Medicare denials after car accident finally cleared up
Q: I am 83 years old and in bad health. I have been on Medicare since December 1990 with no problems until recently, when it stopped payments to my medical providers.
Medicare has been claiming that my Geico no-fault insurance is the primary payer for these claims. Its reasoning for denying the claim is related to a car accident that occurred in February 2004; I don't know why it waited five years to bring this up.
These denied payments were for medical appointments or treatments that had no relationship to the accident. Both Geico and I have made attempts to rectify this problem to no avail.
I have not been able to solve this problem with numerous appeals, telephone calls and letters. I would appreciate any assistance that you could give me to bring closure to this incident.
Lawrence A. Taylor
A: We received a forwarded Medicare letter from you, declaring this issue solved and closed.
Paulette Madison's resolution letter said that your master file has been updated to show the termination of the Geico policy on April 7, 2005. This update should prevent any future claims from being denied based on your accident in 2004.
We also spoke with you and confirmed that all of the claims previously denied because of the confusion have been taken care of by Medicare.
Be persistent when disputing health insurance claim denials
Action receives many complaints just like Mr. Taylor's regarding Medicare. Although it's easy to place the blame on a health insurance agency, the consumer must take responsibility, too.
Be sure to keep up with activity on your account, and immediately notify the company if you find an error. Persistence is key when disputing a claim denial. Be sure to keep detailed records and always send correspondence by certified mail, return receipt requested.
The following contacts for Medicare and the Agency for Health Care Administration may be helpful in avoiding and resolving any health care issues.
Centers for Medicare and Medicaid Services (for information and resources): toll-free 1-800-633-4227; www.cms.hhs.gov.
Medicare Beneficiary Helpline: toll-free 1-800-844-0795.
Agency for Health Care Administration, Consumer Assistance Unit (licenses and regulates health care facilities; takes complaints about quality of care or bills from health care facilities hospitals, nursing homes, ACLFs, home health care companies and HMOs): toll-free 1-888-419-3456; www.fdhc.state.fl.us.
Medical Quality Assurance/Consumer Services Unit of AHCA (to check licenses, complaints about the quality of health care, find out whether any disciplinary action has been taken against a health care practitioner): toll-free 1-888-419-3456; www.doh.state.fl.us, click on the health care professionals link and then follow the practitioner/physician profiling link. You can use the Profile Search System to look up specific doctors.