Julie Shepard-Hall, who is with Senior Spokane sponsor Integrity Insurance Solutions LLC, has provided us with some important information regarding our Medicare plans, billings, and the popular Silver Sneakers benefit:
When seniors are hospitalized, they either have a deductible or copay to pay. But they may also receive a bill from the hospital with no explanation as to what the outstanding balance is for. Many people just pay it because it’s a bill and that is what you should do. But they need to call the billing department and ask for an itemized billing so they can see what those charges are for. These additional charges may be for prescriptions that are administered while in the hospital. If they have a prescription drug plan, they can send the bill to the prescription drug plan using a reimbursement claim form and ask them to pay for those medications.
In one situation, my client was billed $847 for medications. After sending the claim form and the billing to the doctor’s office for a signature, we found out that the medication was used during his eye surgery and should have been covered by the insurance. So we were able to get the hospital to rebill and the medication was covered.
In the other cases, the members were reimbursed a portion of the amount, less what their copay would have been. In both cases these bills were for more than $200. The link explains how self-administered prescriptions are not covered while you are in the hospital.
I think if I were hospitalized I would not pay any bill without getting an itemized bill from the hospital and scrutinizing every charge.
Also… Asuris is now offering the Silver Sneakers benefit with the Medicare Supplement plans. This is the only Medicare Supplement company offering this benefit at this time. So if someone is on a Medicare Supplement Plan F or pretty much any other plan, they could enroll in the same plan with Asuris and get the Silver Sneakers program. They do not have to wait until the Annual Enrollment period like you do with the Advantage plans.
Integrity Insurance Solutions, LLC.