Saturday, November 26, 2011

Managing the Medicare Maze (Part II)

In Part I, I shared the basic details of Medicare, including the reason we chose to go with Parts A and B and a Supplemental Medicare policy instead of relying on one of those much-touted comprehensive Advantage plans. Now I’ll share some of the wrinkles we had to iron out as we tried to get things set up and began to use the insurance plans with our medical providers.


The first issues we faced were a result of Medicare red tape. Social Security couldn’t complete the paperwork until they received notice from Jim’s employer confirming his retirement date. Trouble was, the people at Human Resources didn’t finish their paperwork until the middle of his last month on the job, barely two weeks before D-Day--or to be more precise, R-Day. Once that was done, Jim had to take the Medicare form to HR and get it filled out and signed, then mail it back to Medicare.

Because of that delay, we didn’t get our Part B cards until well over a week after it was to go into effect, and we’d already scheduled an appointment with one of our doctors during that first week. Fortunately, the office manager, who happens to be the doctor’s wife, was completely understanding and took our information for an emergency form she uses in such cases. Then she sent it to their billing service, and we hoped everything would work out fine.

But within the next few weeks, we had a couple of other medical appointments, and soon we began to receive calls from them because Medicare was denying our coverage. I called Medicare and found out the problem was that they hadn’t registered the fact that his employee insurance had ended on the last day of his employment.

While he was still working, the employee insurance was his primary provider, while Medicare would be the secondary provider, to be billed only for deductibles and co-pays. Now, of course, Medicare is supposed to be our primary insurance provider and the Supplemental plan we’d purchased from a private company is our secondary provider. But that’s not what our records said at Medicare.

We were told that Jim would need a letter documenting the fact that he was no longer covered by employee insurance. It took almost a full day and involved people at his old employer’s HR Department and the old insurance company calling and faxing back and forth. Finally we had copies of those letters, one for Jim and one for me, in our hot little hands. Then we called Medicare again and learned that as long as we can produce the letter, they were satisfied and nothing else needed to be done. They didn’t even need us to fax the letters to them.

I then had to call people at all the medical service providers or their billing departments to advise them that we’d corrected the problem and things should go smoothly from then on. Ah, but not so fast. This is the one time when the government agency didn’t work as it was supposed to.

Turns out the main Medicare Department is not the agency that takes care of all that. It’s handled by a separate government agency called Centers for Medicare & Medicaid Services that handles all billing and payment matters. Only after the second denial of a particular payment a week after we obtained those letters did I learn that little tidbit. So, naturally I had to call CMS and get them to straighten out the problem.

When I explained the situation to the very nice young man at CMS, he made sure to keep me on the line while he went through all the steps necessary to update our accounts. Again, we didn’t need to show them the letters documenting the old insurance coverage and termination dates. We just have to make sure we have all that information and can prove it if we ever need to. That’s where good record-keeping comes in handy.

In fact, those good records proved to be a blessing with later issues that came up. But I’m getting ahead of myself here. In the next article in this series, I’ll explain how those records are helping us with our Part D coverage. Watch for it!

Managing the Medicare Maze (Part I)
Managing the Medicare Maze (Part III)
Managing the Medicare Maze (Part IV)

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