On Retirement: Be vigilant with Medicare claims

It was hardly the kind of caution one might expect in a 7:45 a.m. exercise program for seniors.

Normally we are warned to listen to our bodies, told to breathe (“in through the nose, out the mouth”) and encouraged to “strengthen our core” while we follow routines with weights, bands, balls and the like. But at the halfway break one morning last week, one of our crowd had a warning. Health related, yes, but not to physical exercise.

Rather, Nancy told us of a notification she received from Medicare of a charge for a procedure on her behalf.

It was costly medical treatment (she did not specify the amount) for care she never received.

Nancy said she called Medicare to report a fraudulent billing.

“Read any Medicare notification you receive,” she urged us. “Call Medicare if it appears to fraudulent.”

She did not give us the contact number. Nor did she need to.

It was right there on the bottom the Medicare notice that was in my mailbox that very afternoon.

This was different, however. It was the second “Summary Notice ... Not a Bill” of a February emergency room (outpatient) service, advising me that “You May Be Billed” for $654.

That’s a hefty amount. In fact, it is $204 more than the summary notice I received in March for the same provider, date and service.

Both letters were a courtesy of sorts, as I have Medicare coverage for hospitalization only.

That is Medicare Part A.

Medicare Part B helps cover “medically-necessary” doctor services and tests, outpatient care, home health services, durable medical equipment and the like. It also covers some preventive services.

Most of those costs for me are covered my our health insurance. The insurer had paid a lesser “adjusted” amount in March to this particular provider for the specified date of service.

My guess is that the provider was not sending a fraudulent bill to Medicare, but assumed that it had been overlooked. More likely, it was the provider’s billing office that had failed to notice the information on my health records that designates Medicare Part A only and the insurance carrier.

I have no guess as to why the bill jumped by $204 for the physician assistant to look at the scan and visit me with a short diagnosis — ironically one that did not match the surgeon’s review, as it turned out.

Fortunately I kept the earlier claim, with my notes of the payment last March that are reported on the insurer’s website (thankfully no long phone call required). There have been no additional payments to that provider, suggesting our insurance company tagged the second request as having been already paid.

Our insurance premiums increase yearly, just as those of Medicare Part B.

In March, the Medicare trustees projected a 2024 increase of about $10 for the standard $174.80 monthly deduction from Social Security payments.

That amount quite likely will be revised upward with the federal Food and Drug Administration’s approval of a new Alzheimer’s treatment. The nonprofit Senior Citizens League projected an increase of about $15 monthly.

Social Security recipients next year likely will see a cost-of-living adjustment (COLA) of about 3%, according to a forecast from league.

That’s less than half of the 8.7% COLA this year.

It may change when the final 2024 COLA is announced. It is based on the third-quarter (July, August and September) inflation as measured by the Consumer Price Index for Urban Wage Earners and Clerical Workers.