Saturday, February 14, 2015

IBM Medicare Supplement Provider Refund Problems

My happy dance over getting the 2014 cheapo supplement insurance plan to properly pay claims didn't last long.  Since the middle of December I have been trying to get the providers (doctors and hospitals) that have been overpaid to refund our money. 
The Medicare supplemental (aka medigap) insurer sent us a letter stating they only provided claim payments to providers and not to beneficiaries.  We had paid all the claims to these providers, who were very prompt about requesting payment, by the end of September.  So, when they received payment from the insurance company they were obviously overpaid.  I waited a couple of weeks after being notified the insurance company sent them payments before calling providers to see if they got the money and issued refund checks.  I am such an optimist.  By early January, I received no refunds so I started calling providers that had been overpaid.  It was an easy call for doctors who were part of a group practice.  The accounting office readily agreed they were overpaid and said they would refund the money.  I am mildly irritated that I needed to call at all, but at least they acknowledged the overpayment.
Dealing with the hospital and the hospital doctors was not as easy by a long stretch.  I struggled through calls to different accounting departments - which I had to do based on what service was provided.  I was told there were multiple accounts and needed to talk through each procedure's payment for the customer representative to tell me whether or not it was overpaid.  In one case, the customer representative said they had sent a payment back to the insurance company because it had been overpaid.  In another case the customer rep said a claim had never been submitted to the insurance company but that she would do it. Unbelievable, right?  
One customer service rep finally did agree a refund was due and said it would be sent. It was less than what I believed it should be but at this stage any refund is a good refund.  Anyway, nothing was repaid to us.  In mid January I wrote to the different accounting departments in the hospital (no joke) and provided evidence of overpayment to try to get a refund.  Still, we received nothing.  This week (mid February) I wrote to the hospital CEO to complain about the situation. 
I also went on the hunt for a governmental agency that might help.  It turns out the Department of Health only takes complaints about providers who are medically negligent.  They clearly state, don't complain to us if you have a billing problem. Medicare won't take the complaint.  CMS (the agency handling Medicare operations) clearly states they only handle provider fraud complaints. Fraud is when a doctor bills Medicare for a procedure that was never administered. This isn't fraud. The only agency I found where I can complain is the state Attorney General Consumer Protection Bureau.  I am hoping I don't have to do it as it will likely take months, if not years, for the Consumer Protection Bureau to even read my submission much less act on it.    All governmental protection agencies have had significant personnel reductions.   It's no wonder organizations are casual about their consumer interactions.  The complaint process is also onerous as I have to supply all the supporting documentation as well as file the complaint.  I sure hope the CEO letter provides some magic.
So, I once again urge you all to be diligent about analyzing your insurance statements, making sure doctors have submitted claims properly and making sure you track your deductibles before making provider payments. 

Update:  The CEO complaint letter seems to have been the catalyst to finally get the hospital to refund money.  I just got off the phone with the billing supervisor who agreed that we are due a refund but not without some taffy pulling.  At first she insisted there was no refund due.  I had all the information about the claims, dates and payments and started listing them off.  She then looked more closely at all the claims and agreed the hospital had been overpaid.  She said, "I was just looking at the payments for May".  It's beyond me why she was not looking at ALL the payments!  Although I feel it might finally be resolved,  I will refrain from doing a happy dance until I get the check.

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