Medicare won't pay for the hospital's error - what do we do now?
My grandmother has had several mini-strokes and suffers with moderate dementia. She receives Social Security and a very small pension. She has Medicare and AARP health insurance. She went in for a blood test and shortly afterward the hospital called and said they didn't get enough blood and she needed to have more drawn.
Medicare paid for the first procedure but refused payment on the second. Apparently my grandmother signed a paper agreeing to pay if Medicare refused. She has no memory of the incident and is not aware that the hospital has been sending threatening collection letters.
The latest is a notice that her tax refund will be reduced until the debt is paid (plus a $50 fee). She doesn't make enough money to even file a tax return, and has not received a tax refund in 20 years. Is she liable for this bill? When she dies will I be liable (I am her POA). Should I just pay the bill? I hate to think that money that could be used to pay her sitter is going to pay for the hospital's error.
Expert Answer
Your story is one of those outrageous ones that makes one wonder where the "care" is Medicare can be found.
I encourage you not to simply pay the amount billed, but to try instead to get some human at the Medicare office to see the error of the ways of coverage denial.
It sounds as if you will be the one to be advocating on your grandmother's behalf"”and know that the act will likely take patience, perseverance and possibly some legwork or your part.
Contact Medicare, but go directly through the appeal procedure at http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=11365.
It may become especially important to bolster your grandmother's claim with additional evidence that: 1) that second procedure was required only because of the hospital's error, 2) verification that her dementia kept her from knowingly understanding the waiver you mentioned, if that is the case. In both instances, her attending physician might be most helpful in nudging along hospital administrators and in supplying written verification of your grandmother's condition.
If you end up connected to a Medicare staffperson who seems less than helpful or knowledgeable, hang up and call later, when you might be able to get a more sympathetic eye and ear. It's surprising how often this phone trick works to the caller's advantage.
If the appeal procedure seems too daunting, or you don't get the results you want there, contact the Office of the Medicare Ombudsman at http://www.medicare.gov/navigation/help-and-support/ombudsman.aspx?Nav=Top. These trained individuals have been designated to help consumers enforce their rights and protections within the Medicare system.