If there was ever a lesson in why it is best to learn your insurance coverage statements: that is it.
Mary Godfrey mentioned she may be very diligent about reviewing all of her rationalization of advantages summaries from Flordia Blue, and in 2018 one thing jumped off the web page.
There have been claims paid to a podiatrist and a doctor’s assistant at a “domiciliary dwelling”.
“I’ve by no means been in a nursing dwelling,” mentioned Godfrey.
When she referred to as the suppliers listed, she found that somebody together with her similar identify and date of beginning had acquired this care and by some means obtained connected to Godfrey’s Medicare complement plan with Florida Blue.
In response to Godfrey, Florida Blue informed her the fees can be reversed and the problem resolved. However for 3 years, claims paid for the opposite Mary Godfrey continued to indicate up on her insurance coverage statements.
Florida Blue wouldn’t talk about the scenario with WINK Information. Just one supplier, Bayfront Venice, responded to inquiries.
A spokesperson for the hospital system mentioned their data indicated that they billed the right particular person for an ER go to.
However Godfrey insisted that she had by no means been to that emergency room, by no means been transported by ambulance from that hospital and positively had not spent any time in a nursing dwelling.
“That’s why I referred to as WINK Information to assist me as a result of it’s uncontrolled now, it’s like what do I do now?” mentioned Godfrey.
In response to public data, the opposite lady died in August 2020. Godfrey’s rationalization of advantages from that timeframe present claims shortly earlier than her loss of life.
“There’s lots of people with similar and comparable names and similar date of beginning typically, so it’s not very laborious to combine up a affected person in the event you’re not paying consideration,” mentioned Tiffany Drake, a billing supervisor not linked to the scenario.
Drake agreed to evaluate the statements for WINK Information to supply some rationalization.
In her expertise, she mentioned insurance coverage advantages are verified by date of beginning when an insurance coverage card just isn’t obtainable.
That verification occurs by a third-party system and people advantages would keep connected to a affected person as they’re transferred and referred between hospitals and medical doctors.
“If somebody’s asking us to see a affected person and so they ship us the affected person’s data we use that data. If it’s fallacious and anyone doesn’t confirm it when the particular person will get right here, then we’re going to proceed to make use of that fallacious data till somebody brings it to our consideration,” she mentioned.
Drake mentioned she was stunned that Godfrey’s difficulty persevered for therefore lengthy, even after she knowledgeable the suppliers and the insurance coverage firm of the problem.