Medicare and patient overbilled for bone density shot

Karen Lawson was surprised when her doctor’s office told her she had a $500 charge for her bi-annual bone density shot. Lawson spent her life working in medical billing, so she considers herself pretty sharp when it comes to understanding her medical costs.

“It was my understanding that Medicare was going to cover it and I wouldn’t have a charge, but I needed the shot so I just went ahead and paid it,” she said.

But her instincts were spot on. When she opened up her explanation of benefits summary from Medicare and from her part D supplement plan, she discovered that Lee Health billed both parts of her plan and was actually paid twice for the shot.

An explanation of benefits statement comes from your insurance provider and breaks down exactly what your plan paid and what your out of pocket cost should be for any procedure. Medical billing experts say checking that statement is the best way to find a medical billing mistake.

“It’s really important to look at those. One, just to make sure you understand what’s being billed and what the charges are to make sure you agree with them and that they seem to be correct based on the service you received, but also because deductible and out of pocket amounts change,” said Tiffany Drake, a medical billing director at a Fort Myers orthopedic practice.

The practice where Drake works administers the same bone density medication that Lawson got at Lee Health. She said at their practice it is always billed under Medicare Part B, and there is no out of pocket charge to the patient.

After viewing Lawson’s explanation of benefits statement for the injection, she also concluded that it was an overbilling error.

Lee Health refunded Lawson and Medicare the overpayment after WINK News brought the situation to their attention. By email, a spokesperson categorized it as a human error.

Mary Briggs, system director for Strategic Communications for Lee Health wrote in a statement, “Lee Health has more than a million patient contacts each year. While we do our best, billing errors will happen.

Drake said the situation is a perfect example of why everyone should review their explanation of benefits statements before paying an outstanding balance.

“It is really difficult (for doctor’s offices) to get accurate benefits from insurance companies … We do our best to get correct information but it’s not always accurate, so you definitely need to look at your EOB’s,” she said.

COST OF CARE: Read more stories in the WINK News Cost of Care Series


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Reporter:Lauren Sweeney
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