True Story: 1

Today we wanted to share our first true story of an experience we had with one of our Medicare clients recently. Short disclaimer, all names and sensitive client information will remain anonymous to protect client’s identity.

This client signed up on a Medicare Supplement (Medigap) plan F when they were first eligible for Medicare. Before we jump into this story, it’s important to understand how a Medigap Plan F works.

What is a Medicare Supplement plan? It is a type of health insurance plan sold by private insurance companies to cover the gaps in traditional Medicare. Thus where it gets the term, “Medigap”. When someone chooses a Medigap, original Medicare remains primary and their Medigap plan is secondary. The Medigap plan helps to pay for costs that would normally be the client’s responsibility under traditional Medicare such as copays, coinsurance, and deductibles. With Medigap plans, Medicare pays first then the Medigap plan steps in and pays its share. Depending on the Medigap plan selected, this could mean the remainder of a bill.

In this post, we are talking only about Medigap Plan F. Take a look at the chart below that shows the Medigap Plan F benefits:

Medigap Plan F

As you can see, Medigap Plan F pays for all the gaps in traditional Medicare Part A and B (Part A deductible and Part B outpatient deductible, Part B 20% that Medicare does not cover, excess charges, etc) Typically, this means anyone on a Plan F should not receive any bills for out-of-pocket costs from their providers.

Now, let’s get back to the story of our client. This particular client went to their provider and had to have lab services done. Lab services fall under Medicare Part B. The client showed the provider their Medicare ID card as well as their Medigap Plan F insurance ID card but still received a bill from their provider for $250. The client, worried their bill would go to collections, paid their provider the $250.

The client then remembered our previous conversations we had about their Medigap Plan F and called me to tell me of their scenario. I explained the bill was likely sent to them in error and possibly never made it to their Medigap Plan F insurance company. We called their insurance company and not only did they receive the claim, they had already paid it and showed the check was cleared. So, the client’s provider was double paid for the same service!

At this point, the client was understandably upset that no one from the provider’s office caught the error and reimbursed them for the services they were not responsible for. I made it my goal to ensure the client received all of their money back from the provider. We called the billing department for the lab every week for 2 months reminding them the client was owed their reimbursement. During this 2 month period, the lab took new ownership and had a total turn over on employees. It appeared that each time we called, we spoke to a brand new billing representative and had to state our case all over again. Though we were frustrated, we did not give up!

Eventually, the client was feeling defeated and called me to say that they had given up on the idea that they would be reimbursed their $250 and that maybe we should just forget about the whole situation. I, however, did not want to throw in the towel. It was important to me that they receive their reimbursement for a service they were not responsible for in the first place.

After about 3 months, the client FINALLY received their check in the mail from their provider for $250. The client called me elated and grateful that I, their insurance agent, took the time to help them and would not give up until they received the $250 that they were owed.

This story is a good example of a simple billing error that can cause issues and frustrations. The client was not responsible for the bill but was nervous of it going to collections and paid it any way. Typically, I advise my clients who have a Medigap plan to give me a call if they ever get a bill for services they receive before they pay it. This way we can review it together and possibly help avoid paying for something that may not actually be their responsibility. It is always a good idea to clarify!

We hope this post was helpful to anyone who may face similar situations. If you have any questions or concerns, please feel free to reach out.

I know it’s only Thursday, but have a great weekend everyone!



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