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Improper Billing Tracking Tool
The information we collect will only be used for tracking purposes and to inform our overall advocacy efforts to protect dual eligibles from improper billing for Medicare deductibles, co-pays, and co-insurance.. We cannot take action on individual incidents noted here. We ask that that you refrain from submitting protected health information or other information that could violate confidentiality rules or agreements.

While we will not share specifics with anyone outside of Justice in Aging, we may use aggregates and trends in our advocacy. Note: Consumers who need help resolving a bill should not complete this form. Instead, they should contact 1-800-MEDICARE or their local legal aid organization. California consumers can contact the Health Consumer Alliance at 1-888-804-3536.

Email address *
What is your name? *
Your answer
What is the name of your organization? *
Your answer
Your Phone Number *
Your answer
In What State do you Work?
What Type of Provider Issued the Bill *
Required
For What Service was the Bill? *
Required
What Type of Insurance Does the Consumer Have? *
Required
If you answered other, what type of insurance does consumer have?
Your answer
What was the Approximate Date of Service? *
Your answer
What was the Amount Billed, Approx? *
Required
Was the Bill Sent to Collections? *
Was the Problem Resolved? *
If So, How Was the Issue Resolved?
Would you like a Follow-up from Justice in Aging for Technical Assistance on the Issue? *
Comments or Additional Information
Your answer
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