If you’re on Medicare…

Many of our local senior population is on Medicare, usually Parts A and B.

Part A will cover your expenses if you are a patient, admitted to the hospital, and receive care from the doctors and nurses. Part B will cover office visits and diagnostic tests but not pharmaceuticals (that is Part D).

However, sometimes a patient will receive a bill from the hospital, often a hefty one, and they believe that they have to pay it. The bill is for things not covered under Medicare Part A.

When the bill comes, it’s a shock. I know this because I received two bills, totaling $1,700. There was no indication of what the charges were for.

I called Medicare and spoke with a rep. What I learned was important, and you may find this of importance also.

If you are hospitalized and the doctors (or other health care practitioners) intend to employ a treatment option that is not covered under Medicare Part A, they must advise you in advance—both verbally and in writing. This is very important.

Not only are you to be advised in advance, you are to be given an ABN form (Advance Beneficiary Notice of Noncoverage). It must also be explained to you—that these treatments are outside the coverage of Medicare.

Now you have a choice: you can agree to pay, sign the form and check the “yes” box. If you decline, you still sign the form, but check the “no” box.

In other words, if you decline the treatment, you’re done. If you say yes, then you have agreed to pay the costs.

What the hospital did in my case was to simply send me a bill—a big one. There was no ABN form to sign, and no one explained anything to me. I assumed that Medicare Part A would cover my stay in the hospital.

A billing person from the hospital called me up to ask about my bill.

I told her, “If you can produce my signed ABN form, in which I agreed to pay for these charges, then I will pay.” (I never signed anything). She replied, “I’ll get back to you.”

I got a similar bill from a diagnostic imaging place in Guam for $600. It was for an echo-cardiogram. At the time I received the “echo” there was no ABN, no explanation, nothing. I sent them a note back and suggested that they try Medicare, since the “echo” ought to have been covered.

If you think you have been unjustly billed, call Medicare, at 1-800-633-4227.

It’s one of the few government agencies where you can speak with a knowledgeable rep, quickly, without a long delay.

You may also visit the Medicare website, explaining the ABN:

https://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html
Good luck and stay healthy!

Russ Mason
As Teo, Saipan