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Seniors may be susceptible to participating in grey area fraud – my term.
Many seniors routinely have their toenails trimmed under Medicare. It’s a covered expense but only under certain medical conditions like a diabetes complication, but it’s convenient, less costly than a pedicure and many podiatrists are willing to oblige.
Physical therapy is unlimited under Medicare as long as it is necessary for existing conditions and there is progress treating a condition. But hey it feels good. Providers have no incentive to deny a script for visits. I know a couple who both go regularly to improve balance. Never heard them express a balance concern in fifty years.
Ears clogged with wax? You doctor will remove it and Medicare will pay. How do I know, Connie has it done a couple of times a year when she can’t hear well. In the past by a ENT specialist, but now by a group PA. However, here is what Medicare.gov says:
“Medicare only covers procedures deemed to be medically necessary. Ear wax removal does not usually fall into that category. In fact, Original Medicare benefits do not provide coverage for any hearing exams or hearing aids. This means that all ear wax removal procedures will need to be paid for out of pocket.”
We have never paid OOP. How does that happen? The secret is in the procedure and diagnosis codes. And our Medigap picks up the 20%. The PA now says avoid her services and buy a kit in the pharmacy – of course.
Medicare covers non-emergency medical transportation (NEMT)
NEMT vehicles are usually vans that can accommodate patients in wheelchairs or who need extra help getting in and out. Medicare will only cover the cost of taking you to the closest appropriate facility. Medicare generally doesn’t cover routine trips from home to the doctor. But there is great temptation especially with a willing provider. One ambulance service was found allowing patients to ride up with the driver.
By far this kind of fraud is small potatoes.
Any claim filed on your behalf with or without your knowledge will generate a claim report and Explanation of Benefits (EOB). According to Medicare you will be able to see a claim in your account within 24 hours. Paper EOBs take a few months. Part D plans send a EOB monthly.
Reviewing your online account may spot fraud for services you didn’t receive, and will give you an accurate amount you may owe.
Never pay a health care provider- Medicare or not – until your claim has been fully adjudicated. If you see something questionable question it and report it.
Months after I had surgery a few years ago I noticed a $5,000 claim for assistant surgery denied by Medicare and indicating patient responsibility. I was getting ready to do battle because I wasn’t paying it. I was never billed, they were just rolling the dice against Medicare.
Using your online account is also a good way to keep track of your health visits and procedures.
Like with all health care, Medicare beneficiaries need to be involved every step of the way from first doctors visit forward.
“I know a couple who both go regularly to improve balance”.
I don’t know the details, but as a retired orthopedic Physical Therapist I do know that if a patient is being seen for balance issues only, in most cases only a few visits are necessary then the exercises can be performed independently at home.
The way they describe it, it sounds like a regular social event for two bored seniors.
“I know a couple who both go regularly to improve balance. Never heard them express a balance concern in fifty years.”
Unnecessarily snarky.
First, people don’t have balance concerns at 30 or 50. They do at 70. Gee, maybe that’s why these folks are only expressing it now.
Second, many people don’t have balance concerns until their hip actually hits the stairs. Falls shorten lives. Dramatically. Wise of this couple to address the issue in advance. Preserving balance is a lot easier than recovering it once lost.
And third, physical therapy ain’t exactly Swedish massage. Most of the time it doesn’t “feel good” at all. I’ve had a fair amount due to my athletic background, and I’ve found it ranges from merely uncomfortable to downright painful.