Contact 6 helps to unravel man's "Medicare Mystery"

MILWAUKEE (WITI) -- A man's mission to understand why he was billed one amount but told to pay another had FOX6's Contact 6 trying to unravel a "Medicare Mystery" -- and it took months!

Jeff Klimek did his homework, but couldn't get any answers.

"I can't see any sense of paying a $68 bill for a $25 service," Klimek said.

Klimek's elderly father had a basic blood test at All Saints in Racine. He was charged $25, but a "Medicare adjustment" for $43.79 brought the total bill to $68.79.

"If I owe $25 for services, I'll be glad to pay the $25.  How can somebody adjust it for an extra dollar amount?" Klimek said.

Klimek says he called Medicare multiple times, but couldn't get an explanation of what this "Medicare adjustment" was -- and it appears on Klimek's father's bills every time he has the test done -- and in different amounts.

"It finally got to the point that I had to get a hold of Contact 6 - looking for an explanation," Klimek said.

Contact 6 thought Klimek's Medicare mystery would be simple to solve. Contact 6 sent Medicare representatives multiple emails and made a lot of calls -- but Medicare didn't want to speak on camera.

Only when Contact 6 said the story would be broadcast, did they get a response.

One response included a statement that didn't explain very much, and another that included mathematical formulas.

"It's very complicated.  The average person would not understand it," Dianne Kiehl said.

Kiehl runs the Business Health Care Group, which works to make health care more understandable for consumers.

"Medicare sets the fee that they're going to pay the provider.  The provider has no option but to bill that amount to the patient - no matter what," Kiehl said.

So even though the hospital says the test was worth $25, Medicare says it's worth $68.79. Medicare adjusted the $25 charge up to meet the set amount of $68.79.

Kiehl says she is happy Klimek put Medicare to the test.

"If he had not gone to the lengths that he did to understand this bill, you wouldn't be doing this story - which hopefully it'll reach more people and more people will understand how Medicare actually works," Kiehl said.

Klimek says he understands the charge, but still isn't happy about it.

FOX6's Contact 6 says you're well within your rights to question anything on your bill before you pay it.

CLICK HERE for to visit Medicare.gov.