Description
Louise is an 89-year-old woman who was discharged from the hospital
after having a cardiac valve replacement for mitral valve stenosis.
After going home, she had home health services for a few weeks. Louise
had both Medicare and secondary insurance. She received a bill
requesting payment for the home health services provided. She was
prepared to write a check for the total amount. Fortunately, her
granddaughter, Marie, an HIM professional, was visiting and reviewed the
bill. Marie immediately saw that neither Medicare nor the secondary
insurance had been billed. Marie assisted her grandmother by calling the
home health agency to discuss the bill. She was told that the home
health agency did not have the insurance policy numbers. Marie provided
the policy numbers. When she was about to hang up, the billing office
representative told Marie that when Louise received a Medicare Summary
Notice from Medicare to call them back to let them know so that they
could bill the secondary insurance. Marie explained to them that it was
their responsibility to identify this. If Marie had not gotten involved,
then Louise would have paid the bill and her insurance companies would
never have been billed. Also, Louise would have called the home health
agency to ask them to bill the secondary insurer.Using the case study above, write an essay of at least 300 words regarding:Identify how this case applies to consumer informatics and consumer engagement.What could the home health agency have done in order to prevent this problem?
