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Balance Billing
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Balance Billing

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  • Post
    • May 7, 2017 at 6:47 pm
    1derdog
    Participant

      My husband has been on Keytruda for over 16 months.  His tumor is not spreading & hasn't increased.  So, our doctor has taken him off Keytruda & us just montoring him for now.  We get scans every three months.  So, it's a wait & see.  I don't have to tell you all that with every scan we hold our breath & hope the best.  I know this my new normal but I, as his caregiver, an slowing breaking.  He also suffers from several other ailments not withstanding Parkinsons disease.  He's in chronic pain & I believe his cognitive ability is diminishing.  Sorry for not getting to my question yet. On top of doing my best to take care of him we're dealing with billing issues from the hospital for his Keytruda.  My husband has a Medicare Advantage Plan (PPO) Anthem Medigap Blue.  They will not pay more than what they pay Medicare for Keytruda & the hospital has charged us with the balance.  For three treatments at their facility they are demanding over $27,000 that we simply don't have. We don't qualify for any assistance program through Merck or the hospital.  But more importantly, the hospital didn't inform us of the discrepancy until 20 months after they sent an initial bill only requesting $200.00 which we paid promptly.  Has anyone else encounter this sort of billing problem.  I have spoken to the hospital several times & informed them that this is unacceptable & a big surprise to us since we're retired & are concerned to use Keytruda if we need to because of this differential in payment. They continue to leave phone messages & send us demanding payment.  We no longer go to that facility so we no longer have a relationship with anyone there to advocate on our behalf.  We are desperate for help.   Has anyone on this Board encountered this problem or know how we can proceed.  All we hear from the insurance company is that"balance billing" is illegal but they can't help us short of us getting either a billing advocate or an attorney.  If anyone here can help we would greatly appreciate any guidance.  This Board is a life saver.  

      Thank you & God Bless!

      loving wife & Caregiver

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    • Replies
        • May 7, 2017 at 7:04 pm
        Bubbles
        Participant

          I am not an expert in this area, since I care for children rather than patients on these plans.  But this link:  https://www.cms.gov/medicare-medicaid-coordination/medicare-and-medicaid-coordination/medicare-medicaid-coordination-office/medicaremedicaidgeneralinformation.html  

          …though it is talking about doctor's office billing…rather than facility/hospital services…would seem to apply and the answer would be NO!  They can not bill you for that which they have already cut a deal with your plan to accept. I would call the medicare folks through which you have your plan.  

          Sorry you are dealing with this ridiculousness on top of everything else!!  Perhaps Tim or others from MRF will chime in with more infor or assistance.

          celeste

            • May 7, 2017 at 7:26 pm
            1derdog
            Participant

              Thank you sooo much for your response.  I will call Medicare & file a complaint.  

              • May 7, 2017 at 7:27 pm
              1derdog
              Participant

                Thank you sooo much for your response.  I will call Medicare & file a complaint.  

                • May 8, 2017 at 7:54 pm
                1derdog
                Participant

                  Celeste,

                  called CMS & the rule of not charging for balance does not apply unless you're on Medicaid which we're not.  Just thought I would let you know.  Hopefully, someone else on the board can give me another option   

                  Thanks again.  

                  Terry

                  • May 8, 2017 at 9:34 pm
                  casagrayson
                  Participant

                    Terry, I really don't think that is correct.  Under Medicare laws, I thought you could only be charged the Medicare-negotiated rate.  I wonder if the rules are different for pharmaceuticals…

                    • May 10, 2017 at 1:04 am
                    Bubbles
                    Participant

                      Terry, 

                      I agree with Susan.  If you puruse that link I gave you…it really seems to indicate otherwise.  I would keep calling. I would avail myself of the resources noted here:  https://www.medicare.gov/claims-and-appeals/index.html  

                      Hang in there. Celeste

                       

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