Helping Parents with Medicare Payment Errors

This post will be useful only for American readers today since it is about the American Medicare system.

In the last few years of mom’s life, she had a lot of difficulty following up with errors in medical billing. By that point, she was having vision problems and some difficulty hearing on the telephone. She had many medical office visits and some hospital stays.

Several times Medicare refused to pay legitimate bills because of their rigid rules. One time mom and dad saw their physician for flu shots in the morning and then had an automobile accident on the way home. Mom ended up in the hospital due to the auto accident.

The medical bills from the auto accident were paid by their auto insurance carrier because that was part of their insurance coverage. Therefore Medicare didn’t pay anything from that hospital visit, which was legitimate. The problem came from the fact that Medicare also refused to pay for the flu shot office visit because it occurred on the same day as the hospital visit.

One of Medicare rules is that all medical visits on the same day come under the same code or something strange like that. I tried to help mom talk sense into Medicare but they simply refused the doctor’s total charges for the flu shot visit which came to $80. In the end the doctor wrote those charges as uncollectable because I wouldn’t let mom pay them as they were Medicare covered.

While she was hospitalized after the auto accident, she had also been treated for a chronic illness. I won’t go into details but it was like diabetes in that it had to be followed whether she was hospitalized or not, and it was coded as one of her diagnoses, though not the primary diagnosis for the hospitalization.

Several years later when mom was hospitalized for a different unrelated medical problem, Medicare refused the hospital bill saying that the car insurance should pay it. This was because one of the diagnostic codes was the same as the one that was used for her chronic (diabetes-like) illness that she also had when she had was hospitalized after the auto accident. This new hospitalization was in another state and caused by a new problem — unrelated to the auto accident. It took many phone calls and months of delays before Medicare finally paid.

There were many procedural things I learned while trying to help mom. First of all, Medicare bill payments are actually done by third-party contractors and these contractors make more money by paying out less – even for legitimate claims. So it is difficult to sometimes get them to follow the correct rules. One has to be persistent to get them to pay eligible bills.

I have written before in “How to Talk to Your Parent’s Doctor”  about the necessity of having a health care surrogate form completed by your parent in order to be able to discuss medical matters with your parent’s doctors. Likewise, Medicare has their own separate authorization form that must be completed before they will talk to a relative instead of the patient himself when the patient is unable to speak up for himself. (That is – Medicare will NOT accept the Health Care Surrogate Form that you or your lawyer completed for exactly this purpose!)

Instead, you must use the Medicare form. Please refer to the following web page: for more information about how to complete a Medicare authorization form. I have taken the following text from that web page:

“By law, Medicare must have your written permission (an “authorization”) to use or give out your personal medical information for any purpose that isn’t set out in the privacy notice contained in the Medicare & You handbook. You may take back (“revoke”) your written permission at any time, except if Medicare has already acted based on your permission.

If you want to allow Medicare to give your personal health information to someone other than you, you need to let Medicare know in writing. ”

“If you are requesting personal health information for a deceased beneficiary:
• Click the ‘Download Medicare Authorization to Disclose Personal Health Information Form’ link in the Related Materials section to download this form.

• You will need to include a copy of the legal documentation which indicates your authority to make a request for information. (For example: Executor/Executrix papers, a Letter of Testamentary or Administration with acourt stamp and judge’s signature, or personal representative papers with a courtstamp and judge and/or county clerk’s signature.)

• You will also need to explain your relationship to the beneficiary.

• Mailing instructions are included on the form.

If you are completing this form as a personal representative:
• Click the ‘Download Medicare Authorization to Disclose Personal Health Information Form’ link in the Related Materials section to download this form.

• Mailing instructions are included on the form.

This form is a 3-step process and will take approximately 10 – 15 minutes to complete.

Click the link below to view and print a copy of the Medicare Authorization to Disclose Personal Health Information Form. If you are requesting personal health information for a deceased beneficiary, or completing this form as a personal representative, you must use the PDF version of this form and mail it to CMS.”
Click on this link: for a PDF version of the form.

I will add that I had helped mom complete this form before the online form was available. I made several copies before I mailed it in. Several times I had to send it again. Medicare keeps only computerized records, so they seemed to lose the form periodically. I believe this is because I was working with a third-party vendor as I mentioned before. The third-party vendor covered a large metropolitan area and seemed to have several computers in different offices in different geographic locations. Sometimes when I called they insisted they did NOT have the form on file and refused to talk to me. I insisted and usually asked to speak to a supervisor. As I went up the chain, eventually someone would locate the computer that showed that they really had the form completed and they could talk to me and then we could proceed to talk about the billing problems.

This was a major problem for me but I was very persistent and eventually was able to take care of these billing errors. I wonder if the computerized form they now have will eliminate some of the problems that I had. I don’t know, but can only hope it is getting better now. In any case, right now, while your parent or spouse can still sign the form, fill it out and submit it so you can help with Medicare billing errors. You may never need it, but if you do, you will be glad you have that form on file!

And if your parent is not able to complete the form, have the appointed health care surrogate or personal representative complete it.

However, since I am now the Social Security Personal Representative for dad, Medicare has never refused to talk to me about his Medicare bill payments. It might be that the Social Security Personal Representative is already presumed to be authorized to talk to Medicare about the payments made on the parent’s bills.

About letstalkaboutfamily

I am a retired and was the primary caregiver for both my parents before they passed. I have children and grandchildren. This blog is an attempt to connect with other caregivers and share ideas and experiences. I hope you will let me know what worked for you if you had an experience similar to mine. The main issues I am going to talk about are elder care, death and dying, assisted living, family relationships and hoarders and hoarding. Other topics will come up as I address the issues and my relationship with other family members.
This entry was posted in Alzheimer's Disease, Caregiving, Eldercare, Health Care, Health Insurance, Medical bills, Medicare and tagged , , , , , , . Bookmark the permalink.

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