Monday, July 1, 2013
Ethical Workaround for a Medicare Hard Error
Medicare has my name wrong in their computer but I cannot get them to fix it b/c it looks "right". They put my middle name in with my last name in the last name field. Doctor A doesn't get paid b/c he won't put the claims in that way. Dr. B adapts, gets paid and is fine with it. Dr. A is angry, refuses to put it in that way and is after me for $1000. It is not enough to interest a lawyer ** but could happen again. What should I do? What should they do?
March 2011 Medicare eligibility starts
Applied for and received card with CHRISTOPHE J CLEMENT (R omitted)
Visited SS office twice
received a new card with YHRISTOPHER JOHN CLEMENT (starting with Y)
March 16, 2011 Rec letter from Senator Nelson confirming release of inf form
April 6, 2011 received another card with YHRISTOPHER JOHN CLEMENT (starting with Y)
Apr 22, 2011 SS letter from Sally T. to Sen Nelson
Apr 28, 2011 received letter from Sen Nelson with copy of letter from SS
received a new card with CHRISTOPHER JOHN CLEMENT (appears to be correct)
occasional calls from providers having difficulty but ultimately resolved *
THIS IS HOW SUCCESSFUL CLAIMS ARE BEING MADE BY DR B.
THEIR COMPUTER THINKS MY LAST NAME IS “JOHN CLEMENT”.
07/31/2011 - DC invoice with error messages for service dates 2/18 and 6/28
I was told it w/b resubmitted.
12/16/2011 - check 1492 sent to DC for $100
01/31/2012 - end of year no problems reported
01/30/2012 - check 1495 to BCBS for $1347
05/02/2012 - check 1500 to BCBS for $1347
08/23/2012 - check 1519 to BCBS for $1236
10/29/2012 - check 1530 to BCBS for $1236
12/18/2012 - DC statement with errors asking for $403.00.
01/14/2013 - check 1545 to DC for $24.86
01/28/2013 - DC statement with errors asking for $905.00. I was told it w/b resubmitted.
Similar billings continued all with unpaid claims on Nov 5, Nov 8, Dec 7 and Jan 18.
I tried to find contact info on "First Coast" having heard something about it being their
problem. Got a press email and a provider call in number and tried them with no success.
Discussed with Alice and was told they were working on it.
02/01/2013 - Pink "reminder" from DC asking for $905.00
03/13/2013 - Error laden statement from DC asking for $795.73
03/20/2013 - Filed 1st appeal to Medicare. Sent copy of a report with highlighted error codes: "MA61" from Alice "Missing/incomplete/invalid social security number or health insurance claim number."
My name was spelled "CLEMENT ,CHRISTOPH".
03/25/2013 - Doctor "A" (in above scenario) successfully bills Claim Number: 1013087836820
for later service not including the unpaid claims.
04/02/2013 - Error laden statement from DC asking for $795.73
04/08/2013 - Filed 2nd appeal to Medicare (via Sen Nelson) after not receiving response to 1st.
Sent copy of a report with highlighted error codes: "MA61" from Alice "Missing/incomplete/invalid social security number or health insurance claim number." My name was spelled "CLEMENT ,CHRISTOPH".
04/16/2013 - Rec letter from Sen Nelson, has contacted FCSO on my behalf.
04/22/2013 - Error laden statement from DC asking for $795.73
Found this later. They will not talk to me, provider must call. Higher level #'s available.
FCSO provider contact center:
• Toll-free telephone number: 866-454-9007
• Speech and hearing impaired: 877-660-1759
• Fax number (for general inquiries): 904-361-0696
• Interactive voice response (IVR) system: 877-847-4992
05/07/2013 - Letter from Alice - Please contact Medicare "provider" as they do not recognize insured party. I called 1 800 Medicare (633 4227) but they said I was insured.
05/14/2013 - A billing arrived from Reliance Pathology Partners for $136 without itemization or
evidence of attempted insurance processing for service on 11/8/2012. I left a telephone
message requesting documentation and send back a note requesting the same.
05/14/2013 - (and about this time)
I was unable to register on MyMedicare.gov: Name was not matching SS#.
Several calls showed no claims were submitted for above dates.
Another call to Medicare got me into my account but name had to be "John Clement" as
the last name. This is when I first became aware of the exact nature of the problem.
My middle name John was conjoined with my last name of Clement so that their record has
first name = "Christopher" and last name = "John Clement".
05/21/2013 - Received letter from Tameika at FCSO with instructions to ask provider
to resubmit BY MAIL to POB 2525 with control info from letter. I sent a copy to Alice and
asked her to comply.
06/04/2013 - DC statement with $14.59 patient amount due and $810.32 total amount due.
No error messages were present but it stated:
"This acct is processing for collections."
Called Medicare and found nothing had been received.
06/13/2013 - Check 1581 to DC for $14.59
06/14/2013 - Janet from SHINE held 3-way with Alice and me. Nothing was resolved.
06/17/2013 - MyMedicare.gov produced a list of claims covering 02/02/2011 - 03/25/2013
The listing showed no claims for above unpaid dates.
These were apparently filed under "Clement".
Successful claims apparently were processed as "John Clement"
Called DC to express intent to cancel next appointment with partially unpaid doctor "A" for ongoing treatment . **
06/17/2013 - Visited Helen at Clw DC. She printed the claims to be sent to POB 2525 and
gave me a 3 point checklist:
1) Mail in docs to POB 2525 - DONE by certified mail
2) Call, find out who they expect to pay (other ins, workmans comp, car accident, etc.) - NONE
3) Is the name still "John Clement"? - I don't know how to test this since they got me logged to MyMedicare.gov in as this.
06/18/2013 - My 5th visit to SS office. They denied there was a problem and said I needed to call
Medicare. I showed correspondence and letter from Sally T. They had a meeting and
filled out some forms to be sent to Atlanta. I only got a handwritten "receipt".
06/19/2013 - Pink slip from DC. Send $810.32 or else. Final Notice. **
Received call from Maranda T. from Medicare. Sees record with problem HI Q4
but MBR ledger is correct. Calls 3way into SS 800 line. SS says everything ok
but later finds a note resulting from my last visit 6/18. Said fix would take 10 days.
Maranda T. is to call me then with results.
06/20/2013 - Received reminder call for appointment.
Called DC to cancel next appointment with partially unpaid doctor "A" for ongoing treatment . **
I found a way to test item 3) above. For obvious reasons I cannot post the required information but
someone working on this with private information can run this little test:
Authorization to Disclose Personal Health Information Form
"Beneficiary?s Last Name does not match our records. Please re-enter the beneficiary?s last name."
As long as this error message appears, my Medicare number does not match with my last name of "Clement". The computer is looking for "John Clement" as the last name. I proved this by advancing past the above error but going no further.
06/21/2013 - Called BCBS (secondary insurance) to see if they could help expedite payment
to DC so I can continue treatment with Dr. "A". Rudy D. was helpful and did a 3 way call into
Medicare. Eventually talked with Darlene S. who saw that something was in Advanced Resolution Center with a 48 hour turnaround. I should hear back from them next week. Nothing, however could be done to settle the four unpaid claims and remit to DC in time for my appointment Monday morning.
06/22/2013 - Two things arrived in the mail today. The receipt for the docs mailed to POB 2525
shows they were received Jun 19 by Matt H. A statement from CMS addressed to Christoph John Clement (several blanks before John) containing a summary of claims from 04/09/2013 - 05/17/2013.
These apparently were paid. Nothing, however, concerning the unpaid ones listed above.
06/23/2013 - I discovered this while researching Medicare claims processing flow:
"If your Medicare card is lost, stolen or damaged, you can ask for a new one at this website."
The form takes SSN, first name, middle initial, last name, DOB, AND NOTHING ELSE!
I completed it and it said a card was recently requested. This form, if it supplies
the data for the HI record, could be the magic bullet. No one told me about this!
It should deliver a correction within 30 days and would not incorrectly alter the
file even if a change does get made before it processes. Janet (above) did mention that
the cards usually had a middle initial rather than a full middle name.
06/24/2013 - Visited Bay Pines VA facility - Nurse Flor, Dr. Shear - skin lesion ok
but probably unable to get future dermatologist appointments. Will assign PCP and do blood work
Cheryl from PAF called 3 way with DC pink slip number. DC agreed to put claims in as "John Clement".
Cheryl also told me of the above link. WHY DID NO ONE ELSE?
06/26/2013 - Cheryl (PAF) called at 10:07 and we spent almost 3 hours on 3-way conversations
with Bertie (SS), Kim (FCSO), and Smarya (DC). The only attempt to resubmit claims
by Alice happened 6/17 with no changes and using the automated (IVR) system.
A third action request for a corrected card was submitted by Bertie. A new card should arrive in 30 days and it should be ready to use. I will deliver a copy to DC. Kim (FCSO) said the only way to pay the four claims will be to resubmit them with the new card. Smarya (DC) agreed that the four claims will be resubmitted from scratch at this time and the account will be held for 30 days as well.
An interesting fact emerged that should be better known. Did you know that Medicare cards have no place for a middle name, only one middle initial, if any? I need to notify Cheryl of results in 30 days.
A (second) billing arrived from Reliance Pathology Partners for $136 without itemization or
evidence of attempted insurance processing for service on 11/8/2012. I again left a telephone
message requesting documentation and will prepare a written response to be mailed tomorrow.
I emailed Cheryl (PAF) as well.
07/01/2013 - Called DC to find out if claims were paid (no). Stopped at DC on the way to VA lab appt. to get copies of successful claims, two after and two before the unpaid claims. Paid $100 towards unprocessed medical debt (#1585).
The most significant difference between the successful claims and the unsuccessful claims was not the spelling of my last name. It is "Clement" in all of them. The successful ones were sent to BCBS!
Called Sen Nelson's office for any updates (none). Left message that delivery receipt for claims received at FCSO was received 6/23.
Called Reliance and confirmed that they re submitted as "John Clement". They will let me know if it goes through next week.
Called BCBS talked w Lynn M. and Rudy D. Awaiting callback. Rudy will call Darlene at SS 3-way with me tomorrow between 1 and 3 pm.
VA pointed out that successful claims were "second" (in upper right corner). I left a msg to Helen at DC that I need "primary" HIC 1500's for 3/25/2013, 2/4/2013, 11/16/2011, 11/9/2011.
I received an after hours call from VA setting dermatology appt. My thanks go out to whoever arranged this!
A special thanks goes out to the VA at Bay Pines who helped me long ago with a minor surgery
after having lost a job and insurance but again, today, by stepping in to provide complete continuity of care when a private provider had difficulty filing claims with my Medicare card.
07/02/2013 - Picked up primary HIC 1500's from Helen for claims that did process successfully. I did not see any last name fields with "John Clement". I requested the PTAN so I could query via the IVR but she would not give it out saying it would be "fraud". Meanwhile my paid-for benefits are being
Rudy called 4 way with Glenda at Medicare and Michaela R. at SS. We observed
defect in MBR but would not print as documentation. Michaela's supv Bryan sent Medicare
form 2178 to CMS to fix. Rudy is authorized 16 days and will call back then for results. Four people
and two hours were spent today on this.
07/09/2013 - Marissa T. from Medicare called. Nothing has changed. Health record still
has "John Clement" as last name. Will escalate with 3 way Monday at 11.
07/11/2013 - Called Sen Nelsons office but Peggy G. was not available. Called FCSO
Bryan Thompson and left message requesting Tameika Frederick's phone number and extension
to discuss status of last year's claims that were submitted to pob 2525. Called Sen
Nelsons office to leave same message for Peggy G. Tameika inquiry # is 8713085811020.
Called CMS, long discussion with Sheena J. add notes to file, 3-way call expected Monday.
07/12/2013 - Received call (at Brooksville) from Mica (meeka) at Medicare. She will call
again Monday. Call back # is 404 562 7333 (phone says 770 703 1035).
07/15/2013 - No call (above). Rudy called 3-way with Kendra Carter -> Greg Baily (MC).
No form 2178 received. Appears that MBR has changed but info needs to propagate further. Rudy
reauthorized until 29th. Will call 24th (day after 30-day since request made).
07/17/2013 - Performed test (06/20/2013) SUCCESSFULLY!!!
No error!! Name and number match!!
Tried to login to mymedicare.gov but id/pw not accepted. I expected this since changes were made
to the record that made me register as Christopher "John Clement". I requested help
saying I forgot both. After verifying secret question answers, it gave me the original
id in CAPS and let me pick a new pw. I picked a new, and different pw. I logged in using
id in lower case (original) successfully. The claims now include the Reliance Pathology Partners
which shows they were able to use the "John Clement" workaround I suggested earlier!
07/18/2013 - Rec call from Maranda (MC/Adv Res Ctr). Record is changed. It also had other defects like name in address field. (No wonder it was so quirky.) Letter to come in 10 days, new card in 30. Notified Helen at DC in voicemail. Received 5th Medicare card today with CHRISTOPHER JOHN CLEMENT!
Received call from Alice saying claims went through this time. We still need to wait for the remittance, however.
07/19/2013 - Rec letter from Sen Nelson with copy of CMS letter stating that I need to
contact SSA at 1 800 7722 1213 or visit hos local SSA office (for the 6th time!).
07/20/2013 - Rec bill from DC for legitimate itemized $10.22 and total line showing 793.22.
No entry for my $100 payment on 07/01/2013. Prepared to send $10.22 tomorrow (#1588).
07/22/2013 - Rec note from CMS about password change for My Medicare.gov (no surprise).
Logged in and saw:
Your Search Resulted in 27 claims available.
Type of Claim: All
Service Date Range: 07/01/2010 - 07/22/2013
This does not include the original 4 unprocessed claims Nov 5, Nov 8, Dec 7, 2012 and Jan 18,2013.
07/23/2013 - Rec email from Cara (MC ombudsman) and responded with basic details.
07/24/2013 - Talked with Cara citing importance of unpaid claims. She had contacted FCSO.
Checked MyMedicare.gov and saw 30 claims (3 more) were processed INCLUDING 3 OF THE UNPAID CLAIMS!! all in 2012. The one remaining is Jan 18,2013. Emailed images of the HIC 1500's to Cara.
07/27/2013 - Medicare card #6 arrived today with CHRISTOPHER J CLEMENT. I believe this is
the way it should have been all along. I checked MyMedicare.gov and saw:
Your Search Resulted in 32 claims available.
Type of Claim: All
Service Date Range: 07/01/2010 - 07/27/2013
This includes the above four unpaid claims!! It looks like all is fixed. WOOHOO!
Thanks to everyone who helped. If I can help make this easier for someone else, I will, gladly!
07/29/2013 - Rec call from Cara. She is closing the case but will remain available. Thanks Cara!
I am also expecting to see a cleared up statement from DC with my payment of $100 posted.
07/31/2013 - Rec letter attesting to coverage for CHRISTOPHER J CLEMENT. (Is another card coming?)
08/05/2013 - Rec letter from CMS advising me to send the (previously) unpaid claims to POB 2525.
Letter was addressed to CHRISTOPH J CLEMENT from Janssen C.
08/08/2013 - Rec letter from CMS advising me that above claims were paid July 24 and 26.
Letter was addressed to CHRISTOPHER J CLEMENT from Tameika F.
* Most, but not all realized the need to enter the claims with the "John Clement" last name
to get the claims processed successfully, similar to "slapping" a vending machine after
putting in coins to receive the stuck merchandise.
** Informal advice tells me this changes the case substantially.
This link might be helpful to someone trying to fix it.
HI 00901.245 Correction of Health Insurance Cards - FO Action