In the YEARS after H turned 65 but was still working full time and still getting his primary insurance as an employee, we had years of claims denied because insurer kept trying to get Medicare to pay, even though H didn’t have Medicare B. (He did sign up for A because it was free since he had enough creditable quarters.)
I can’t tell you how many times I had to call his insurer and remind them they were his primary and only insurer in the last 5 years he worked. It was very irksome but I did it and they always promised they’d note his file but it appears they never did.
I’m sure most people didn’t have the wherewithal to keep prodding their insurer to pay and keep paying as it was really tiring but I sure wasn’t going to pay what they were supposed to be paying.
We almost got badly penalized because a clerk at the medicare/SS unilaterally decided he didn’t want to process H’s application, claiming we had not completed the paperwork correctly and was holding said paperwork for 8 months! Fortunately we got him to give us back the documents and H went in the next day and had a competent employee process it in the spot, correctly enrolling H with the paperwork the prior guy was holding up.
I can’t imagine the number of people harmed by this system with bureaucrats who just make arbitrary decisions like that clerk.
Isn’t that inherent to any kind of insurance, due to the existence of insurance fraud? Unfortunately, defense against fraud means that honest claims can also get inappropriately delayed or denied, and probably some insurance companies consider additional denied legitimate claims to be a desirable cost saving byproduct of anti fraud measures.
Yes, it is an insurance reality. Unfortunately, as the article suggests, the consequences can be significant, particularly for those without a ‘work around’ option.
Fraud is just one aspect of why insurers gate keep…for right or wrong, they have been tasked with controlling and/or bringing US healthcare costs down (because that’s what their customers…employers, and in some cases individuals, are demanding in the way of premiums).
If insurers weren’t overseeing some aspects of spending, by hospitals, to take one example, things would be worse. We’ve all read the stories about hospitals charging 10x the in-office price to administer a biologic drug, or $20 for a bandaid, or whatever. Having contracts in place with insurers prevents some of that nonsense (but only some of it). Ironically the very presence of health insurers, especially PBMs, increases system costs.
I agree when things go wrong they can go spectacularly wrong for people. Use your state insurance authorities, as HImom says.
If H hadn’t gotten his Medicare B processed when he did, he would have had to pay a 10% penalty on his premium forever, all because the other clerk wouldn’t process his application and didn’t notify us. That would have definitely added up and be money we shouldn’t have had to be assessed.
Your comments are making me nervous because I only signed up for mandatory A since my H is still working and I’m on his insurance. I hope I don’t run into the same issues as your H did. Yikes!
Just terrible treatment from your hubby’s insurer. Medicare Part A is always secondary for those over 65 with employee coverage and whose employer has 20+ employees. (Medicare is primary if the employer has <20 employees.). It’s been that way for years, so this is not anything that the insurer couldn’t’ have knowledge of.
Did you complain to HR (who ultimately chooses the insurer)?
Actually we chose the insurer and had been pretty happy with them other than their irksome continual refusal to recognize H didn’t have Medicare B until he purchased it after retiring at age 70. It is the main BCBS insurer in our state and all my providers are pretty good about getting paid by them.
In a well functioning capitalist economy, the finance sector is an essential service that serves the rest of the economy. But is the US economy moving in the direction where the rest of the economy, instead of being served by the finance sector, is now just the servant of the finance sector?
I spent months researching Medicare options for DH. Finally, did the part A-B-D-supplement. 6 weeks later I got a surprise job offer with full paid medical for both of us.
I contacted all the arms of Medicare coverage and jumped through the hoops to cancel B-D-supplement.
6 months later DH has an annual wellness visit & other preventative testing. All should be covered 100%. All claims are declined because Medicare B never cancelled. Hours on the phone to learn they got the form the 6th of the month in which I began work 10 days previous to that. They had just never processed it.
They finally processed it about 8/9 months after receiving it. I think those claims are all set now.
They are still billing us for that monthly premium and may, when they. finally adjust the bill, expect us to pay two months coverage that we did not need/use.
Dealing with SS has been really problematic since covid and work from home, which they are still doing 3x per week. SS is so technical and the rules so complex, IMO that is something that requires in person collaboration.
IM and telephone are still options for employees to collaborate. If it’s anything like financial aid, the online resources are robust. I often emailed or called colleagues for advice. Frankly, I don’t think that there is any excuse, in or out of office, for employees to make these mistakes. Particularly when the issue is brought to their attention over & over, it’s just unacceptable.
I agree that there should be no excuse to government workers doing their job. But WFH ain’t getting it done.
During Covid I had numerous calls. with SS and the response was always, 'I’m working from home so I’ll have to e-mail my supervisor, and hopefully she’ll get back to me while you are on the phone. ’ The Level 1 folks can barely answer level 1 questions. My specific issue was with IRMAA. I received a denial letter after filing SS-44 and not one person on the phone could say why my request had been denied, even the “Supervisor”. (sorry, we don’t have electronic access to that file…")
It woudl be much easier if they could turn around in their office seat and ask a cube mate: ‘hey, is Medicare primary for a small company plan?’
Simple stuff like HiMom mentioned is not being handled. It woudl be one thing if it’s being handled wrongly, in which case she could appeal, but stuff is just sitting in e-mail boxes and not being worked on at all.
The feds have antiquated technology systems. I woudl suggest that their home setup is anything but “robust”.
I guess I was assuming that people had the necessary access to information for WFH. If a company (or government entity) isn’t properly set up to handle business remotely, they need to get back in the office.
I think it can be hard to remember how suddenly lockdown/work-from-home happened. Surely by now it’s crazy that systems still aren’t working but it’s not like these systems are funded and administered properly.
Exactly. HW comes out of a separate budget, and is not something Congress likes to fund very often. For example, the IRS is still using COBOL in some systems, and running 60+ year old code. FAA is still using Fortran! (At least its so old, hackers would be lost with punch cards!)
