Medicare and Me: Do You Owe This Bill?

Leah Sugar Kari

As an agent and broker, I ask my clients to contact me first if they need any assistance with their plan. This article describes a situation encountered by more than one of my clients this past year. Don’t ever hesitate to question a bill you receive. Just because you’ve received the bill does not mean you owe it.

The problem: You receive a bill from a hospital or medical service you’ve used before. My clients’ bills ranged from $1,500 to a staggering $13,000. This is not to imply that the biller is doing the wrong thing; mistakes happen and are corrected. The bill may date back to 2019, or more recently where you paid your share of cost at the time of service. Each of my clients searched their Explanation of Benefit statements, and their payment records, but the question remained, do you actually owe this bill?

Your action plan: Contact your agent for their assistance and/or your insurance carrier. Having your agent initiate a three-way call to plan with you on the line can help. Your agent takes notes and assists with the call. There’s generally a favorable outcome, no matter what the problem. The outcome for my clients “owing” $1,500 to the $13,000 bill, each matter has been successfully and promptly resolved. Not one client owed a penny.

Medicare providers cannot bill you for more charges outside of Medicare’s approved fees and rules. This is called balance billing. For Medicare Advantage members, this protection is in your plan’s Evidence of Coverage. Your responsibility is to satisfy your plan’s deductible, if any, and pay your copays or coinsurance for care from your plan. You pay nothing more, even if a payment amount is in dispute, or if the carrier did not pay the full amount the provider charged.

For Medicare Supplement members, your provider bills Medicare first for Medicare approved expenses, and your plan pays what remains. Whether the provider accepts Medicare’s payment as payment in full (called assignment) or not, there are maximum rates allowed for services and strict rules on how much Medicare will pay. If you’ve received a bill as my clients did, contact your agent, the supplemental carrier, or the billing office listed on the statement you’ve received to question the bill. You’ll have resolution with no additional payment from you as the member.

One client thought he had to pay the $1,500 bill. I called to say hello and learned about the bill. Our three-way call to the plan proved he owed nothing, and the client stopped payment on his check he’d mailed the day before. Stop before you mail that payment—you may not owe that bill!

Leah Sugar Kari, AMR, FHIAS, is a local licensed life and health insurance agent specializing in Medicare insurance products. Reach Leah for comments at 520-484-3807 or at [email protected] (TTY users dial 711).