Berkshire Senior Online

By Margie Ware, Regional SHINE Director

If there is anything that characterizes the over-65 generation, as opposed to their younger colleagues, it is their commitment to paying their bills on time. In our family, we used to joke with my father-in-law, who would never go on vacation for more than two weeks during his retirement, because he wanted to be sure to get home to pay the bills!

So it has been especially distressing for Berkshire seniors who have recently received "dunning notices" from physician offices, saying they are being sent to a collection agency because of an unpaid bill. Often the bills are incredibly small, less than $25.00. Understandably, these elders are confused, disconcerted and understandably angry. And, in many cases, they didn’t even owe the money indicated on the statement!

Medicare beneficiaries sometimes have a difficult time figuring out just what they owe a physician because of the time lag between the date of service and the completion of paperwork by HCFA (the Health Care Financing Administration that runs the Medicare program), their supplemental insurance carrier and the doctor’s office. Understandably, a well-run physician’s office sends out monthly statements advising patients of their payment status. Unfortunately, it takes a Philadelphia lawyer to assemble the right combination of doctor’s office statements, Medicare benefit notices, and printouts from the supplemental health insurance carrier in order to determine what the real amount owed is!

So here are some helpful hints to guide you when you are considering paying a bill to a physician’s office.

1. Is the service covered by Medicare? If so, you should have received a notice from Medicare indicating the allowed amount and that Medicare has paid 80% of the charge. If you haven’t received that notice, call the physician and ask if they have billed Medicare. If the service is not covered, and Medicare has been billed and rejected the claim, you will receive a copy of that notice too. Remember that routine physicals are NOT covered by Medicare and are your responsibility.

2. Do you have supplemental ("Medigap") insurance? If so, the portion of your bill that is your responsibility should automatically be sent to that carrier. So even if you receive Medicare notices indicating a charge is "your responsibility" wait until your supplemental carrier sends you a notice indicating that the charge has been paid, less any deductible you may be responsible for.

3. Only when all of your insurance sources (Medicare, Medigap, etc.) have paid their portion, should you consider paying any balance billed by the physician. The billing office personnel are most helpful if you have questions about the status of your bill. Do not hesitate to call them if you have received a statement from the physician which you think is in excess of what you should be billed.

4. The SHINE program volunteers are available all over Berkshire County to assist with billing questions. This is especially important when bills indicate that a collection agency may be contacted.

In the event of a billing dispute or concern, please contact your local Council on Aging and ask to have an appointment with a SHINE Volunteer. If no volunteer is on duty in your community, please contact Elder Services at 499-0524 or 1 800 957-3557 to make an appointment for assistance.

It’s important to pay your bills on time to keep your excellent credit rating. But don’t pay bills you don’t owe!