Saint Al’s didn’t file Medicare claims for a year. What does that mean for patients?

Feb. 21-- Feb. 21--Saint Alphonsus Health System delayed submitting some insurance claims for a year, its patients were told in a letter mailed out this month.

Saint Al's held the claims back between Feb. 9, 2018, and Jan. 16, 2019.

One letter from Saint Alphonsus Medical Group -- the arm of Saint Al's that includes doctor's offices and clinics -- said the business "recently experienced some issues related to our Medicare billing processes."

It didn't specify what those issues were, and Saint Al's officials would not provide more details to the Statesman. The health system said in a written statement that the claims were held in "an abundance of caution."

Saint Al's "had to pause submission of certain claims until we were able to complete a review of our processes and to implement an improvement plan," the letter said. Saying the issues have now been fixed, Saint Al's has started filing all the insurance claims for that year, it said.

Saint Alphonsus told the Statesman that Medicare considers claims "timely" as long as they're filed within a year.

The health system didn't go into detail about what its review discovered or what it's doing to address any problems it found.

"Our comprehensive review identified ways to improve compliance with some technical Medicare requirements regarding billing for hospital outpatient services," Saint Al's told the Statesman. "As a result, we have standardized policies and practices to confirm compliance with Medicare's technical requirements."

What does this mean for Saint Al's patients?

While patients won't have to pay higher rates because of the delays, the fact that a year's worth of claims are being filed could result in some patients getting a bill now for their out-of-pocket responsibility for those claims.

"Saint Alphonsus did continue to collect co-pays while claims were being held, but because of the hold, patients may receive some bills later than they otherwise would have," Saint Al's officials said in an email.

Glenn Kelley of Nampa got the letter in February. He said Saint Alphonsus has been charging him co-pays whenever he needed medical services in the past year. But he has received a confusing array of bills and refunds, too, he said.

Kelley hopes that, after Medicare processes all his delayed claims, he won't find out he owes more than he's already paid.

The letter has gone out to patients who have basic Medicare plans, which are operated by the federal government; as well as Medicare Advantage plans, which are operated by private insurance companies.

The letter said Saint Al's hadn't submitted "any insurance bills to insurance carriers." The health system did not answer the Statesman's question about whether that means the backup affects non-Medicare patients as well.

"My big issue with it is, how can they not bill your insurance company for a year without telling you," Kelley said, "and then tell you that, 'Oh, by the way, you may just get ... a very large lump-sum bill?'"

That "just doesn't sit well," he said.

Saint Alphonsus says patients who have been affected can call its customer service line at (208) 367-2130.

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