The Joski Files, Episode 1

Author: Steven Robles
Published: May. 14, 2018

Last month, we had a client’s son-in-law contacted our office due to frustration with claims from her Assisted Living Facility being denied payment. Due to her deteriorating mental health, he had a POA (Power of Attorney) to manage her finances. It initially seemed that her Medicare Advantage carrier was responsible for the denial, but after contacting them we learned that wasn’t the case. Investigating the matter further with a call to her Assisted Living Facility’s billing department, it came to light that Medicare itself was denying the claims.

What was the reason? Despite the Assisted Living Facility and the client’s Medicare Advantage carrier having the son-in-law’s POA on record, Medicare itself didn’t. Due to his name appearing on the billing claims, they were rejecting them…and because they had no record of a POA for the client, their request for an “alignment of benefits” phone interview to address the discrepancy obviously never reached him.

Hoping that we could help rectify the problem, our office helped the son-in-law contact Medicare directly…or so we thought, but in reality our poor secretary got redirected to multiple numbers and departments trying to find the right person for him to speak with. Eventually, someone requested that the POA be faxed to multiple departments and that he allow 48 hours for everything to be processed before calling back to conduct the “alignment of benefits”.

It turned out that the root of the problem wasn’t the POA: it was that the client’s previous out-of-state address managed to slip through the cracks and avoid being updated to reflect her new residence at the Assisted Living Facility.

The son-in-law was finally directed to come to the local Social Security Office to update the address: all of that, because updated information wasn’t sent to all the right places in the middle of a busy move!

In conclusion, remember these steps if you or a loved one has moved and have Medicare:

  • Be sure to check with Medicare and Social Security to ensure contact information is up-to-date! This can be checked at MyMedicare.gov, or by calling 1-800-MEDICARE (1-800-633-4227). Mismatched information can also delay or cancel the processing of a Medicare Advantage application if what’s on the form doesn’t match what Medicare has.
  • When faxing or mailing important paperwork like a Power of Attorney, it’s important to follow-up with the recipient to be sure everything has been received and processed. It might seem like a hassle at the time, but it can help prevent major stress and frustration later.

Disclaimer:
All PII and PHI have been redacted from this entry, to ensure the anonymity of all involved.