Thousands of dollars in a surprise medical bill - do I have options?
My wife (57F) is in Texas, and on Medicare for the first time this year. We’re both on fixed income. She receives a weekly medical treatment for something relating to why she is on Medicare at age 57. This is about the patient fee for that treatment going from $10 to $280 per week without notice, and there being a backlog of weekly payments for the whole year now coming due.
Last year my wife had Marketplace insurance, and was in a program to help cover costs of the weekly medical treatment, making the patient cost about $10 a week. She got forced off the Marketplace coverage this year for being eligible for Medicare. The clinic providing the weekly treatment said they would submit the expenses to Medicare and “we’ll see” at the beginning of the year, and that’s the last we heard about billing until last week.
Well, their billing is messy. At this moment they are trying to print out a ledger of her expenses, but it seems it’s not all in one system. As a result, even the clinic personnel didn’t realize they were charging the Medicare rate of ~$280 per week. Apparently their accounting doesn’t recognize the fee and move it to the patient ledger until after the insurance process is done. (It seems this might be standard? I guess most places have an idea what the end charge will be and collect it into a reserve at the time of service?) We only found out because an internal process automatically looped in a billing agent once the patient ledger had more than $1000 in outstanding balance.
So, surprise! We owe them $280 a week for the year-to-date. They’ve collected $1200 so far, which they told my wife was everything she owed. She even has a receipt that tells what transactions it was applied to and that she owes no money. But, back to things not hitting the ledger until the insurance process is done and the expense is recognized, that’s just the beginning of about $5000 as a surprise bill that’s going to be trickling in for the rest of the year.
I’ve looked at surprise billing laws, and they don’t cover Medicare patients or non-hospitalization bills. The $1200 she already paid was a painful surprise, I’m not sure what we’re going to do about the following $5000.
Do I have any recourse, here? Any suggestions?
(This is a vent rather than billing related, but the part that sucks the most is this treatment was genuinely helpful. After being forced onto Medicare, which is barely cheaper than the Marketplace coverage she had, she’s going to be forced to stop this treatment over the way Medicare forces this to be billed. This is not the only treatment she’s lost access to, either. Almost all manufacturer discount programs specifically exclude Medicare patients. It’s like the government is playing “quit hitting yourself” with her medical coverage.)