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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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You
must contact all involved parties when dealing with
claims
June 11, 2004
Q:
I
have paid my supplemental insurance premiums to go along
with Medicare for over two years. My local hospital
turned me over to a collection agency last year.
I live on a fixed income and paid what I could to the
hospital. Why doesn't my supplemental insurance pay
their part after Medicare pays?
I
have an address book full of names and numbers that
I have called since I bought this insurance policy.
I paid for my long distance calls to an Independent
Subscribers' Account and I have talked to many different
people there. They sent me another insurance ID card
with a different number on it. That's what they keep
doing. I now have four different cards with four different
numbers on it. I wish they would get my account straight
and pay my claims and not send me new cards. My explanation
of benefits says my claims were rejected because I had
been canceled. But when I call they say I have never
been canceled. I spoke to one man who said to just throw
away all of my papers I get because they don't mean
anything. He told me to ignore all of this.
I
am sixty seven years old. I am not senile or wrong about
this. I have bank statements to prove I am up-to-date
on my premium payments. I pay $1318.20 a year. I prayed
before I wrote you this letter. I have a sound mind
and I try to fight my battles. I am alone and need to
take care of my business. When you get older it sure
makes a difference. Just think…I pay them for this
headache.
A:
And
it is a mighty expensive headache. First, call Medicare.
Explain the problem to your representative. They can
confirm your ID number and they may be able to tell
you what is going on since Medicare is the one that
sends your claims to your supplemental insurance. Perhaps
Medicare can help fix your problem or at least tell
you what is happening to your claims and give you some
guidance.
Now
call your supplemental insurance company again and speak
only to a supervisor. The phone number is on the back
of your ID card. It should be a local number or a toll
free phone number. Go over your problems with the supervisor.
Let the insurance company know they are the reason you
were sent to the collection agency. Not only do they
need to resolve your coverage problem, they need to
now clear your bad credit rating. You also need to know
when they will be making payments on these hospital
claims. If anyone suggests that you should throw away
any papers regarding this claim, hang the phone up,
call the insurance company again, and ask to speak to
someone else. That is not an acceptable or responsible
answer.
Next
call the hospital. Explain your problem to someone in
public relations. Ask them to have the supervisor of
the billing department help you get this resolved. You
may also want to call the president of the hospital
and inform his office about how the hospital handled
your account. Let them know you would like a review
of your entire situation since you don't think you were
treated fairly.
If
none of these suggestions resolve your problem, you
may want to turn to legal aid as a last resort. Try
to speak to someone who has experience with medical
claims and billing issues.
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