Troubleshooter: Billing mix-up

September 22, 2008 8:12:00 PM PDT
A billing mix-up that caused Peggy Magnum months of frustrations. It started when she got a statement from Medicare for a nursing home. She tells Troubleshooter Diane Wilson, "I'm thinking my gosh, I'm 81 but I haven't been in a nursing home."

Peggy got the first statement in March. She says she called Medicare right away to let them know the mistake. She says they told her, "It's just a clerical error. We'll get that straightened out."

The bill was only for $63.49, and Peggy's insurance Blue Cross Blue Shield of North Carolina did pay the bill to the provider and apply it towards her deductible.

In April, Peggy got another statement for the same charge, so she was back on the phone. She adds, "It's only $63.49 but it's the principal of it. They say let us know if it's not ours and that's what I'm trying to do and I'm thinking I'm the good guy."

Peggy wanted it in writing that it would be corrected, each month she says she continued to call both Medicare and Blue Cross Blue Shield of North Carolina.

She says, "I have talked with many, many, many people. Chris said it was going to be fixed, Gail said it was going to be fixed, and Margaret said it was going to be fixed." Peggy says everyone she talked to was always nice, but claims they didn't straighten out the bill. Even more frustrating, she says no one understood her fight to get it right. She adds, "Why in the world are you fooling with $63.45 but it's the principal of it. It's not right, it's not right and I think it should be corrected."

Peggy turned to Troubleshooter Diane Wilson. She got in touch with Cigna Government Services, which processes claims for Medicare in North Carolina. A rep immediately got in touch with Peggy who says a rep assured her this claim was taken care of and her deductible was credited for the amount.

A rep with Cigna Government Services says while they can't talk specifics about Peggy's case due to HIPPA regulations, she said standard operating procedures is that if an error has been made by the Medicare provider, the claim is adjusted and the corrections are reflected on the beneficiary's explanation of benefits.

She adds this notice is mailed quarterly, so it might not show up on the individual's statement for a few months. A rep for Blue Cross Blue Shield of North Carolina also confirmed it was taken care of.

Peggy says she did just get an explanation of benefits in the mail over the weekend that confirmed the problem has been taken care of and her deductible was credited the amount that was paid towards the claim.


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