Update to hospital possibility overbillibg Medicare patient...
I posted last month I think, that we received a $170 bill from the hospital for bloodwork MIL had done in June 2017. Medicare had paid $36 and the hospital was demanding $170 from MIL. Her deductible HAD been met by then. Anyway the update is, my husband was just going to pay the entire bill and I told him let’s call Medicare first and make sure she really owes this much because it seems awfully high considering they can only bill her 20% of the accepted amount. So I called Medicare a week ago Thursday and explained that we were concerned about an overbilling and would like a copy of the explanation of benefits. The gentleman on the phone was very nice and confirmed what I already knew about the 20% and sent us a copy of the EOB. He couldn’t tell us anything over the phone. So the EOB came today and yes she does owe $170 and here is why. She had blood work done—Medicaid covered and approved blood test clotting time, insertion of needle, protein measurement, and a comprehensive group of blood chemicals blood test. They DID NOT approve a “coagulation assessment blood test” which cost $170 so MIL was responsible for that amount. So we will be paying that bill in full. It would have been nice if the rude man in the hospital billing department had told me that when I called last month. I was basically told that it had to do with the way they coded the lab work and that she signed a piece of paper acknowledging she would pay that amount. Anyway thanks to all who helped me on that post. Hopefully my update helps others in a similar situation :)
And when the hospital asked your mother to sign for the coagulation assessment blood test, did she understand why the test was recommended and what its clinical justification was?
If Medicaid doesn't approve a test, there's probably a good reason why not, and as I understand it it's usually that there is no justification. For example, if the test is a fancy-pants minor variation on themes already covered.
Too late now, and in your mother's interest I hope the test was completely pointless! But I should watch those buggers in future, just in case they feel like flogging her anything else she probably doesn't need.
But glad it got all straightened out. How are things working out now, was it Moms friend, is no longer in the picture?