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General LGBT Aging Issues


Q Medicare not covering all my expenses
  Mar 11, 2008

I have Medicare parts A and B and a Medigap plan from AARP, so I am well-covered and shouldnât have to pay anything for my doctor visits. Yet when I do have an outpatient visit I get billed by the doctorâs office. When I tell them I am covered, I am told that Medicare has rejected the bill and said they are not my primary insurance. It causes a lot of stress for me, particularly when I am threatened with being taken to a collection agency and having my credit ruined. There does not seem to be anyone to turn to to get this situation straightened out because there is sloppy record keeping in the doctorâs office. They have entered the wrong Medigap number or miscoded the procedure. Who can I turn to for help?


A Response from Mr. Stewart

Understanding how to bill and get paid for medical services is a job for a Ph.D. The only way to clarify issues is to ask and then ask again.

In your case, Medigap should be the primary insurer or payer. Medicare then should follow as the second payer. It would be important for you to call AARP and speak to their Medigap representative asking for an explanation of what they pay for and how to make sure there is payment.

It's also important to know that Medicare will pay only 80% of the bill.

Social Workers like me usually have a difficult time understanding complicated billing issues, that's why I asked the billing staff at the Village Care of New York Health Clinic.

Peace and Good, Ken

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