Medicare and medical billing

I just learned something that might also be useful to other people on Medicare. Maybe most of you know it already but I didn't.

I was looking at a big bill for routine lab work that Medicare refused to pay for. Apparently, there's a thing called an Advanced Beneficiary Notice (ABN) that, if you have not signed off on it, you don't have to pay. If the lab tries to bill you, you can say "show me the ABN that I signed" and if they can't, you're off the hook. I guess it's not unheard-of for the lab to send a bill when they shouldn't.

^^At least, according to the billing clerk at my local clinic.

I'm sure in real life it's complicated, but if you get a weird bill, it's definitely worth checking out all your options before paying it. Those little footnotes on your "Medicare summary notice" are not necessarily the final word. I found the Medicare help desk + the clinic billing clerk very helpful. The lab did not make it easy to find contact info. If the bill had been smaller, I might have just paid it to make it go away; I'm glad I didn't.

FWIW!

About signing the ABN. A lab told me I had to sign 'just in case' Medicare didn't pay. Medicare did not pay, saying I had signed that I knew they wouldn't and that I knew I would have to pay. I will not sign another one ever again.

Yeah, I've gotten pressure to sign those, too.
Just like I've had pressure to sign hold-harmless clauses (~"I agree to be liable for every damnfool thing anyone on this project does, even though I have no say in it") clauses for freelance work. "Don't worry, it's only a formality, just go ahead and sign" grrrr!

Yes, be very careful with this.

My PCP told me last fall that I was due for a dpt booster, which the nurse gave.

I then got a bill for nearly $400 that insurance initially refused to pay.

They eventually did pay it all, but said if I had signed something saying I would be responsible for anything insurance did not cover they wouldn’t have been able to pay it. I would have then been responsible.

The other issue, of course, is that my PCP should have known Medicare/my insurance wouldn’t cover a booster given there, which had not occurred to me.

Boosters and other vaccines are completely covered at the pharmacies.

WanderingRose said:

The other issue, of course, is that my PCP should have known Medicare/my insurance wouldn’t cover a booster given there, which had not occurred to me.

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Yes, it would be nice if they were more proactive on warning patients about this stuff.

Also be very careful that if you go to the hospital make sure that you are admitted and not held for observation... Medicare does not pay for the latter... You're supposed to sign a form acknowledging that but you know how paperwork goes when you're in the middle of a medical emergency confusing as hell...

It is a sad situation when we have to be wary of our medical providers tricking us into signing things that then make us responsible for large fees.

And it is not uncommon to be asked to sign something electronically, like on a pad, when you can’t see what you are signing.

I know, I hate that! I wonder how those are even legal. I have asked in the past to have print-outs of everything I signed that way ... but who knows if they're really giving you everything?

Here's a great help for older people & the disabled with medical, credit card & other non secured debt. I found them helping a friend & with one call no more harassment calls, letters or contact of any kind. No charge if you can't afford it & very minimal donation if you can. They're a 501c3. https://www.helpsishere.org/index.html

I would check out this or any other law firm carefully before using it.
Here are some red flags regarding HELPS which showed up quickly:
They refer to themselves as a 501(c)3 but do not list their EIN (Employer Identification Number) or Federal Tax ID.
They do not seem to be listed by the IRS as a 501(c)3. At least, I could not find them on the IRS's search page (see below).
They describe themselves as a law firm but give the disclaimer "HELPS does not give legal advice."
They do not list any affiliations or accreditations.
They give a Salem, Oregon, address but are not listed in the membership directory of the Oregon State Bar with a Salem location.
Their website seems poorly edited.

In short, based on appearances, they really don't seem to pass the sniff test for either a law office or a nonprofit.

IF YOU ARE IN TROUBLE OR NEED HELP, BE CAREFUL AND SYSTEMATIC ABOUT HOW YOU GET THAT HELP. You don't want to make things worse than they already are~

Your state bar association, your city or state government senior or low-income support agency, the Salvation Army, your local 211 number or website, even your doctor's office could have leads for you. START WITH A SOURCE THAT IS WELL KNOWN TO BE TRUSTWORTHY and drill down from there.

TO CHECK AN ORGANIZATION'S NONPROFIT STATUS, go here: https://www.irs.gov/charities-non-profits/search-for-tax-exempt-organizations. You can search by EIN, which should be on their website, or by name.

TO CHECK A LAW FIRM'S STANDING, try your state bar association. Ask the law firm for their state bar association number. State bar associations also often have a program where for a small fee you can get a consultation with a lawyer who can at least give you a good idea of how to move forward.

Don't pick anything just because someone -- including me!! -- recommended it here. Check it out for yourself.

Morgana, aren't you the one always preaching verify before posting? 1 search got all this):
I'm only trying to help people that for whatever reason get out from under that strain.
BBB report, 1 complaint, resolved & sounds like a misunderstanding.
https://www.bbb.org/us/or/salem/pro...for-seniors-disabled-1296-22715010/complaints
Birdseye/yahoo reviews 4.7 out of 5 https://www.bbb.org/us/or/salem/pro...for-seniors-disabled-1296-22715010/complaints
Helps IRS letter https://helpsishere.org/501c.html
Proof from Charity Navigator it's a real Charity, It has a low score from not turning in all the requested forms but I saw Rotary get a huge ding for doing that. Look at Eric Olsen salary $0
https://www.charitynavigator.org/ein/462637954
Eric Olsen is a lawyer https://www.seniorliving.org/expert/eric-olsen/

Of course I say you should verify, and that is exactly what I did.
I stand by everything I said. I would think twice before trusting this organization, and the material you provided would not reassure me.

The IRS is the place to verify 501c3 status, not some non-letterhead nine-year-old xerox posted to the organization's own website.
The Charity Navigator rating is either very bad or completely useless, depending on how you look at it. There's no evidence there that says you should trust this org.
I use BBB and Birdseye a lot too, but they're not the be-all-end-all. If you can't verify via the IRS and the bar association, review sites won't make up for that.

There are lots and lots and lots of organizations and law offices claiming to help people with financial problems. Some of them are good. Some of them are not. Use reputable sources to evaluate them, is all I'm saying. If your friend really got some kind of miracle cure from one phone call, I'm happy for them. But it would need a lot of very positive research results to get past the red flags in this organization's record.

I'm not going to argue this any further. I'm tired of going down these ratholes based on sketchy websites and crackpot videos. Personally, I wouldn't touch this thing with a 10-foot pole; YMMV.

The point is, BE CAREFUL AND CHECK THOROUGHLY. Please, people. Check what Gr8tful says, check what I say, check what everybody says. And the more of your money and personal info you have to invest, the more carefully you should check.

Like Sergeant Phil Esterhas used to say, Be Careful Out There.

Over and out.

Your local Senior Center can also be a good resource for help with all sorts of things, from financial resources to managing your new phone.

I just want one more time to encourage people to check things out for themselves. In debt like in health issues, the more urgent your problem is, the more carefully you have to proceed. The very moment when you would most like to trust someone else to take care of things for you = the very moment when you have to keep the reins yourself. Be careful. Make people prove themselves. Remember that "if it looks too good to be true, it probably is." A forum like this is a great place for sharing tips but you still need to do your homework to check it out. And that absolutely includes anything I say as well as what other forum members say.

View attachment iDcMnc.mp4

shadowmoss said:

You were good till that last sentence. That is the difference between stating a usually helpful fact, and being disrespectful.

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Not really, if you fail to post those proofs and reviews with the original post then degrade the individual that does instead of thanking them it just isn’t in the sprit of this forum and it’s goals of being helpful in my opinion. Short tempers and outbursts are out of bounds when you really are trying to help the people that come here for answers and assist those that are here trying to help. Not to mention no reliable proof or personal recommendations by the person receiving the service have yet been posted. Once again all opinion no facts. This is how misinformation gets started and fact checking comes into play.

Also that the helpful facts are still missing.

HELPS PROOF
The following information outlines how to find our filing with the IRS as a 501(c)(3) nonprofit. Our Employer Identification Number with the IRS is 46-2637954. You may verify our status with the IRS at: https://www.irs.gov/charities-non-profits/exempt-organizations-select-check.

Here is the step by step instructions to find the entry:

• Scroll down to Blue Bar “Exempt Organizations Select Check Tool”
• Select the following:

• Type the EIN: 46-2637954 or the Name: Help Eliminate Legal Problems for Seniors and Dissabled (Yes, there is a typo)

If you have further questions or would like to speak to a representative about how HELPS can help, please give us a call at 855-435-7787.

Helps was real & legit all the time. I hope they can help someone here.

Gr8ful said:

Helps was real & legit all the time. I hope they can help someone here.

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In the future please post all sources of reference so others can review and vet them. As in this case not all may have the same experience when doing so. Results may vary and if they do don’t take it personal.