Why did the Kleiman Evangelista Eye Center in Arlington, Texas charge my mother $3,000 for doing her cataract surgery even she is 84 years old? She has Medicare too.
You would need to contact the eye center to see why your Mom was charged, instead of having her health insurance pay for the service. Maybe it was a coding error. Maybe your Mom hadn't meet her met her deductibles.
Francis; I hope you get the answers you need today from the facility and that you come back and tell us what you found out. We learn from each other here!
Medicare does not cover for all types of cataract surgery.
When I discussed surgery with my ophthalmologist, I learned that at that time there were 3 types of cataract surgery for which Medicare would pay. The one which applied to my situation would be either distance or close-up vision corrected, but not both.
This would have been permanent, no corrective surgery could be done later if one or the other aspect deteriorated, or continued to deteriorate. That was quite a dilemma - which type of vision to have corrected, then and forever w/o any further type of surgery being covered by Medicare.
There may even have been more tightening of Medicare's regulations since I had that consult, which was more than a few years ago.
I suspect Francis' mother may have had something similar, without realizing that Medicare didn't cover everything.
Francis, you need to get an itemized statement from the ophthalmologist's office, compare it with the Medicare EOB statements, and call Medicare with your mother present (to confirm that you can speak with Medicare on her behalf) and address the specific aspects of the surgery which aren't covered.
Or appeal Medicare's decision (you have 120 days from the date of the EOB) and ask for elaborations on their decisions - let the EOB be your guide; it uses alphabetical codes to indicate which services were and were not covered.
Absolutely agree get the facts and appeal the decision. If Mom did not have Medigap policy the bill may have been for the 20% Medicare does not cover for a procedure altho one is told Medicare covers cataracts in full. Full coverage only applies to the standard distance implant which means you may still need reading glasses. The bifocals cost an extra $600 each. One pair of glasses is supposed to be provided free but you have to have cheap Medicare frames and there seems too be a co-pay for the lenses. As GA said there is often a lapse between hospital billing and insurance payment so as usual be vigilant. Many facilities will negotiate a lower fee in hardship cases or take time payments. When you reuest the billing statement ask what policy the facility has for hardship cases. I plan to get the other half of my medicare glasses after the second surgery then a little way down the road I will order something reasonably priced online for reading.
The billing department should have gone over the cost before the surgery. Did ur Mom make sure the doctor took Medicare? Maybe they didn't bill her supplimental. Agree, you need to look at the Medicare statement and supplimental statement to see what each covered. There is usually a Dr. Charge, what Medicare approves, the 80% that Medicare paid. The 20% maybe covered by supplimental. I know a 98 yr old man who had his cateracts removed.
https://www.medicare.gov/coverage/cataract-surgery.html
Often, hospital bills get sent before Medicare or other insurance gets billed. Tell your mom it's a billing error and call them tomorrow.
When I discussed surgery with my ophthalmologist, I learned that at that time there were 3 types of cataract surgery for which Medicare would pay. The one which applied to my situation would be either distance or close-up vision corrected, but not both.
This would have been permanent, no corrective surgery could be done later if one or the other aspect deteriorated, or continued to deteriorate. That was quite a dilemma - which type of vision to have corrected, then and forever w/o any further type of surgery being covered by Medicare.
There may even have been more tightening of Medicare's regulations since I had that consult, which was more than a few years ago.
I suspect Francis' mother may have had something similar, without realizing that Medicare didn't cover everything.
Francis, you need to get an itemized statement from the ophthalmologist's office, compare it with the Medicare EOB statements, and call Medicare with your mother present (to confirm that you can speak with Medicare on her behalf) and address the specific aspects of the surgery which aren't covered.
Or appeal Medicare's decision (you have 120 days from the date of the EOB) and ask for elaborations on their decisions - let the EOB be your guide; it uses alphabetical codes to indicate which services were and were not covered.
Full coverage only applies to the standard distance implant which means you may still need reading glasses. The bifocals cost an extra $600 each. One pair of glasses is supposed to be provided free but you have to have cheap Medicare frames and there seems too be a co-pay for the lenses.
As GA said there is often a lapse between hospital billing and insurance payment so as usual be vigilant. Many facilities will negotiate a lower fee in hardship cases or take time payments. When you reuest the billing statement ask what policy the facility has for hardship cases.
I plan to get the other half of my medicare glasses after the second surgery then a little way down the road I will order something reasonably priced online for reading.