Natalie was having a medical issue and her doctor ordered some tests. Since she had Medicare A&B along with a Medicare Supplement (Medigap), she wasn’t worried about the bill payments; between the two coverages the medical bills would be covered. All seemed to be going well; a diagnosis was made and her path to recovery was laid out. A few weeks later, her medical issue was resolved, and she was cured. Sounds like a happy ending, right? Not so fast.
In the coming weeks, Natalie got a shock when she received a bill for a medical service not covered by Medicare. The bill was $6,200 dollars. She called the medical provider for an explanation and was told she had to pay the bill. “But no one told me this was going to cost me money!” she cried.
In frustration, she remembered what we tell all our clients — if you have an issue call us and maybe we can help you resolve the issue. She called and we discussed her dilemma, and after getting a copy of the bill and all the facts, she did have recourse.
With Medicare, there is a term “Medicare Advance Written Notice of Noncoverage”. If your doctor or medical provider orders a test or procedure that is not covered by Medicare, they must notify you in writing. This was an ah-ha moment in Natalie’s case.
The medical provider never told her or gave her written notice that the procedure is not covered by Medicare. The Medicare rule is “If the beneficiary does not get written notice when it is required, they may not be financially liable if Medicare denies payment, and the provider or supplier may be financially liable instead”. There is a CMS (Center for Medicare/Medicaid Services) form, CMS-R-131, that must be given to the patient.
Natalie called the doctor and asked why he didn’t tell her the medical services he ordered would not be covered by Medicare as required by CMS. The doctor had no excuse and had his billing department write off the bill. Natalie didn’t have to pay… not one penny! She was relieved, as she was living on a fixed budget and had no way to pay the bill.