AboutMerry Schiff Expertise I am very familar with Medicare and general insurance questions. I can answer general questions about HMO's.
Experience I have been in the medical billing industry for 50 years. I have helped develop software for this industry. I am a consultant to billers and the medical profession.
Organizations I am the Executive Director of NEBA, a medical billing organization with nearly 1000 members.
Education/Credentials I have been teaching medical billing for many years as well as being a published author with Pearson Education. One book on medical billing (nearly 800 pages) and one on HIPAA.
Question QUESTION: My dad passed away on 3/07 at age 66 with pancreatic cancer. He was fully insured with medicare A&B and supplemental by banker lift&casuality. Last month (6/04/08), I received a pile of medical bills of $~ 5000.00 (service period of 2/06 to 10/06) from his oncologist that requires my mom to pay. Prior of that, I did not receive anything. I called the oncologist's billing office to find out and again provided my father's (suppl)insurance policy # to them. Billing office stated that they did not have that policy# at that time (which was not true! insurance company did pay some during that period of time and I have copies of the benefit papers) and insurance company might not cover if they send those bills in at this time 6/08. It has been more than a year and 90 days. Surely, insurance company sent us letters stated the claim period is beyond their policy (one year and 90 days). What should I do?? My mom can't afford the bills. Should we make some type of arrangement?? Please Help! Thank you so much for your time, looking forward to hear from you
ANSWER: I have some questions..Was the Bankers Life a Medigap policy? Was the oncologist a Medicare participating provider..in other words, did he accept what Medicare allowed for the procedures..where Medicare paid 80% of the allowed amount and Bankers Life paid the remaining 20% of the allowed amount. Do you have Explanation of Benefit papers that show that in this time frame, Bankers DID pay on some of the claims from the oncologist? If you can answer this, I will try to help you.
Merry
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QUESTION: Merry, so glad to hear from you!
Bankers life is like a medigap (in NJ, medicare supplemental that pays 20% and medicare part B pays 80% just like you stated). This oncologist is a medicare participating provider, and yes, he got paid by the medicare and billed us for those 20% he did not get paid. Banker did pay some of the claims in those service period from 5/06 to 10/06 (I have some EOB). I don't have any information on wether or not doctor's office billed from 2/06 to 4/06 and/or Banker denied payments. I didn't know my dad's medical bills ($5000) until now 6/08. I would take care of it and make phone calls if I have known initially, now it's too late to contact the insurance (they don't pay the old bills)?? why the doctor's office did not bill us when they did not get paid for the 20%. ( I read that is patient's responsibility to check in but dad was fully insured! I have no idea how doctor's billing system and nor anyone contact me until I received this pile of bills) I am really stress out by this, how is my mom going to pay? please help! Thank you Merry
This is the very best place to go. They know NJ law and will be familiar with what you need. If you have to wait for an appt, please contact the drs office, get the name of the manager of the office and tell him/her that you are making arrangements. Please do not give them more information. Then, write the office and say the same thing..I would send it registered mail and to the attention of the dr. Registered mail says that it is important. Then, SHIP will help you but just in case you have to wait, at least the drs office knows that you are not ignoring this.
