Got my Medicare Summary Notice which summarizes recent Medicare activity
(3 mos?). One of the charges was denied w/ the following footnotes:
a) service being denied because payment has already been made for similar
service within set time frame (I interpret that as meaning this is an every 12 mos procedure--from the Medicare Handbook---and that I violated this since my annual physical last yr was in Nov but it was Dec the previous yr).
b)you should not be billed for this service. You are only responsible for any deductible /coinsurance amounts listed in the "you may be billed" column
(which is 0.00)
c)It appears that you did not know that we would not pay for this service so you are not liable. Do not pay provider for this service. If you have already
paid provider, submit to this office 3 things: 1)copy of this notice 2)provider's bill and 3) proof of payment............
Future services of this type provided to you will be your responsibility.
My question is what that last sentence above means: "of this type"
1) Does this mean that if I violate the every 12 mos. rule in the future( for services where that rule applies) that I will be responsible for that bill? or
2)If I do this particular procedure XXXX in the future, I will be responsible for the bill regardless of whether I violate the 12 mo. rule or not? or
3) I will be responsible for the bill if I do procedure XXXXX and violate the
12 mo. rule?
Apparently the regular 24x7 phone reps didn't know the answer so the case was referred to the Advance Research Group who does not work extended hours and is a "Don't call us, We'll call you" type of group. They did call back within 48hrs as promised and, of course, I wasn't there. They will make another call and , if unsuccessful, do a snail mail run. My understanding is that I will be reimbursed for payment that I made if I submit the documents requested but,
if case 2) above is true, I might not want to be reimbursed. If case 2) is not true, then I would want reimbursement. There is a deadline for submitting documents that is looming so I would want to submit documents soon providing I knew the correct interpretation and consequences.
Anyone have any experience or appropriate links
I talked to a supervisor about how much friendlier a once per calendar yr
rule would be vs the every 12 mos. rule; also how un-customer-friendly
the "Don't call us. We'll call you" policy was when you're under a time deadline but can't sit around the phone waiting for their call. Can't say she was very sympathetic. I think they know there is no competition that can steal their customers away.
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