• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Hospital doesn't accept Medicare Plus Blue

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

kduquaine

New member
Being from out of state and faced with what appeared to be a potentially dangerous medical issue we did what any prudent couple might do - went to the nearest emergency room. This happened to be the one at the Mayo Clinic Campus outside of Scottsdale, AZ. I was experiencing a sudden onset of severe dizziness and finding it difficult to keep my balance. My husband drove me to the ER and I spent several hours there undergoing various tests. Those that came back during my stay there were negative and I asked to be released, stating that I could follow up with a doctor in the area. I was told by ER personnel that further tests were needed because of my condition and that it might be dangerous for me to leave without having all results back. I was cautioned about the possibility of stroke and heart issues. Ultimately I was convinced by ER personnel to allow myself to be admitted overnight.

My husband had left long before I was admitted and I was quite mentally distraught. At no time was I told that Mayo did not accept Medicare or Blue Cross Blue Shield. Nowhere were there signs indicating this. At no time was my husband informed that such was the case. I have been hospitalized in the past while in other states and insurance has never been a problem. Never did it occur to my husband or me to question whether a major medical institution like the Mayo Clinic would or would not accept Medicare or Blue Cross Blue Shield. If that fact is stated in admitting papers that patients are asked to sign, that ought to be pointed out to them verbally at the time of admission, as many patients are not in a state of mind at that time to be able to read and comprehend what is stated in those forms. I certainly would have refused admission had I been told that I would be responsible for payment. Do we have any recourse?
 


cbg

I'm a Northern Girl
At any time did either you or your husband ASK if the hospital accepted your insurance?

I can quite understand that you had other things on your mind at the time, both of you. However, the fact remains that it is not the responsibility of the providers to volunteer or post what insurances they accept, and they surely are not responsible for posting what insurances they don't accept. It is your responsibility to ask.
 
The issue is not with the insurance. The issue is a hospital that does not accept Medicare part A.

There seems to be nowhere for a person to submit Part A application for reimbursement.... CMS (those companies that do Medicare billing via contract with the Federal Government) only accept part B applications. They do not even have a process to get the bills from the patient and not the hospital.

So...the secondary is the insurance....not primary. Secondary only pays what Medicare has approved...and only what Medicare did not cover. If Medicare has had no bills submitted for part A (hospital inpatient) then secondary insurance has not come into play (yet)

When a person is take by ambulance to the “nearest” trauma hospital....what choice was involved on the part of the patient? The ambulance drivers are often required to take patient to that exact hospital. So...the real question is...how does a person submit Part A application for reimbursement?

I have another thread on the exact issue.....anyone know the answer?
 

PayrollHRGuy

Senior Member
I think you need to contact the clinic. According to their website they aren't participating in Part B. It makes no mention of not participating in Part A.
 

Zigner

Senior Member, Non-Attorney
Zigner, that form up near the top mentions Part B but not Part A.
I agree, but that statement is not exclusionary. If you read the instructions for the form, it states that the form is to be used for claims for services received as an in-patient at a hospital.
 

PayrollHRGuy

Senior Member
But the form does mention Part B and the instructions are titled Part B.

On the Medicare.gov website it says this... With no mention of Part A.

How do I file a claim?
Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). Follow the instructions for the type of claim you're filing:

 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top