Medicare billing at a Lubbock Hospital. Could you assist with that? - AgingCare.com

Medicare billing at a Lubbock Hospital. Could you assist with that?

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My mother lives in Rotan, Tx, (Fisher County) and has a question about the hospital involved is Covenant. They are billing us amounts that are not supported by the MSNs that we have received.

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I think there is a fraud hotline if you are reasonably sure after talking to them that the services billed for were not actually received.
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For Medicare, you should be getting statements from CMS each month. CMS = Centers for Medicare & Medicaid. They love to send mail! On the statements it should indicate what Medicare paid for and what possible co-pay is due for each coded service. Usually it is 20% that is not covered for hospital based services under traditional Medicare. Direct hospitalization services can be at 100%. On the CMS mailing will be their # to call on questions and you need the statement to be able to refer to the specific item and it's coding to get anywhere with CMS.

Now if you have a secondary Medicare or MediGap policy and it is within the hospital group then the remaining 20% gets paid from that. But if they do not have a gap policy, then they are fully responsible for pay all this. And it could be a lot of $$ too. If your mom has income and assets she is expected to pay too. Hospitals tend to turn stuff over to collections within 90 days if you do nothing too.

Now there may be items which are not covered at all the Medicare. Often these will be for radiologists or lab fees which are sent outside of the hospital and the vendor just flat does not take Medicare. That will be all private pay and will be expensive. Now those you can call and try to negotiate as something is better than nothing but they too will turn over to collections pretty quickly.

This is all pretty bleak, I know. BTW the biggest reason for bankruptcy is due to medical and health care costs. One good hospital stay with surgery will run over 100K. This is why having the Affordable Care Act is just so important to have in place despite your political mind-set. Good luck!
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That kind of help isn't available here. Best bet: Call the hospital. Talk to their Patient Billing Department.
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