FW: (QMB) Qualified Medicare Beneficiary Program

FW: (QMB) Qualified Medicare Beneficiary Program

Jeremy Sprouse

9/20/2019

I'm looking for guidance concerning Medicare dually patients, in this case
it is a First Choice VIP dual enrollment plan. I have been providing for
this patient for over 10 years and never had any problems. Now I bill for
diabetic shoes and only get paid $152 out of the allowed $254. After calling
First Choice I was told it was reduced because she had a deductible and/or
co-pay (even though the EOB doesn't state either). So I billed the patient
only to get a call back from First Choice stating I couldn't bill the
patient because she was on a QMB plan.

<URL Redacted>
MattersArticles/Downloads/SE1128.pdf

First Choice was unable to answer these questions.

Since they claim she had a roughly $100 deductible, if the claim had only
been $100 then would I get absolutely nothing for providing for the patient?



Is this her Medicare deductible or is it a First Choice deductible? And if
it's a First Choice deductible what is preventing them from saying the
patient has a $5000 deductible and then not pay providers at all.



How is it that a provider is responsible to Donate to patients? We pay money
to get/make the items we furnish, yet we can't get paid.



Medicare states some Medicaid plans MAY cover the difference, however; since
their EOB doesn't state it was a deductible or co-insurance it was denied.



Is there any way to collect on these claims?

Thanks in Advance.





Jeremy Sprouse CPO