Dealing with Unexpected Medical Bills: A Comprehensive Guide
Welcome to Medicare School Daily, where we are dedicated to simplifying the complex world of Medicare just for you. Our mission is to empower you with the knowledge and tools to save money, avoid pitfalls, and make the most of your Medicare benefits. In today’s discussion, we will delve deep into a topic that affects us all – unexpected medical bills, with a special focus on how it relates to Medigap Plan G.
Understanding Medigap Plan G
Medigap Plan G is just one of the many choices you have when it comes to Medicare supplemental plans. When you sign up for Medicare, you typically think about sticking with Original Medicare A and B. In this case, Medicare A and B act as the primary payers, while your selected supplemental plan comes next in line.
If you decide on Plan G, and many people do as it’s among the most popular, Medicare A and B pay your bills first. Your Plan G then comes in to pay second, covering everything with one exception—the Part B deductible.
Each year, Medicare establishes the Part B deductible, which for this year is set at $164.90. But what exactly does this mean? When you choose to enroll in Medigap Plan G, your plan will cover all other expenses, with the exception of the initial $164.90 that you are responsible for the year. If everything goes according to plan, this will be your only out-of-pocket medical expense until the following year.
Dealing with an Unexpected Bill
Imagine this scenario: you receive an unexpected and disappointing bill for around $226. After analyzing your Explanation of Benefits (EOB), you note that Medicare paid just $18 while your supplemental plan contributed $4. Your responsibility is pinned at $226. Here, we will explore three fundamental questions you should ask in such scenarios.
- Have you met your Part B Deductible Yet?: The bill of around $226 that you are responsible for is most likely your deductible. Meeting your deductible once a year is required, but after that, you can enjoy complete medical coverage, as long as Medicare approves it.
So for the first bill, maybe from an MRI or cataract surgery, you will have some responsibility. But after paying reaching the $226 deductible, you should ideally meet all your Medicare and supplemental plan obligations.
- Was it Coded Correctly?: In some instances, you might receive a bill for a procedure, say worth $1,000, and your explanation of benefits indicates a surprising responsibility on your part for the entire amount because Medicare paid nothing.
If you find yourself in this situation, the culprit may be an incorrect coding of the procedure. It’s important for the doctor’s office, outpatient surgery center, or any other healthcare provider to review and rectify this coding error. Once they’ve made the necessary corrections, they can resubmit the claim to Medicare, and you can anticipate your bill balance to decrease significantly.
- Was it a Medicare Covered Service?: There may also be instances where you receive services that unfortunately, are not covered by Medicare.
For instance, suppose you visit a chiropractor who charges $40 for an adjustment to the spine, $125 for an X-ray, and $85 for acupuncture. If Medicare covers only the spinal adjustment but not the X-ray and acupuncture, you will receive a bill for the latter two services totaling to $210.
Before opting for any procedure, always confirm with your provider whether Medicare covers the service. If Medicare doesn’t approve it, it doesn’t matter whether you’ve met your deductible or not, you will be financially responsible for those services.
In Summary
These three questions—have you met your Part B deductible, was it coded correctly, and was it a Medicare covered service—can help you navigate the murky waters of unexpected medical bills.
Remember, in the Medicare realm, asking questions is not just imperative, but also potentially money-saving. Be proactive and always enquire from your doctor or hospital whether they accept Medicare, and if further recommended procedures will be covered.
Visit medicareschool.com to watch our complete Medicare workshop. As always, we’re here to help you compare all your insurance options, and provide free enrollment assistance.
Until next time!