| Home | About Us | Benefit Check Up | Story Bank | Find Your BenSpec | Contact Us |
Mary Velcich, EBS in Green County, recently helped a client with a Medicare Coordination of Benefits and Recovery case. The client had been involved in a car accident and received treatment for her injuries. Although her car insurance paid up to the policy coverage limit for medical expenses, the client needed additional care. Medicare believed that it had paid nearly $27,000 in conditional payments. Mary helped the client submit documentation showing that the car insurance could not pay any additional amount for her care and that all of the money from the insurance company had been paid directly to the hospital. Although the Benefits Coordination & Recovery Center sent another notice insisting that the client received a settlement because of the accident, Mary resubmitted the documentation from the insurance company, and the client finally received a notice saying that the issue had been resolved and that she did not owe Medicare any money.
Monetary Impact = $27,000
10/31/2023
Story #125
Karen Nichols, EBS for Burnett County, was recently contacted by a client who had received Medicare Summary Notices (MSNs) stating that certain claims were being denied based on records of an insurance payment stemming from a car accident that happened more than ten years ago. The Medicare Benefits Coordination & Recovery Center (BCRC) insisted on documentation from the insurance company showing that the case was closed, but when the client contacted the insurance company, she was told that the company did not keep records that long. Karen helped the client follow up with the insurance company and convinced them to send a letter to the BCRC. The insurance settlement is now cleared off the client's record, paving the way for Medicare coverage of claims exceeding $200,000.
Monetary Impact = $200,000
10/31/2023
Story #121
Pam Fuchs, EBS in Sauk County, also helped a client with a Medicare coordination of benefits and recovery case. The client had been injured in a car accident before undergoing treatment and surgery for a hernia. Unfortunately, Medicare determined that over $1,000 worth of claims related to the client's hernia surgery were conditionally paid. Pam helped the client show that these claims were not related to the car accident, and the Benefits Coordination & Recovery Center agreed!
Monetary Impact = $1,000
1/25/2023
Story #48
Joanne Welsh, EBS in Richland County, helped a client successfully dispute over $6,000 worth of claims that Medicare had determined were conditionally paid. The client had recently undergone hip replacement surgery and shoulder surgery. Unfortunately, Medicare determined that the claims related to his hip and shoulder treatment were related to an old workers' compensation claim involving an ankle injury. Joanne helped the client clarify that the claims listed on the Payment Summary Form were completely unrelated to his workers' compensation case, and the Benefits Coordination & Recovery Center agreed!
Monetary Impact = $6,000
1/25/2023
Story #47