Thomas Greene, accompanied by his wife Bluizer, resides in Oxford, Pennsylvania. Recently, Thomas underwent a leg procedure, and unfortunately, the anesthesia providers failed to bill Medicare in a timely manner. Consequently, Thomas found himself in debt and facing collections. Bluizer, speaking on Thomas’s behalf, revealed that the procedure aimed to alleviate pain caused by a complication from his diabetes. As a retired electrician and HVAC technician, Thomas chose to undergo an outpatient procedure to increase blood flow in his leg.
Thankfully, Thomas experienced no complications and felt a reduction in his discomfort. Bluizer, however, believed that their Medicare coverage, along with their supplemental Humana policy, would cover all associated costs. Unfortunately, this was not the case.
The operation took place at Jennersville Hospital in West Grove, Pennsylvania, which ceased operations in December 2021. The anesthesia services were provided by North American Partners in Anesthesia (NAPA), a private equity-owned company functioning as one of the largest anesthesia staffing providers across 21 states.
NAPA neglected to bill Medicare in a timely manner and instead pursued Thomas directly for payment. Consequently, the couple received collection letters before discovering the issue. Despite eventually submitting the claims to Medicare, they were denied due to the late filing, which occurred nearly 17 months after the surgery. Additionally, Humana denied the claims, as their policies do not cover services rejected by Medicare. This left the couple bewildered and taken aback.
In the spring of 2022, the couple received a letter from a collections agency demanding payment of approximately $3,000. Bluizer promptly contacted NAPA and the collections agency, C.tech Collections, based in Mount Sinai, New York. Unfortunately, their attempts to resolve the matter through communication proved futile. Subsequently, the couple began receiving further collection notices.
Bluizer expressed her anger and distress at the situation, stating that they had never encountered a bill sent to collections during any of Thomas’s hospitalizations. They firmly believed that their insurance would cover the expenses, as it had done previously. Worried about potential credit implications and seeking assistance, the couple sought guidance from Harold Ting, a volunteer counselor for Pennsylvania’s MEDI program, designed to aid Medicare beneficiaries.
Medicare typically covers anesthesia services. Ting was appalled by the circumstances, stating that it was unfair for Medicare beneficiaries to bear the financial burden of services that should have been fully covered. Two explanation of benefits statements from Humana illustrated that the company received claims from NAPA shortly after Thomas’s surgery but could not process them until they also received the Medicare coverage statements.
Humana’s spokesperson, Kelli LeGaspi, explained that a Medicare EOB is necessary for the supplement carrier to consider a claim. Denied Medicare claims result in corresponding claim denials by supplement plans. LeGaspi emphasized that if Original Medicare declines to pay, the plan must also decline payment. She refrained from commenting specifically on Thomas’s case.
In December 2022, a NAPA representative informed Bluizer via email that the claims were initially denied by Medicare in August 2021, prompting them to send the claims to collections. However, Bluizer contradicted this statement, as a Medicare representative confirmed that no claims had been received from NAPA. Thomas’s Medicare account showed that NAPA finally filed the claims in September 2022, 17 months after the surgery and five months after the first collections letter. These claims, too, were denied due to the expired filing limit.
Meena Seshamani, director of the federal Center for Medicare, clarified that Medicare denies claims submitted a year or more after the service unless there are extraordinary circumstances. Unfortunately, there is no exception for provider errors. NAPA’s spokesperson declined to comment, despite receiving a signed release waiving federal privacy protections.
Billing expert Martine G. Brousse of AdviMedPRO explained that the Medicare statement showing zero balance provided by Greene should have assured the couple they owed nothing. If a provider bills Medicare over a year after a service, the patient is not legally responsible for the debt. Brousse, uninvolved in Thomas’s case, asserted definitively, “That is the end of the story.”
Mysteries still linger regarding why NAPA billed separately for the nurse anesthetist and anesthesiologist. Bluizer was not provided with an explanation, and some insurers consider this practice to be double billing. Brousse suggested possible explanations like the nurse anesthetist beginning the procedure and the anesthesiologist completing it or the anesthesiologist serving in a supervisory role. However, the Medicare claims document shows both providers billed for the same amount of time, raising questions about the validity of the separate billing.
Unable to obtain answers, Ting connected Thomas with a nonprofit organization, Pennsylvania’s Center for Advocacy for the Rights and Interests of Elders. In March, an advocate from the center contacted NAPA on Thomas’s behalf and emphasized that federal law prohibits the billing of Medicare patients for services not covered by Medicare. This prompted NAPA to cease billing Thomas. Bluizer expressed relief and gratitude toward the center for their assistance in resolving the issue.
Denial of responsibility! SamacharCentrl is an automatic aggregator of Global media. In each content, the hyperlink to the primary source is specified. All trademarks belong to their rightful owners, and all materials to their authors. For any complaint, please reach us at – [email protected]. We will take necessary action within 24 hours.
Rohit Malhotra is a medical expert and health journalist who offers evidence-based advice on fitness, nutrition, and mental well-being. His articles aim to help readers lead healthier lives.
