WSVN — If you have health insurance and they pay for a medical provider like a doctor or a hospital– do you have to pay what the insurance company does not? It’s why one man called Help Me Howard with Patrick Fraser.
Spend five minutes with Rich Rahmey and you realize… this fellow is a fighter.
Rich Rahmey: "I got polio when I was 6 months old. I didn’t walk until I was 5… I have been walking with braces and crutches since the age of 5."
As an adult, Rich opened a studio in Brooklyn where he recorded a song in the 50s that’s still being re-done today.
Rich Rahmey: "My claim to fame– I’m the recording studio that recorded Santo and Johnny "Sleepwalk" recorded by over 100 different artists."
Rich is a character who never gives up… and today he’s in another battle.
Rich Rahmey: "Broke my already dislocated hip."
To recover the 80-year-old was sent to a rehabilitation center in Wilton Manors.
Rich Rahmey: "First Medicare paid the first 100 days. When that ran out, my family paid."
Rich then researched the rules regarding Medicare insurance and concluded his family should not have had to pay– that Medicare and Medicaid should have covered it… so he filed an appeal and won.
Rich Rahmey: "It was decided by the judge that I was indeed getting necessary care… and not custodial care and therefore, I was entitled to get back the money that I had paid."
Medicare then sent Wilton Manors Rehabilitation Center $23,644… Rich called them to get that money since his family had already paid it.
Rich Rahmey: "All they were going to give me is possibly $10,000 and all the rest is going to pay for the money that Medicaid didn’t pay."
Rich argued with them that they were doing what is called balance billing, meaning they were taking his money to cover what Medicare insurance didn’t cover.
Rich Rahmey: "I am what they call a Q1B, qualified Medicaid beneficiary. And as a result, they are not allowed to what they call balance bill… they can’t bill the balance of what they think they owe."
Rich argued by balance billing, the rehabilitation center was being paid twice– by Medicare and Rich’s family.
They said no, Rich had to pay $13,000 in bills Medicare did not pay. As you might expect, this fighter is fighting… and not for himself.
Rich Rahmey: "What I would like to see is for my family to get the money back. They were so nice. Not a penny of it will go to me."
Well Howard, balance billing protects all of us who have health insurance. Does it mean Rich should get the $13,000 back?
Howard Finkelstein: "Because Rich is what’s called a qualified Medicare beneficiary, federal law prohibits a provider from charging him what Medicare does not cover and because of that, it seems that Rich is entitled to get that other nearly $13,000 back."
We contacted Greystone which owns Wilton Manors Health and Rehabilitation Center. A spokesperson wrote due to privacy laws, they could not confirm or deny whether or not Rich Rahmey received services, but did tell me we do not have any outstanding issues at this location regarding patient billing.
Next step Howard?
Howard Finkelstein: "Rich needs to file a complaint with both the agency for health care administration and Medicaid. And if they are reading the law the same way we are, they can force the provider to return his money. And if a health care facility tries to bill you for more than your private insurance paid, contact the Florida Department of Insurance."
Rich Rahmey: "No I’m not giving up at all, no! The money is legally owed and must be paid."
Rich is determined to collect the nearly $13,000 and we are not giving up trying to help him either.
Rich Rahmey: "The fact that Channel 7 is willing to extend themselves further to pursuit this thing is really a wonderful thing and it’s a credit to Channel 7."
Patrick Fraser: "What an amazing guy… and we will let you know how this turns out. And remember with balance billing, a medical provider cannot make you pay what the insurance does not pay, but you may still have to pay a co-payment or deductible. So make sure you know what that is."
And those agencies Howard mentioned to complain to are at wsvn.com under this Help Me Howard story.
Off balance because of a billing problem? Want to ensure it gets corrected? Contact us. No co-payment with us… we will just co-operate with you. With this Help Me Howard, I’m Patrick Fraser, 7News.
FOR MORE INFORMATION:
Agency For Health Care Administration
1-888-419-3456
www.ahca.myflorida.com
Medicare Complaint
1-800-Medicare
Florida Dept. of Insurance
Consumer Helpline Contact Information
Statewide Toll-Free: 1-877-MY-FL-CFO (1-877-693-5236)
Out of State Callers: (850) 413-3089
TDD Line: 1-800-640-0886
consumer.services@myfloridacfo.com
CONTACT HELP ME HOWARD:
E-mail: helpmeHoward@wsvn.com
Reporter: Patrick Fraser at pfraser@wsvn.com
Miami-Dade: 305-953-WSVN
Broward: 954-761-WSVN
On Twitter: @helpmehoward7