John R. was admitted to the hospital through the emergency room. He never had a chance to meet with the people in the admission office. Flo, his wife, was with him every step of the way, and she never left his side to go down to Admissions, either. When he checked into the emergency room, Flo showed the clerk John's Medicare card, but she forgot all about the card from his secondary insurer.

John was in the hospital for almost three weeks. He had a lot of expensive tests, and then surgery. It was not an inexpensive stay. Happily, he went home in better shape than he went in, and he has recovered well.

His pocketbook hasn't recovered quite so well, however.

Soon after John returned home the statements from Medicare began to arrive. Each one said in big black letters across the top, "This Is Not A Bill." So John and Flo filed them away.

Then, about two months later, they began to receive bills from the hospital. And then bills started flowing in from a multitude of doctors, some of whom they had never heard of. Each bill was for several hundreds or even thousands of dollars. Again, John and Flo weren't worried, because their secondary MediGap insurance was supposed to cover everything Medicare didn't.

The bills turned into statements, each more urgent than the last. John and Flo thought their MediGap insurer was a little slow, but that all these bills would eventually be covered.

Months passed, and the couple began to get nasty calls from bill collectors. John and Flo aren't stupid people, but they are uneducated about how hospitals and Medicare work. Early on they made the logical assumption that everyone in the system communicates with everyone else. Sadly, logic doesn't prevail in the world of medical insurance.

Medicare does not automatically pass along bills from medical providers to secondary insurance companies. If the hospital or other provider doesn't know about a secondary insurance policy, they will not be able to send the secondary insurer a bill for the balance not paid by Medicare. That balance is instead billed directly to the patient.

That's what happened to John and Flo. Eight months or so into this saga John and Flo were frightened enough by all the bills and telephone calls that they gave in and paid the outstanding balances. They refinanced their home to do this, so now they have higher mortgage payments, no home equity, and little left in the way of savings.

Bitter about the "useless" secondary policy they bought, they switched from their traditional Medicare policies to Advantage managed care policies.

Had they understood how the system works, they would have contacted the hospital. They would have given the hospital John's MediGap policy information. The hospital would have then billed the secondary insurer for everything not covered by Medicare. If something is covered by Medicare, then the secondary policy must cover the insured portion.

Unfortunately, John and Flo never called the hospital or their MediGap insurer, and they never asked for help with their problem. They didn't know that the fault didn't lie with their MediGap insurance, who never knew about any of this. By the time the real problem came to light, they had made their financial mistakes, and too much time had elapsed for them to make a secondary insurance claim. All insurers have deadlines built in to their claims mechanisms. Wait too long to file a claim and it will be denied as "not timely." Six months appears to be a common cut-off.

So now, two years later, it's much too late to do anything to help John and Flo.

The important thing to learn from this is that making the assumption that anyone communicates with anyone is a big mistake. If you or someone you care about is receiving medical care, take it upon yourself to make sure that every provider has complete information about all insurance. Keep photocopies of the front and back of all the cards, and pass these copies out like candy.

If bills or statements come in and you see no evidence that a secondary insurer was billed, immediately request that this be done. One telephone request is fine. After that, if you don't see progress, make your communication in writing so you have a paper trail. You can make yourself a form letter to reduce your workload.

Once you have started your paper trail, the clock is also ticking for the medical provider. If the provider does not bill the insurance company, they may well be held responsible for the amount not billed. They may not be permitted to bill the patient for unpaid balances if they have not billed the insurance company in a "timely" manner after receiving complete and timely insurance information.

This is all very confusing for an elderly person who may not be in the best of health. Taking over responsibility for tracking the medical bills and insurance payments is one way you can be extremely helpful, even from a distance. Even if you are confident that your elder is able to manage the bills and paperwork, you might ask how things are going. Sometimes simple lack of knowledge can derail even the most competent of us if we don't know that we're missing critical information.