Medical Federal and California State Government Websites That Will Actually Help You If a Medical Service Provider Victimizes You – Plus Some Important Tips

This includes hospitals, general doctors, specialists, X-ray places, CT scan or PET scan centers, blood test places, and pretty much any other medical facility or entity that engages in illegal or unethical conduct. Emphasis is on illegal, unethical contracts and on illegal, unethical billing practices. Also includes resources regarding insurance company misconduct or for when a Medicare, Medicaid, or Medi-Cal case worker makes a mistake or acts in bad faith. Sooner or later, you will need the information on this page.


Patients Rights Help and Support Resource List

A list of resources regarding the rights patients are legally supposed to have. Many provide complaint forms and will actually help you. All listed websites are government or other well-known, reputable resources. All links go directly to the website's patients rights page and/or patients help page.
  • MedlinePlus, from the U.S. Library of National Medicine.
  • HealthCare.gov, your rights under the Affordable Care Act.
  • Medicare.gov, your Medicare rights.
  • The Medicare Beneficiary Ombudsman. , a resource for filing complaints, grievances, appeals, etc.; in other words, a place to rat out medical service providers. The page also promises to provide information, help, assistance, and other services. The page is apparently also the starting point for when you need to deal with Medicare's own shenanigans.
  • CMS.gov, Centers for Medicare & Medicaid Services. The particular link I provided has to do with Consumer Information & Insurance Oversight. The page may not especially look it, but these guys are your friend. Sometimes, out of the blue and without any action on your part, they will send you notices a particular medical bill from a service provider or insurance entity is not valid and that you don't have to pay it. This website is definitely worth prowling around when you have the time.
  • California Department of Public Health (CDPH), the go-to page for filing medical complaints in California.
  • Office of the Patient Advocate (OPA), another go-to page for filing medical complaints in California.
If a link suddenly stops working, it means the website moved that particular page. Let me know in the comments section and I'll find and post the new location.

Some Tips for When Dealing with the Medical Bureaucracy

  • The Medicare 1-800-633-4227 number is open 24/7. They have always been friendly, professional, and helpful.
  • Referring doctors make paperwork mistakes all the time. Whenever possible make sure the medical treatment specifications match what the Medicare white book says. This is mostly applicable to preventive services. Not kidding here, make sure the doctor's instructions exactly match what the white book specifies. I've personally saved myself one financial disaster already by doing this.
  •  Never walk into a medical service provider's diagnostic center without the proper Medicare COPD 5-digit code included on the referral paperwork. 
  • Referring doctors make paperwork mistakes all the time (did I mention that already?). Always call the Medicare number first and verify the accuracy of the Medicare code on the paperwork before going to the specialist's or medical service provider's office. Confirm with Medicare that the Medicare code number is valid for your circumstances and procedure(s) and that Medicare will approve and pay for the procedure.
  • When referred to a specialist, sometimes a COPD code isn't provided; the specialist adds the code after the fact. Your only defense against this is having diagnostic information showing the necessity of the visit to the specialist, e.g., CAT scan shows potential malignancies in lungs, thus being referred to a pulmonologist makes medical sense. If the specialists uses the wrong code(s) after the fact and the claim is denied, don't just give up. Work with Medicare and the specialist to get the mistake straightened out and resubmit the claim.
  • The referring doctor does not not always know if the referred specialist or medical service provider takes Medicare, Medicaid, Medi-Cal, etc. When you walk into that referred specialist's office or medical service center for the first time and have identified yourself, always ask first:
  1. Do you accept Medicare as full payment?
  2. Do you accept Medicaid, Medi-Cal, or whatever other supporting insurance applicable in your situation as full payment?
If any part of their answer is no, leave immediately. As a Medicare beneficiary, you have the right to go to any specialist or service provider center you wish. Tell your doctor what happened and they'll take care of it.

An important note. If a medical entity financially victimizes you or is trying to victimize you happens to be a referral from your doctor, first check with Medicare via their website and/or phone calls and find out exactly what is going on. If that doesn't clarify or fix the situation, then tell your doctor's office all about it. They might be able to fix the problem with just one phone call to the offending medical entity; not so surprisingly, your doctor's office will often be quite successful at this.

A personal note. That medical contract you are always forced to sign is basically a blank check allowing the medical entity to do whatever they want. You've given them the right to do anything and everything their hearts desire and then to bill you for whatever insurance doesn't cover. For that reason, I always print directly above my signature the following in caps:

"ONLY PROVIDE INSURANCE COVERED SERVICES ONLY"

If the medical service provider then refuses you as a patient, immediately inform your primary physician that referred you. If that doesn't solve the problem, i.e., your doctor being able to find a different service provider in the area; I'd personally let Medicare, Medicaid/Medi-Cal, and any other involved insurance/government entity know all about it. I would think they would all want to know about a medical service provider that turns away patients simply because that patient only wants those services that are covered by insurance. Who knows? They might even be able to help you.

1 comment:

  1. Two thumbs up for this valuable guide! Bravo, and thanks for doing all that research!

    ReplyDelete