Social Security & Medicare Questions: July 2015

Social Security & Medicare Questions: July 2015

After Surgery What Can I Do About Unexpected Bills?

Q: I’m new to Medicare and recently had surgery. I’ve received several unexpected bills, including one for $1,100 from the anesthesiologist. I thought these costs would be covered. What can I do?

A: When you get surgery it’s often difficult to know the costs in advance. Medicare covers anesthesia provided for medically necessary inpatient or outpatient surgical procedures. But it’s important to understand how services like anesthesia work because they are often billed and paid separately, and administered by specific providers who may not be affiliated with your in-network hospital or doctor’s practice. In addition, billing errors frequently occur, and bills often need to be corrected and re-submitted for reimbursement. Here are some steps to take to make sure all your bills get paid.

  1. Does your anesthesiologist have your correct Medicare number and your health plan or supplement information? Patients often meet the anesthesiologist just minutes before surgery, but it’s better to learn ahead of time whether the anesthesiologist who will provide your care accepts Medicare and is in your plan’s network. Hopefully your anesthesiologist has the paperwork correct, but before they knock you out the next time, make sure.
  2. Was your surgery for an inpatient or outpatient procedure? Even when you spend one or more nights in the hospital, that doesn’t automatically make you an inpatient. Ask your hospital or facility’s billing department. Whether the service is provided as an inpatient or outpatient is important, because it will be billed differently. If your elective surgery was an outpatient procedure and your anesthesiologist billed it as an inpatient service, or vice versa, then Medicare or your health plan may reject the bill. If an error was made, ask your anesthesiologist to correct the bill and resubmit it.
  3. Check with your Medicare health plan, supplement, or other insurance — like coverage through an employer. Often your insurer can tell you why a bill has been denied, and, more importantly, what you need to do to get the bill paid.
  4. Check or your last “Medicare Summary Notice” to see if you’ve met your deductibles. Deductibles are the amount you must pay before the service is covered, and vary widely depending on the type of coverage you have in addition to Medicare Part A and Part B.
  5. When all else fails — appeal. If you disagree with a coverage or payment decision by Medicare or your health plan, you can appeal. Learn how here.

To read more about Medicare see the 2015 Medicare & You handbook. Get a copy here.