Eight weeks following her surgery to correct “droopy eyelids” (which impaired her vision) she is now almost fully recovered, and her eyes look great! There is some photosensitivity to bright lights but the blurred vision has mostly gone away and the same for dry eye.
From a financial perspective, bills from the surgeon and anesthesiologist were paid in full (80% Medicare Part B, 20% by Anthem Medigap G) in a few weeks.
The outpatient surgery bill from the hospital was another story.
The first notice (This Is Not a Bill) indicated $19,681 in gross charges and Medicare paid $0.
Obviously something was wrong and I had to wait a few weeks before the claim showed up in
account. Sure enough, Medicare denied the entire claim even though they approved the doctor fees and paid them.
Further looking showed the HCPCS codes for the doctors were correctly coded as “medically necessary” while the hospital bill was coded as cosmetic. The HCPCS code was off by one digit but, like a wrong phone number, one digit wrong is enough to derail things.
It took a couple more weeks
getting the surgeon’s office involved and documenting the coding trail. The miscoding was not intentional, just a keypunch data entry error.
Once the hospital agreed with the coding error and re-submitted the claim to Medicare the bill was approved and adjusted (discounted), Medicare paid $1952 and Anthem paid the balance of $498 leaving us with $0 out of pocket.
The takeaway is this. Don’t ever pay a bill, or a “This is not a bill”, until you have checked what you owe against your Medicare claim summary (found in your MyMedicare account) and the EOB (explanation of benefits) from your Medigap carrier. It doesn’t have to be a $19,681 bill, little ones can add up too.