Adventures in Medicare Billing

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"All I wanted to do was save Medicare $174.55," writes Lucille Kearl Armati about her mission to correct a payment by that agency for an October 2000 bone marrow test she never had. Notice of the payment showed up on a $244.10 bill the Reston senior received earlier this year from Quest Diagnostics for her share of the $418.65 price of the test.

Fixing the problem -- or at least trying -- cost Armati months and the threat of a visit from a collection agency.

After phoning her physician, Anthony J. Felice, to verify that no bone marrow screening had been ordered for her, Armati called Medicare to alert the agency to the error. Medicare followed up with Quest, which refunded the agency's payment. It seemed a happy ending. Then a second bill reached Armati -- for the entire $418.65 charge.

Upset, she dialed Quest's customer service but got only a dose of frustration. Not only was the medical testing giant unresponsive, she says, but soon it was dunning her to pay up. "I'm a member of the greatest generation and we were taught to trust authority," she says, but not when company officials defend "fairy dust" like the figures on her bill.

Medicare billing problems like Armati's are all too common, says Alfred Chiplin, managing attorney for the Health Care Rights Project of the nonprofit Center for Medicare Advocacy. An audit by the the inspector general of the Department of Health and Human Services (HHS) showed that last year, 6.8 percent of service fees to Medicare were paid in error, costing taxpayers $11.9 billion.

Such findings, says Chiplin, emphasize the need for consumers to review their bills carefully -- including Medicare's "Explanation Of Benefits" -- and be willing to fight.

Of course, when the error is not the amount billed but the appearance at all of an unrendered service, as in Armanti's case, it makes the task harder, says Ben St. John, a spokesperson for the inspector general. Physicians and testing companies like Quest have both been guilty of such errors, he says.

If calls to your doctor and Medicare don't resolve a dispute, Medicare officials suggest phoning the HHS inspector general's hot line, 800-447-8477 (800-HHS-TIPS). St. John says the hot line receives 45,000 calls per month.

As for Quest, a company spokesman blamed the Armati incident on regulatory confusion. "Health care billing for Medicare . . . can sometimes be complicated and confusing," wrote spokesman Gary Samuels in a prepared statement. "I can assure you that this was not a typical patient experience." Armati now expects the bill to be canceled.

Washington Post

-- Anonymous, December 14, 2001


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