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  1. #1
    Join Date
    Mar 2013
    Posts
    1,279

    Default Healthcare Provider Refuses to Bill Medicare for Eligible Service

    My question involves a person located in the state of: California

    I was discharged from the hospital in December of 2017 with direction from the hospital that I needed oxygen at home. Prior to discharge the hospital sent a vendor to my room to arrange for this service. The vendor took my credit card, Medicare and Blue Cross information. I was initially billed $325 for oxygen, which I believed would be refunded once approval was obtained through Medicare and Blue Cross.

    I followed up with my Pulmonary physician, who concurred oxygen was necessary and he provided the vendor with additional documentation justifying the need.

    Not having received any adjustment to my $325 credit card charge, in January of 2018, I sent the vendor two emails inquiring as to its status, but received no response. However, I received no further bills for oxygen but also noticed I received no EOBs from Medicare or Blue Cross indicating they were being billed for the service.

    Just recently, I received a bill from the oxygen vendor for over $1,000 for several months' service, which was going to be charged to my credit card. When I inquired as to why they had not been billing Medicare and Blue Cross, they stated that in their opinion, substantiation by my physician was insufficient to meet Medicare criteria, so they elected not to do so and decided to charge my credit card instead. When I followed up with my physician's office, they insisted that not only did their substantiation meet the required Medicare criteria, but that the vendor sent them a Certificate of Medical Necessity form to sign, something the vendor would not have done unless they concurred the criteria had been met.

    So at this point, the doctor says the Medicare criteria has been met while the provider says it has not, refuses to bill insurance and insists on charging my credit card. Needless to say, I can't afford $1,000+ every quarter for oxygen. Any thoughts on how to resolve this? (And yes, I am looking for a new oxygen provider.)

  2. #2
    Join Date
    Mar 2013
    Posts
    18,340

    Default Re: Vendor Refuses to Bill Medicare for Elliegibe Service

    So, how about you getting the bills and sending them to Medicare for reimbursement?

  3. #3
    Join Date
    Mar 2013
    Posts
    1,279

    Default Re: Vendor Refuses to Bill Medicare for Elliegibe Service

    Can I do that? Is there somewhere I can find the procedure/forms/etc. for doing so?

    I've never run into this before and this is all new to me.

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Vendor Refuses to Bill Medicare for Elliegibe Service


  5. #5
    Join Date
    Oct 2006
    Posts
    16,474

    Default Re: Vendor Refuses to Bill Medicare for Elliegibe Service

    Quote Quoting L-1
    View Post
    Can I do that? Is there somewhere I can find the procedure/forms/etc. for doing so?

    I've never run into this before and this is all new to me.
    I kinda sorta disagree with you submitting the forms yourself. I seriously suspect that the prices that Medicare pays to the vendor for the services are considerably less than what the vendor is attempting to charge the you. I also find it highly suspect that a vendor of oxygen and its equipment is questioning the decision of an actual doctor as to what is or isn't medically necessary. Therefore I am afraid that if you do not raise a stink with both the doctor and the vendor so that it gets submitted by the vendor to Medicaid, that you will end up being out of pocket on the difference between what you paid the vendor, and what Medicare will reimburse.

    You also need to tell them that they do not have permission to put the charges on your credit card and that you will dispute the charges with the credit card company if they do.

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