Patients think they have traditional Medicare, but it's actually an HMO

The medical specialty group I am a business office manager and assistant administrator for has been struggling with Medicare and Medicaid patients showing up for regular Medicare, only to find out after Medicare processes and denies our claims that the patient has a HMO policy.

It is very disturbing to see that most of these patients do not understand what policy is in effect. It is also evident that insurance companies selling Medicare replacement and HMO products are not explaining the policies and procedures to their clients.

CMS should have a dedicated Web site at no charge to providers to assist in verification of the replacement policy as soon as the changes are made.

CMS should be responsible to see that the patients understand their new coverage. Since physicians' personnel are spending their time to consult and explain the policies to the patients, we should be able to bill for our service in addition to the medical service.

We are caught between a rock and a hard place. The sad part is no one takes responsibility at the insurance companies. This is why I suggest CMS take the responsibility, since they allowed these companies to take over what was a simple Medicare. The Web site would cut down our insurance consulting office time and would give us the information we need when the patient is not sure what their correct policy is.

Confusing the patients is an underhanded way that CMS and insurance companies use to keep them from paying for medical services. It is unfair to the doctor and certainly unfair to the patient. Again, no one takes responsibility, but I'm sure insurance companies make certain to collect their premiums.

We need your help. The AMA is the only organization large enough that the federal government might listen to.

Sylvia Gonzales, Corpus Christi, Texas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/07/09/edlt0709.htm.