Why I built MedCarePrecheck (and gougestop.com)
For the last 14 months I have been dealing with a couple of different bills where Medicare denied a couple of tests and paid for the rest and I was billed for what was left. Medicare paid in one instance $76 for 5 of 7 items and then I was billed $173 for only two of the tests. This just felt wrong. I could see Medicare was paying a fraction of what was billed on covered items, but I didn’t know for sure what would have been paid for the two they were billing me for. In my discussions with the provider, I’ve never been able to get them to give me a copy of the ABN. The individuals I talked with have also consistently acted like they had no idea what Medicare would actually pay them for these items.
In talking with Medicare, the customer care reps I talked with were great but also told me they didn’t know what the specific reimbursement was for the items I was talking about. I had never appealed a Medicare decision before and, as a result, procrastinated and didn’t get the appeal in before the 120-day time limit. I did eventually send an appeal which helped me learn how to do it, but it was too late for these bills.
Over and over again, I’ve asked the provider to allow me to pay the Medicare rate and they refused. I did this not knowing for sure what the premium was. This is what got me started on the idea of building these tools. I don’t like seeing people being taken advantage of, so this is a scenario that’s easy to get passionate about.
I don’t like seeing people being taken advantage of, so this is a scenario that’s easy to get passionate about.
My story is still unfinished. The collection agency which the first bill is with now offered me a 50% discount on one bill this past December. When I put my appeal together for Medicare though I went ahead and put letters together for the provider and told them that I have not seen a copy of the ABN and am not sure I signed one. So I’ve told them since their claim rests entirely on the ABN that I won’t pay until they provide a signed copy… I have not heard a word from them since… outcome to be determined.
The provider representative kind of chuckled when I said I was going to make a hobby out of trying to help myself and others beat this problem. I’m hoping these tools will help others do that going forward and help them show others (like our legislators) how substantial this premium is. The premium just doesn’t feel reasonable, particularly since many of the patients are on Social Security, and can’t afford large bill surprises. That just seems wrong and shining a light on it feels like a way to help people impacted by it.
With the app, I took a pic of my bill and in 60 seconds it told me what Medicare would have paid vs the bill… about $27 vs $173, a 550% premium above what Medicare pays!!! It’s easier to make the point that it is unfair when you have it all in black and white.
One problem, two tools
What started as one app became two, because the problem has two sides:
- MedCarePrecheck is the prevention side — upload your doctor’s order before the lab visit and we’ll catch coverage problems while there’s still time to fix them with your doctor.
- gougestop.com is the recovery side — if a bill has already arrived, GougeStop walks you through the appeal, the negotiation, and the pricing data you need to push back.
Same mission, two entry points. Use whichever one matches where you are in the process.
Thanks for trying it. Hope it helps you.
— David