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Erica’s Story

I am a 93-year-old Medicare beneficiary in California. In 2022, I fell at home and needed medical treatment. My doctor recommended a scan, but when my radiology practice submitted the claim to Medicare, the claim was denied, and Medicare directed me to first submit the claim to an automobile insurance company under an insurance policy that Medicare considered my primary coverage entity. No such insurance coverage ever existed. 

While I was involved in an automobile incident that occurred twenty-three years ago, it clearly had nothing to do with the fall at home or with the radiology treatment that my doctor recommended. As a result of Medicare’s denial of the claim, I was forced to submit an appeal to Medicare and was left uncertain as to who would have to pay the claim.  

Sadly, a friend had exactly the same claim denial situation.  Her auto accident had occurred twenty years prior to her fall in a restaurant.  She told me all her medical bills were not paid until a year after her recent hospitalization.  

Medicare needs to correct its systems.  By erroneously shifting responsibility to another insurance entity, Medicare only ‘kicks the can down the road.’  Medicare will eventually pay the claim, the doctors and medical facilities will not receive timely payments, various insurance companies will spend man hours and dollars to correct the Medicare error, and the Medicare beneficiaries will be unnecessarily stressed by the whole situation, which is what happened to me.  While eventually my appeals were approved and Medicare covered the radiology claim, the claim should never have been denied in the first place because of an auto accident over twenty years ago.

Note: This is not the real name of the patient.

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