I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Dry-Pack-Babe on May 30, 2018, 06:13:51 PM
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I recently received bills from Medicare. One essentially told me that my I had no part B Medicare unless I paid X numbers of dollars. So I sent them the money and they sent me a new Medicare card. They have requested more money for bills from years ago. I always took the Medicare premium bills to the social worker who supposedly submitted them, but evidently, he didn't submit them, if Medicare wasn't paid. I have to figure out some way to raise the money. I don't know if this is making any sense. But the social worker at the clinic is not doing his job.
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I would ask to speak to the SW manager. If you get no resolution get a lawyer, if you can’t get a lawyer call a local news station, lack of insurance due to provider malfeasance makes a good story. If all else fails contact the Center for Medicare and Medicaid Services (CMS). And file a formal complaint. If every thing fails contact your local congressman’s office and tell him or her what has happened they may be able to get SSA off of your back.
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You shouldn't get bills from Medicare, unless you mean the Part B Premiums which are about $100 to lately $140 dollars a month.
Was there a program paying your premiums?
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Do you have a third party policy that pays what Medicare doesnt pay? I call it a Gap policy but don't know if there is a formal name for it or not. If you do not have such a policy then you are financially liable for the charges not paid by Medicare.
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The whole Medicare thing is so confusing.
Medicare has several parts, generally speaking:
- Part A covers inpatient hospitalization and is free.
- Part B covers 80% of the cost of outpatient services (dialysis is considered an outpatient service, also things like doctors' appts), but you pay a deductible and a premium of like $134 per month. If you have SSI or SSDI, this is taken out of your monthly benefits check from the SSA.
You are responsible for the remaining 20% of the cost of outpatient services.
People cover that 20% through either A) their employer insurance if they're working, B) gap insurance through a private insurer (I have a plan from Cigna for example), C) through Medicaid if they qualify, or D) through private insurance paid by the kidney fund (if you qualify for that -- ask your social worker. you essentially get private insurance coverage and the kidney fund pays the premiums on your behalf).
Like Bill Peckham says, Medicare will not send you bills or take money from you except for premiums. They do, however, send out regular Explanation of Benefits statements, which identify all the services you have received in the time period, how much Medicare paid, and how much you're responsible for. The Explanation of Benefits is not a bill -- just a record of payment by Medicare. If you have gap insurance, you will get a second Explanation of Benefits from the insurance company showing you how much of the remainder they were billed, how much they paid, and any balance you might be responsible for.
Although I am fully covered, periodically I get bills from providers. Usually they are in error due to coding. I usually call them up, provide my insurance information, and they run it through again.
Hope this helps...
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I think the problem here is the payment of Medicare premiums, the providers provide donations to a charity like the National Kidney Fund which then pay the premiums for people with limited income. The social worker at most clinics is resoncible for processing the paperwork to make thi happen. It appears that the social worker did not do this in this case leaving the patient who thought the payments were made responsible for the missing payments. Her problem seems to be tha SSA is requiring past due payments in order to pay for treatments.
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The social worker SHOULD be able to help, but Fresenius usually has a person that covers an area and is respnsible for the paperwork that will tell if you qualify for a waiver of the Fresenius costs, and can tell you if you qualify to have premiums on gap insurance paid by the Kidney Foundation.
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There are state and even county/municipality level programs that will pay Medicare premiums, deductibles, and coinsurance if a person has low income and few assets. Like a lot of things it depends on you zip code. The American Kidney Fund has their HIPP program (http://www.kidneyfund.org/financial-assistance/information-for-patients/health-insurance-premium-program/) which will pay premiums for Part B and gap policies. One thing to keep in mind RE: AKF support, they are a charity, relient on donations if donations are down or demand is up people with support one year may find out that support is unavailable the next.
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I believe if you qualify for Medicaid, that will pay the Part B premiums.
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I get a pension and my wife makes a good income. I also make good investments that paid off. As a result my Medicare payments tripled. It's almost a thousand dollars every six months. That's in addition to the regular insurance I get through my wife's employment and coverage at a hospital.