Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
DECEMBER 2000 NICA NEWS
GOLD RECORDS
Record #3(Beatrice)1/00 (B. Stiles): Client had received treatment at the Mayo Clinic - they do not accept assignment. She had a number of EOBs, but the amounts did not match the bill totals. NICA Volunteer sorted the individual items on the EOBs and matched them to the Mayo coding. Medicare had paid all of their claims and the private insurance paid the remainder. (Time=4 hours; $=0; Satisfied=unk)Yes, the Mayo Clinic does not accept assignment. Matching their billings with the Medicare bill codings can be confusing. Thank you for assisting the client with this complicated matter.
Record #3(Beatrice)7/00 (B. Stiles): Client had GammaKnife surgery and had received a notice from her MedSup that Medicare had denied the claim and, therefore, they would not pay either. Client was prepared to convert CDs and bonds to cash in order to pay the bills. Tried to contact the business office at the hospital, but they were closed on the weekend. Recommended that client not do anything until more information was obtained. Contacted the hospital on Monday. They had not gotten any notice from Medicare at that time, but did not seem at all concerned. The hospital said they would probably have to send additional information. NICA Volunteer recommended that client not pay any money at this time and wait and see how everything worked out. Client later received a new bill from the hospital for $776 and shortly thereafter a notice from her MedSup that the amount had been paid. (Time=1.5 hours; $=$43,500; Satisfied=unk)
Good job, Betty. It is helpful to contact the hospital and let them know that Medicare denied the claim so that they can send additional information if needed.