Quote:
Originally Posted by alemorkam
Has anyone been successful in fighting Medicare to pay a bill from a Canadian Hospital. We are on our third appeal and have had no luck. Was airlifted from a cruise ship to a Canadian Hospital and Medicare refuses to pay the bill of around $!00,000.00.
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Sounds as if your coverage is Medicare A (hospital inpatient), B (Outpatient) and D (medications) with a Medicare Supplemental ("Medigap") policy. If that is the case you deal directly with Medicare, and they cover almost no services received abroad.
There are a few exceptions however: how close your ship was to an American port when the emergency occurred, medical treatment rec'd on the ship, etc. You can appeal any decision made by Medicare by jumping through their hoops: Sounds as if you've already done so, but "visit Medicare.gov/claims-appeals/how-do-i-file-a-claim to get the “Patient’s Request for Medical Payment” form CMS-1490S" (Medicare website, "Medicare Coverage Outside the United States"). It might be worth your while to check this out if you've not already gone this route.
The other type of coverage would be a Medicare Advantage (PPO) coverage. If the card you present for medical services is NOT the Medicare card but instead a card issued by an insurance company, and you use that when obtaining care, then that is what you have. That coverage varies widely though; some Medicare Advantage policies do cover medical services abroad. Our does: for medical services received abroad it will pay UP TO the amount that they'd have paid had you received your services from American providers. The kicker though is that they don't reimburse the provider directly: you still have to pay out- of-pocket for services received abroad, then deal with your insurance company to get reimbursement.
If you continue to hear "no" from Medicare, then it might be worth your while to talk to an attorney who specializes in such types of cases. If you are already on the hook for $100,000, then a few thousand more to get expert help might not be a bad idea.