AARP Medicare Complete Complaint - Confusion With What I Owe--No clear answer from AARP Medicare Complete
Near the end of 2009 I went on line to medicare.com to compare the Medicare Advantage insurances in my area. I switched from ConnectiCare to AARP Medicare Complete. In February I went for my yearly physical along with a blood test. In April I got two Explanation of Benefits from AARP Medicare Complete which were confusing, so I called up. Total Patient Cost on the Explanation of Benefits was $21 on the physical due to a tetanus shot. Total Patient Cost on the Explanation of Benefits was $0 on the lab blood work. About week later in April the lab sent me a bill for $212.75. I called AARP Medicare Complete and the lab back and forth FIVE times. Neither one could agree on what I owed. Neither billing department wanted to call and talk with each other to straighten this out.
The various five AARP Medicare Complete representatives told me this:
the lab codes were wrong and the lab needed to call them to straighten it our, AARP Medicare Complete pay lab cost ALL the time, the lab should resubmit the bill, I should not pay this bill, I only owe a $10 copay, the lab was "balance billing" me which is illegal and the lab should write off the balance. When I asked on the fifth call what I should do about this bill because the lab refused to call the provider number I had given them, insisted they were not balance billing me and that I owed them the $212.75, I was told by AARP Medicare Complete that I should put my foot down and tell the lab that if they wanted to get paid they should call AARP Medicare Complete and resubmit the bill.
I had also called the lab five different times. I told them to use the provider number and call AARP Medicare Complete and they refused. I told them I was told it was a matter of wrong codes and, I was told by the insurance company, if they called them, it could be straightened out. The lab said the codes were the right ones according to what my referring physician from my routine physical had put down. If the physician had put down that the blood tests were because of a head ache or cholesterol, they would have used different codes. They said I should try to have the physician or even his office staff call them and resubmit the order for the blood work so they can change the code and resubmit it. They said that they weren't balance billing because the insurance company rejected the other codes and nothing was paid on the bill except $3 for venipuncture. They wrote off $23 for the venipuncture. They said I am responsible for the remaining $212.75. I said last year with Connecticare, a Medicare Advantage insurance, I didn't have to pay anything for the lab blood test after my physical right before I had my cataracts removed. AARP Medicare Complete was also a Medicare Advantage insurance. They said just because they're both medicare advantage programs, doesn't mean they pay for the same things.
So now I am very frustrated with AARP Medicare Advantage for not paying, for putting me in the middle going back and forth between the lab and insurance representatives, for not coming out and telling me what I owe, for having a 'no call' policy and not contacting the lab and settling this with the lab. I'm also frustrated with the lab for not calling the provider number and working this out with the insurance company.
I have to warn everyone that comparing the online medicare advantage insurance companies at medicare.com is not good enough. I got caught by surprise this year, but next year I will be more careful and know what to look for when I go shopping for another medicare advantage insurance company. I will insist on seeing the whole plan information booklet and also Google the insurance companies to see what kind of feed-back I get from people who had used them.