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Why did the Kleiman Evangelista Eye Center in Arlington, Texas charge my mother $3,000 for doing her cataract surgery even she is 84 years old? She has Medicare too.
Medicare does not cover for all types of cataract surgery.
When I discussed surgery with my ophthalmologist, I learned that at that time there were 3 types of cataract surgery for which Medicare would pay. The one which applied to my situation would be either distance or close-up vision corrected, but not both.
This would have been permanent, no corrective surgery could be done later if one or the other aspect deteriorated, or continued to deteriorate. That was quite a dilemma - which type of vision to have corrected, then and forever w/o any further type of surgery being covered by Medicare.
There may even have been more tightening of Medicare's regulations since I had that consult, which was more than a few years ago.
I suspect Francis' mother may have had something similar, without realizing that Medicare didn't cover everything.
Francis, you need to get an itemized statement from the ophthalmologist's office, compare it with the Medicare EOB statements, and call Medicare with your mother present (to confirm that you can speak with Medicare on her behalf) and address the specific aspects of the surgery which aren't covered.
Or appeal Medicare's decision (you have 120 days from the date of the EOB) and ask for elaborations on their decisions - let the EOB be your guide; it uses alphabetical codes to indicate which services were and were not covered.
The billing department should have gone over the cost before the surgery. Did ur Mom make sure the doctor took Medicare? Maybe they didn't bill her supplimental. Agree, you need to look at the Medicare statement and supplimental statement to see what each covered. There is usually a Dr. Charge, what Medicare approves, the 80% that Medicare paid. The 20% maybe covered by supplimental. I know a 98 yr old man who had his cateracts removed.
You would need to contact the eye center to see why your Mom was charged, instead of having her health insurance pay for the service. Maybe it was a coding error. Maybe your Mom hadn't meet her met her deductibles.
Francis; I hope you get the answers you need today from the facility and that you come back and tell us what you found out. We learn from each other here!
Absolutely agree get the facts and appeal the decision. If Mom did not have Medigap policy the bill may have been for the 20% Medicare does not cover for a procedure altho one is told Medicare covers cataracts in full. Full coverage only applies to the standard distance implant which means you may still need reading glasses. The bifocals cost an extra $600 each. One pair of glasses is supposed to be provided free but you have to have cheap Medicare frames and there seems too be a co-pay for the lenses. As GA said there is often a lapse between hospital billing and insurance payment so as usual be vigilant. Many facilities will negotiate a lower fee in hardship cases or take time payments. When you reuest the billing statement ask what policy the facility has for hardship cases. I plan to get the other half of my medicare glasses after the second surgery then a little way down the road I will order something reasonably priced online for reading.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
When I discussed surgery with my ophthalmologist, I learned that at that time there were 3 types of cataract surgery for which Medicare would pay. The one which applied to my situation would be either distance or close-up vision corrected, but not both.
This would have been permanent, no corrective surgery could be done later if one or the other aspect deteriorated, or continued to deteriorate. That was quite a dilemma - which type of vision to have corrected, then and forever w/o any further type of surgery being covered by Medicare.
There may even have been more tightening of Medicare's regulations since I had that consult, which was more than a few years ago.
I suspect Francis' mother may have had something similar, without realizing that Medicare didn't cover everything.
Francis, you need to get an itemized statement from the ophthalmologist's office, compare it with the Medicare EOB statements, and call Medicare with your mother present (to confirm that you can speak with Medicare on her behalf) and address the specific aspects of the surgery which aren't covered.
Or appeal Medicare's decision (you have 120 days from the date of the EOB) and ask for elaborations on their decisions - let the EOB be your guide; it uses alphabetical codes to indicate which services were and were not covered.
Often, hospital bills get sent before Medicare or other insurance gets billed. Tell your mom it's a billing error and call them tomorrow.
https://www.medicare.gov/coverage/cataract-surgery.html
Full coverage only applies to the standard distance implant which means you may still need reading glasses. The bifocals cost an extra $600 each. One pair of glasses is supposed to be provided free but you have to have cheap Medicare frames and there seems too be a co-pay for the lenses.
As GA said there is often a lapse between hospital billing and insurance payment so as usual be vigilant. Many facilities will negotiate a lower fee in hardship cases or take time payments. When you reuest the billing statement ask what policy the facility has for hardship cases.
I plan to get the other half of my medicare glasses after the second surgery then a little way down the road I will order something reasonably priced online for reading.