Medicare won't pay for the hospital's error - what do we do now?

6 answers | Last updated: Oct 14, 2016
A fellow caregiver asked...

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 Answers

Barbara Repa, a Caring.com senior editor, is an attorney, a journalist specializing in aging issues, and the author of Your Rights in the Workplace (Nolo), now in its 10th edition.

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.


Community Answers

Reed answered...

I work in a hospital and double billing is wrong. The hospital is responsible. Call the billing department and explain the situation. Most times they cancel the second account. If you don't get a quick response go to the hospital administration. You are not responsible for their error. If that was true they'd be able to double bill everyone for "errors"!


Gerij9 answered...

I do makreting for plaintiff attorneys. I urge you to go see a plaintiff attorney who focuses on elder abuse. Though I am not a lawyer, from what I've seen, if your grandmother cannot be held liable for a contract she signed if she is not competant to sign it (i.e., suffering from dementia). Good luck to you.


Sjaweha answered...

Go to the Hospital and they will correct this. Someone dropped the ball here. The Hospital knows very very well all medicare guidlines.Medicare will never pay for the same test for the same reason within a 24 hr period it's in their contract with the patient. Someone was not thinking (at the hospital). THE HOSPITAL IS RESPONSIBLE, go to the hospitals Human resource Dept. (who oversees all things with employees), ask them why an employee or supervisor would have run another blood test knowing Medicare would not pay. Ask them where you can go to rectify this. Hospitals want good PR.

This will be a non issue.


Chris115 answered...

The 2 above are absolutely corrct. THE HOSPITAL is the one to rectify this mess. Maybe just some human error in the billing dept. but if the lab tech didn't get enough blood, then it is the hospital's fault. The form your grandma signed is called an ABN- advanced beneficiaries notice. The hospital had to come up with these cause patients got labs drawn by orders from different doctors they saw and ended up, for example, getting cholesteral checked more frequently than Medicare allows (Once a year for people with no cholesteral issues, no heart disease, etc-people with these problems can get up to 4 times a year WITH THE CORRECT DIAGNOSIS CODES from the doctor.) Good luck and thanks for looking out for your Grandma!


Vj3904 answered...

Yes, I agree you should contact the billing dept for the hospital PLUS the patient advocate/patient relations office for the hospital so that they can help each other. Often billing offices and the staff who drew the blood work are not familiar with the big picture. The patient relations office type will understand better and know who to talk to. Best to you...