Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and
items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?
The correct answer is - You can offer to review the plan's appeal process to help him ask the plan to review the coverage decision.
Explanation:
Mr. Barker received the bill and there is an excess of the maximum out-of-pocket limit that is a limit a person has to pay for covered medical care services.
As he asked what he could do, you could explain that there are several plans he could review all the plans appeal process and to as well help him to ask the issue, benefits of each plan to review. Explaining and reviewing plans and coverage will help a person to makes decisions about their benefits including the amount they have to pay for their medical services plan.
