Question
QUESTION: I had physical therapy (PT) services 2 years ago in Florida. I was referred properly. I have Medicare and a Medicare Advantage HMO plan (Preferred) which covered most, if not all, of these services. However, the PT never billed my insurance correctly and did not get paid. Do you know the florida statute/law (or is it federal?) which states that the PT cannot charge me over what my HMO plan would have paid had they billed the HMO in a competent manner? I need to be able to reference the law in a courtroom. Thanks!!
ANSWER: Hi Jim
Call 1-800-Medicare. When it opens up, you will be in the auto section so immediately say AGENT. You will be transferred to the customer representative section. When they answer tell them you want to speak to a claims expert. When you finally get that person, explain the situation and make your request for a letter.
Do not call on Monday or early in the morning, or you will be on the phone all day listening to music.
John
---------- FOLLOW-UP ----------
QUESTION: I don't understand the response. It sounded like an answer was imminent if you knew the missing info. Is there no statute or law that you could refer to in order to assist me? Calling 1-800-Medicare does not help me at all. I just need a statute or law to refer to. Is there something you could throw out at me? Please!!
Answer
Jim
I am not a lawyer and can not give you legal advice.
The path to a claims expert that I gave you is the regional office to CMS(MEDICARE) It is their office that enforces the regulations for this area. Providers and Medicare Advantage plans answers to them,
John
