Questions we've answered

Why did I get a big bill for an ambulance ride? Doesn't Medicare cover it?

Medicare Part B does cover ambulance rides — but only under specific conditions, and that is where most surprise ambulance bills come from. Why you may have gotten a bill: - Medicare only pays when the ride is considered medically necessary — meaning traveling any other way (car, taxi, wheelchair van) could have endangered your health. A situation that felt like an emergency to you may not meet Medicare's definition. - The ambulance must take you to the nearest facility that can treat you. If it went farther (for example, to a hospital you prefer), Medicare may pay only part of the trip — or none of it. - Non-emergency rides (a scheduled trip to dialysis, or a ride home after a hospital stay) usually need paperwork from a doctor confirming you could not travel any other way. Without it, the claim is denied. - If the ambulance company has not agreed to Medicare's payment terms, you can be billed for more than the Medicare-approved amount. What you can do: 1. Call the ambulance company's billing office. Ask whether the claim was sent to Medicare and exactly why it was denied or only partly paid — sometimes it is a paperwork or coding mistake they can fix and resubmit. 2. Look at your Medicare Summary Notice (the statement Medicare mails you). It shows the official denial reason and the deadline to appeal. If Medicare decided the ride was not medically necessary, you have the right to appeal. 3. If you also have Medicaid or other insurance, the bill may need to go to that plan next — ask the billing office whether it was sent. Whether your bill can be lowered, resubmitted, or appealed depends on the exact denial reason on your notice — that is the kind of case we review. Describe your situation and we will walk you through the right next step.

Why am i getting a medical bill, it should be covered

I got a bill from my doctor, but i was told that everything would be covered. i only have medicare is that the reason?

Because you have both Medicare and Medicaid, Medicare pays its share first and Medicaid is meant to cover most of the rest — which is why you were told everything would be covered. One important note: if the Medicare part that covers doctor visits is not active, doctor bills can be billed to you, so that is worth confirming first. If that part is active, a bill usually means one of two things: the bill was never sent to Medicaid for its share, or it was sent but denied for a reason that must be corrected before it can be paid. Doctor's office staff are often not trained on how the two plans work together, so this happens a lot. The right next step depends on which of the two happened in your case — we can help you find out and handle it.

Wrong gender demographic

If your plan has you listed with the wrong gender or the wrong date of birth, it can cause claims and services to be denied. The fix is to have your record corrected at the source — the place where you enrolled or where your coverage comes from. If that information is already correct on their end, the insurance company itself may need to fix it instead. Each one applies depends on where the mistake actually is, and insurance staff are not always trained to spot it. We can help you figure out where the error is and exactly what to say to get it corrected.

Third party insurance

In order to remove a third party insurance from your account, you must contact the TPI and request a termination letter. Once you have the termination letter it can be submitted to Medicaid. You will simply call Medicaid and ask for a FAX number to send it to(emailing is not recommended) If you cannot provide a termination letter the process will be the same. Simply send a fax with your information, and a statement that you never had this insurance