most fair basis for determining amounts, since that's what the providers would have received if your relative had signed up for Part B during the enrollment window. Unlike the above, the look-up tool provided by the Centers for Medicare and Medicaid Service (CMS) is not consumer-friendly. You would need to know the specific procedure codes for the services in order to use this look-up; they are sometimes shown on itemized bills. Or you could just ask the provider to tell you, and accept as payment in full, the amount they would have received from Medicare.
posted by Snerd at 12:03 PM on September 13, 2015
Here are some resources for negotiating the bills. These are designed to get past the “list” price to the actual payment rates or ranges for common procedures. Price information for emergency procedures will probably be harder to find.
Guroo, from the nonprofit Health Care Cost Institute
Healthcare Bluebook, which offers some negotiating advice
FAIR Health
For physician services, the Medicare physician fee schedule seems like the most fair basis for determining amounts, since that's what the providers would have received if your relative had signed up for Part B during the enrollment window. Unlike the above, the look-up tool provided by the Centers for Medicare and Medicaid Service (CMS) is not consumer-friendly. You would need to know the specific procedure codes for the services in order to use this look-up; they are sometimes shown on itemized bills. Or you could just ask the provider to tell you, and accept as payment in full, the amount they would have received from Medicare.
posted by Snerd at 12:03 PM on September 13, 2015
Couple of additional long shots.
Are you sure she isn't confusing Part B and Medigap? Medigap is optional private insurance on top of Part A and Part B. It is unusual for someone not to sign up for Part B at the same time they sign up for Part A unless they are considering a Medicare Advantage HMO plan. Part B premiums are $100 automatically taken out of her Social Security check so it may not be obvious whether she has that coverage.
She also has a pension which implies that she also had a company health insurance plan. Check if there is any post-65 overlap of her former employer's plan.
posted by JackFlash at 1:47 PM on September 13, 2015 [1 favorite]
Are you sure she isn't confusing Part B and Medigap? Medigap is optional private insurance on top of Part A and Part B. It is unusual for someone not to sign up for Part B at the same time they sign up for Part A unless they are considering a Medicare Advantage HMO plan. Part B premiums are $100 automatically taken out of her Social Security check so it may not be obvious whether she has that coverage.
She also has a pension which implies that she also had a company health insurance plan. Check if there is any post-65 overlap of her former employer's plan.
posted by JackFlash at 1:47 PM on September 13, 2015 [1 favorite]
As was noted above, hospital bills (the largest component) when surgery is involved, are covered by Part A. It is the billings by physicians (not only the surgeon, but also radiologists reading images and pathologists looking at surgical specimens) that are uninsured.
Like the hospitals, though, doctors' offices are usually pretty good about negotiating fees down and setting up payment plans. One thing to be sure to ask for is a reduction to the level that Medicare would have paid if it had been in force. Often that is about 30% of the "full fee" that is never charged to anyone (except the uninsured) and is never paid by anyone (except the uninsured).
posted by megatherium at 2:06 PM on September 13, 2015
Like the hospitals, though, doctors' offices are usually pretty good about negotiating fees down and setting up payment plans. One thing to be sure to ask for is a reduction to the level that Medicare would have paid if it had been in force. Often that is about 30% of the "full fee" that is never charged to anyone (except the uninsured) and is never paid by anyone (except the uninsured).
posted by megatherium at 2:06 PM on September 13, 2015
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posted by MsMolly at 10:34 AM on September 13, 2015