Question

Mr. Barker had surgery recently 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 a number of services and items he thought would be fully covered. He called you to ask what he could do. What could you tell him?

Answer 1

Refer below for the explanation.

Step-by-step explanation:

You would suggest Mr. Barker to firstly give a look at the services and items covered by the plan

and secondly give a look at MA-PD coverage if it includes all of the services he thought.

Answer 2

B.You can offer to review the plans appeal process to help him ask the plan to review the coverage decision

Explanation;

What I will do is to help him review the plans appeal process to ask the plan to review the coverage decision because since his MA-PD coverage has been very good that means something has happened.

Therefore by reviewing the plan appeal it will help us to detect what went wrong and why he was charge large amount in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. This will help us to further review the coverage decision which will in turn help us to know what really happened to his coverage and why it was so.