Why Did Medicare Deny My Medical Claim?

Dear Toni,

My husband recently was laid off from his job and I needed to sign up for Medicare Part B. I only signed up for Medicare Part A when I turned 65 because his company insurance was excellent. When I went to the local Social Security with the “Request for Employment Information” signed by my husband’s HR department to enroll in Medicare Part B and avoid the “famous” Part B penalty; I asked if I needed to do anything else. I was told I was all set and will receive my new Medicare card in the mail with both Medicare Part A and B dates in a few weeks.

It was not until I went to my cardiologist in January that I had my Medicare claim denied and discovered that my husband’s company insurance was still listed as primary. Now my nightmare begins…

The insurance company said that I had to call Medicare to update Medicare’s system. I have no coverage because the company insurance is still listed as primary and neither Medicare nor my Medicare Supplement Plan G will pay. Please advise what I need to do?  –

Janie from Clear Lake area.

Janie:

Recently, the Toni Says® Medicare hotline has been receiving questions such as yours from those past 65 who have already enrolled in Medicare Part A, leaving employer group benefits and are having their Medicare claims denied. Medicare still has the employer group health plan, whether it is UHC, Cigna, Aetna, etc., as primary employer insurance which supersedes Original Medicare with the Medicare Supplement or Advantage plan which is to pick up Medicare’s out of pocket.

There is a simple process that those leaving employer group health plans whether you are the employee or the covered spouse and enrolling in Medicare should do to verify that Medicare is considered primary insurance, not the employer group health plan which you and/or your spouse are no longer covered under.

The verification process to discover what is your primary Medicare insurance is below:

• Visit https://www.mymedicare.gov/ and register for a My Medicare.gov account.
• View what is in your MyMedicare.gov account and verify that your Medicare information is correct. Knowing this information, you will be able to view what Medicare is viewing while you are discussing your Medicare issues such as what Medicare plan you are using, what Medicare Part D plan you are enrolled in, Medicare claims and other Medicare issues.
• If you see that your employer group health plan is still primary after you have enrolled in you and/or your spouse’s Medicare Part B, then Medicare is requesting that one calls the Medicare Benefits Recovery Center at 1-855-798-2627 and advise the agent who answers that you and/or your spouse are no longer enrolled in the employer group health plan.
• The change from group health insurance as primary insurance to Medicare as primary insurance is estimated to take 48 hours.
• Because Medicare is using online more we are advising all Toni Says® Medicare column readers to open a mymedicare.gov account when enrolling in Medicare whether you are turning 65 with or without employer group health benefits.

For questions regarding the maze of Medicare, call the Toni Says® Medicare hotline at 832-519-8664.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the  Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.