b'Spring 2024WordASSOCIATENews w w w. w m i m u t u a l . c o mAFewImportantMedicare Caveats. Over the past month, I have heard a few hor- Lesson: Although Medicare Part B coverage ror stories that Id like to share in the hope thatcomes at a premium, the discounts and protec-they will keep unsuspecting seniors from fallingtions offered by this coverage are invaluable. prey to these pitfalls. Theyre not meant to scareMoreover, a Medigap policy (like the ones anyone but rather to provide information in thisoffered by WMI) fills in the gaps in Medicare exceptionally complex area of the health insurancepayment and protects seniors from large non-world. As always, you are welcome to contact mehospital claims and balances.if youd like to discuss these stories or if youd like to learn how WMIs Medigap products can help protect you from these risks. BewareFraudulentAir Ambulance? Billing!You better have Over the past month, Medicare Part B! two separate indi-viduals have told me According to recent KFFfraudulent bills were news report, 70-year-oldsubmitted to Medi-Debra Prichard had care in their name Medicare Part A (hospitalfor urinary catheter tubing. One person was coverage) but she hadbilled more than $19,000 for 19 catheters, and decided to forego Medicare Part B (non-hospitalthe other was billed more than $3,000 for three coverage) in order to save the $165/month premi- catheters they never used. Sadly, but somewhat um cost. 1After suffering a stroke in 2023, she wasunsurprisingly, Medicare paid these fraudulent rushed to the hospital via helicopter ambulanceclaims without investigating further! Fortunately, and sadly died soon thereafter. The cost of the 79- the two astute individuals immediately called their mile flight was a whopping $81,739.40! Had Ms.Medicare Supplement insurers before the balances Prichard carried Part B coverage, Medicare wouldon the fraudulent claims could be processed and have reduced the allowable cost of the air ambu- they were able to make sure everything else was lance to about $10,000 and paid their 80% share,denied. Medicare has assured them they will be and she would have either paid the balance herselfgoing after the fraudsters and attempting to recoup or submitted it to her Medicare Supplement carrierthe incorrectly paid funds, but Im sure we can all for payment if she had a Medigap policy. Unfor- agree it would have been much better if the claims tunately, because Ms. Prichard didnt carry Part Bwould have been investigated and denied in the coverage, Medicare denied the claim outright andfirst place.Ms. Prichards heirs were left holding the bag forLesson: Always carefully review claims and the full $81,739. Last I heard, the air ambulanceexplanations of benefits (EOBs) for accuracy company was refusing to reduce the bill and wasand legitimacy and immediately notify your attempting to collect the full charge. insurance provider and Medicare if something seems amiss .1https://kffhealthnews.org/news/article/air-ambulance-flight-surprise-bill-medicare-part-b/56www.wpma.com / Spring 2024'