Sometimes, Medicare makes mistakes, and Christopher Crowson has seen far more than his share.
As the lead attorney for San Diego’s Health Insurance Counseling and Advocacy Program, Crowson has spent decades helping Medicare beneficiaries fight back when the nation’s largest health insurance program denies claims, misunderstands key facts about the care that patients have received or takes an action that is just plain wrong.
Sometimes, he noted, it’s quite obvious that there has been a significant oversight. Take the time 10 or 15 years ago when a spate of women called with startling information: Each had received notice in the mail that their claims could not be paid because they were dead.
“All of the women were second wives of men who died but had been married two or three times,” Crowson said. “Somehow the computer system got mixed up and declared the women dead as well, so we were faced with the question ‘how do you prove someone is still alive?’”
It took some time to get through Medicare’s administrative hearing process, with plenty of supporting documents, and prove their case to Medicare’s satisfaction.
Medicare service and procedure denials are the most common reasons Crowson ends up getting involved. Refusal to pay ambulance bills is a very common scenario, and one case in particular sticks out in Crowson’s mind.
“I had one time where this lady had fallen down, fractured her shoulder to the point where the bone was sticking through the skin, and it came back that the ambulance transport was denied because her situation was deemed to be ‘not a medical emergency,’” Crowson said.
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