Winning the Lottery – It’s all in the Numbers


Have you ever really compared the numbers on your parent’s Medicare summary to what they are actually billed and/or paid?  It might be more of a sure win for your parents than buying a lottery ticket.

Here’s the scoop – if I had a dollar for every billing error that the medical providers tried to get my elders to pay, I wouldn’t need to win the lottery – I’d already have cashed out!

There are three main ways to find money that your elders have paid to providers (or are about to pay to providers) that they do not owe:

  • Compare the Medicare Summary Notice that your elders get regularly to the provider’s invoice. Check the amounts billed and compare them to the amounts filed with Medicare. If they are not the same, call the provider and ask why. Be sure to check the See Notes Below column on the far right of the Medicare Summary for clarification on whether or not a service is allowed, approved or has been billed already.
  • Compare (again on the Medicare Summary Notice) the amounts that Medicare says the patient can be billed to the amount on the invoice. This is easy to find – it is a Big Black Box that says Maximum You May Be Billed. Then compare this amount to the Benefits Summary that the supplemental insurance company sends regularly. If there is a deductible to be paid, make sure that any amounts over that deductible are submitted and paid by the supplemental insurance company. If your elder has no deductible in their plan, make sure the supplemental insurance has paid the Maximum You May Be Billed. In some rare cases, your elder may be responsible for what Medicare calls Excess Charges (but that almost never happens).
  • The provider does not have (or they have lost ) one or both of your parent’s insurance cards. They must have both the Original Medicare card AND the supplemental insurance card. If the providers don’t have both and/or they don’t bill both, your parent can end up being charged for amounts that are covered by insurance. Or, if your parent has a Medicare Advantage plan, then the provider just needs the one card.

When a medical provider sends an invoice to an elderly person, the elderly person usually just pays it. That’s where your detective work can save them money time after time. Call the provider and challenge the amount. Stay focused (this often is a time-eater!) and you will often be money ahead.

If you are the one doing the calling, make sure the providers have a copy of your power of attorney on file or THEY WON’T BE TALKING TO YOU!  Oh, remember a few weeks ago when I said the ticket was to know the ladies in the billing department on a first name basis…well, now you know why!

It’s a jungle out there in medical billing – and I can’t/haven’t covered it all – but this is a great place to start. And to win this kind of lottery, you don’t even have to buy a ticket!

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