Should I Pay a Doctor’s Bill If I Think Medicare Should Have Paid?

Have you ever received a bill from a doctor’s office that you thoughtmedicare should have paid was incorrect? Maybe an incorrect amount – or maybe even a bill that you thought that Medicare should have paid and your Medicare Supplement should have paid? This seems to be happening more and more with Medicare beneficiaries, to the point that I hear about another instance of this every week or two from my clients.

Hear are the three steps that I recommend taking if/when this happens to you:

  1. First of all, DO NOT just pay it right away when you get it if you think Medicare should have paid. No matter what the facility says about sending you to collection, damaging your credit, showing up at your door to get the money, etc., if you don’t think you owe it or that something is incorrect, don’t pay it. Many providers rely on third-parties for medical billing, and the reality is that they make mistakes. It can be difficult to recover money paid after the fact, so before you pay it, move on to step 2 and investigate it.
  2. If you get a bill that you think is incorrect, you should pursue investigating it. Did they bill both you and Medicare? Did Medicare pay but they billed you anyway? If one of these things happened, it does not necessarily mean there was something illicit going on, but you should always investigate it. The best/first way to do this, in my experience, has been to call Medicare (1-800-MEDICARE) to find out if they received a bill for the date of service in question. They should be able to very easily look up that date and tell you if they did. If they did, they can also tell you if they paid it, or if they didn’t, why they didn’t pay it. That is a good starting point. From there, you know what to say when you call the doctor’s office.Keep in mind that Medicare Supplement plans (Medigap) pay when Medicare pays and do not pay when Medicare does not pay. So if Medicare did not receive, or did not pay, a bill then your supplement company would never have any received the Medicare crossover request to pay their portion.medicare should have paidAnother tip as you investigate – make sure to record date/time that you called and who you speak with.
  3. After you call Medicare itself and the provider’s office, you should have some answers to what happened or how it can be fixed. Sometimes, it’s as simple as a coding error on the claim. Other times, the provider’s office could have billed you while waiting for Medicare’s payment. Regardless, you should certainly pursue it and not blindly pay a bill that you don’t think is your responsibility.All this said, it’s possible that the bill IS your responsibility. Keep in mind that Medicare does not cover anything it considers experimental or not medically necessary. Also, traditional Medicare does not cover preventive dental or vision.

If this happens to you and you are one of our clients, please call us. While Medicare will not give us information about your claims, due to HIPAA regulations, we can do a three-way phone call or guide you through the steps to finding a solution to the problem.