Senior Care Insurance Services

By Woodrow Wilcox

On June 11, 2019, I wrote a letter to a doctor’s office for a client with a medical billing problem.

There were so many problems with the bill, that I suspected fraud. But, I did not suspect the doctor of fraud. I suspected the billing service that the doctor used. Here is part of the letter that I wrote.

I am writing to you to help your firm keep a good reputation. Our client sent to our firm a bill from your firm for our review. The bill seeks a balance of $1257.96 on what appears to be Account Number 4XXXX for various dates of service. The number “4XXXX” is not clearly marked as the account number on the pages that I have. Your bills would appear more professional if the account number were clearly noted. The bill is dated 05/17/19.

The lack of clarity for the account number was not the only problem that I found with this bill. I phoned the client’s Medicare supplement insurance company and reviewed your bill to our client with the claims record of the insurance company. For DOS 07/31/18, your firm claimed that $600 was the charge, but the insurance company received a claim with original charge of $900. The insurance company paid the Medicare ruled balance of $65.16 on 09/13/18, but your bill to our client does not acknowledge that payment. For DOS 09/11/18, your bill claimed that $4500 was charged. But, the insurance company’s record shows that $14,500 was charged and that it paid your firm the Medicare ruled balance of $852.38 on 11/2/18. But, your bill does not credit that payment to our client’s account. Similar problems exist with every date and service shown on the bill.

Your bookkeeping department should contact the claims department of the secondary insurer to review and resolve your bill’s serious problems.

Written on June 12, 2019 by Woodrow Wilcox