Medicare forms can be conquered with a little help

Recently, I was studying my mother’s Medicare Explanation of Benefits forms in what turned out to be a futile attempt to understand them. While admittedly, I may not be the brightest bulb in the chandelier, I figured, “How hard can these forms really be?”

After becoming bleary-eyed and incoherent, I answered my own question. The forms indeed are hard to decipher.

Eileen Cox, volunteer coordinator of the Maine Medicare Education Partnership, a program of Eastern Agency on Aging, smiled and gave a nod of understanding when I related my sad tale.

“Your reaction is not unusual,” she said, “and senior citizens can become very frustrated with the Medicare Explanation of Benefits or Medicare Summary Notice forms, because they can be so difficult to read and understand. Often, people try to make sense of the statements, but sometimes it can be so exasperating, they just stop opening the envelopes after a while.”

This is a problem. If a statement is left unread, there is no chance to check for errors in the services for which Medicare was billed. According to the U.S. General Accounting Office’s most recent figures, in 2000 alone, Medicare lost $13 billion to fraudulent or unnecessary claims. It also is reported that $1 out of every $7 spent on Medicare is lost to fraud or abuse, Cox added.

“The primary goal of the Maine Medicare Education Partnership program is to educate Medicare consumers on how to read and understand medical statements so they will be able to detect and report mistakes,” she said. “We train volunteers who then speak with seniors, either in groups or one on one, and show them how to examine the Medicare statements and to ascertain whether errors in billing have occurred.”

One way to check for mistakes is to keep track of all medical appointments and procedures. When the Medicare statement arrives, compare it to your records. The education partnership has made this task easier for seniors and their families by producing the Personal Health Journal. This free booklet has ample room to log all medical information, and can be obtained by contacting Eastern Agency on Aging.

“In many cases the problem is just a billing error, for instance someone typing in the wrong code on a form,” Cox said. “That problem can be easily fixed, but seniors need to be on the watch for it. Another common mistake is billing for two office visits when the person only went once.”

Cox and AARP offer advice that can help put an end to Medicare fraud:

. Treat your Medicare card like a credit card. Never give your beneficiary number out over the phone or to someone who comes to your door. If your card is lost or stolen, report it immediately.

. Don’t accept free medical services or equipment in exchange for your Medicare number. Nothing is free. Unscrupulous providers will later bill Medicare for things you may not have received.

. Be alert to people who claim to “know how to bill Medicare” to get payment even if an item or service is not covered. This is a scam and should be reported.

. Remember to stay informed. Know exactly what services or equipment you are supposed to have so you can avoid getting something that you don’t need. Use your book to keep track of such things.

The Medicare forms are really not so hard to understand after all – with a little help from a volunteer and a little patience.

“Our volunteers are really wonderful and truly make a difference,” said Cox. “But we always need more. And it is very satisfying to watch an older person come to understand and be comfortable with their statements. Aware consumers – that’s our goal.”

To volunteer for Maine Medicare Education Partnership, or to obtain a free medical journal, call Eileen Cox at Eastern Agency on Aging, 941-2865.

Carol Higgins is director of communications at Eastern Agency on Aging. For information on EAA, call 941-2865 or log on www.eaaa.org.